Document ID: chunk:federal_register_of_legislation:F2024C01114:clause:3_6
Version: federal_register_of_legislation:F2024C01114
Segment Type: clause
Provision Reference: sch 3 cl 6
Character Range: 83692–88159

6                                                           Benefit limits (per 12 months)
                                                            For each treatment that is covered by the policy—if there is no annual limit on the benefits that can be paid, the statement "No annual limit".

                                                            Otherwise—the following statements, as applicable, with the bracketed text replaced with the appropriate figures or text:
                                                             (a) either:
                                                             (i) any of the following statements:
                                                              (A) "$[number] per person";
                                                              (B) "$[number] per treatment";
                                                              (C) "$[number] per policy"; or
                                                            (ii) any combination of the statements set out in subparagraph (a) (i), linked by the words "up to";
                                                             (b) if there is a limit on claims per specified number of years—whichever of the
                                                             following is applicable:
                                                             (i) "[number] appliance(s) every [specified number] years";
                                                             (ii) "[number] service(s) every [specified number] years";
                                                             (c) in the case of combined limits:
                                                             (i) for the treatment against which the combined limit is listed— "(combined
                                                              limit for [list treatments listed in item 3 in relation to which limit is
                                                              combined])"; and
                                                             (ii) for the other treatments in relation to which the limit is combined—
                                                              "(combined limit – see [treatment against which the combined limit is
                                                              listed])";
                                                             (d) in the case of limits for individually grouped treatments—whichever of the
                                                             following statements is applicable:
                                                             (i) "$[number] per person (combined limit for [whichever of general dental,
                                                              major dental, endodontic & orthodontic is applicable])";
                                                             (ii) "$[number] lifetime limit for [whichever of general dental, major dental,
                                                              endodontic & orthodontic is applicable]";
                                                             (e) if a sub‑limit applies on any treatment—the statement "Sub‑limits apply" (in bold
                                                             font);
                                                             (f) if:
                                                             (i) there is a limit on general dental; but
                                                             (ii) there is no limit on preventative dental;
                                                              the statement "(no limit on preventative dental)";
                                                             (g) if none of paragraphs (a) to (f) apply—a brief outline of the applicable limits.
                                                            Note 1: If an insured person has used a portion of lifetime limits, this item does not limit the information that a private health insurer may provide with regard to the individual's usage of lifetime limit amounts.
                                                            Note 2: This item does not limit the information that a private health insurer may give to an insured person. For example, if limits apply to the policy other than those listed in this item, private health insurers may provide information about those other benefit limits to insured persons.