Health Insurance Explained
Having dental insurance means that you can take the most advantage of our “no gaps” offering. We will provide you with the information we can, but it’s important that you understand how it all works and what your responsibilities are.
Health Insurance can be complex, so know your dental cover
- There are many different health funds, all with different fund rules, and they offer various levels of cover, so it’s important that you know what kind of cover you have selected and ultimately what benefits are available to you.
- When you first join a new health fund, there may be a waiting period. This is the period of time you need to wait before you are able to claim benefits back from your insurer. Waiting periods will differ depending on your health fund, your level of cover and what kind of treatment you are looking to claim.
- Insurance companies base the amounts they pay on internal fee schedules, regardless of what our fees are. The maximum benefit allowance paid by your fund may not cover the full cost of your dental treatment.
- Most health funds will pay a benefit for a check up and clean every six months, however this is subject to your dental service limit governed by your health fund. Some treatments, such as orthodontics and whitening, may not be covered at all, so it’s best to ask your health fund provider about these topics.
Your dental insurance is an agreement between you and your insurance company
- Our surgeries and dentists are not a part of your insurance contract and therefore we cannot make guarantees of what benefits your insurance will pay and cannot force your insurance fund to pay.
- In addition, due to privacy restrictions, we are not able to contact the fund on your behalf.
Things to ask your health fund include:
- What is my annual monetary benefit limit for
(a) General dental treatment and
(b) Major dental treatment?
- What service limits apply to my cover?
- When does my annual benefit limit expire?
- Do I have a waiting period? And when does it end?
- What kind of dental treatment is NOT covered?
Health Insurance and No Gaps Dental
No Gaps Dental is independent of health funds, so our “no gaps” offer is available to everyone who is covered with Australian private health insurance for dental, regardless of which fund you are with.
For your convenience, all of our locations have a HICAPS terminal so we can claim your insurance benefit direct from your health fund after your appointment, as long as you bring your current working health fund card.
Our “no gaps” offer means that for basic treatment including your consultation, scale and cleaning, x-rays, fluoride and fillings, whatever your health insurance pays as a full benefit will be accepted as full payment (Conditions apply). For all other treatments, if your health insurance does not cover your treatment costs, you will be responsible to pay the remaining balance.
Remember, your health insurance is simply another form of payment for your dental treatment, but you are ultimately responsible for the payment of your treatment.
Medibank Member’s Choice and BUPA Member’s First
We accept all Australian private health funds, however some of our clinics are preferred providers with certain health funds such as Medibank Member’s Choice and BUPA Member’s First. Members of our preferred provider funds will receive a special fee schedule determined by the respective fund, which means they will pay lower fees.