Posted June 2018.
For anyone who has compared private health insurance offers knows how complicated it can be to choose from different providers. Private health funds differ not only in price but also in cover types which is usually divided into hospital and extras cover. Our Coastal Dental Care team have answered the most frequently asked questions about private health cover related to dentistry.
What does NO Gap mean?
Even with private health fund extras cover, your health fund usually only pays a part of the treatment costs and leaves you with an out-of-pocket expense that you will have to pay yourself. This is called “the gap”.
This means no matter what private health fund you are with, you won’t pay anything out of pocket for the required treatment. Most private health funds allow members a 6-monthly check-up and clean.
Coastal Dental Care also offers No Gap mouthguards for all private health fund members with dental extras cover that includes mouthguards. For this reason, you won’t have any out-of-pocket cost for a custom-made mouthguard at our practices. Usually you are covered for one mouthguard per extras period (calendar or financial year depending on your health fund policy); however, some health funds allow 2 mouthguards per year. Please check your private health fund policy to find out.
What is Extras cover?
Extras cover is an optional part of your private health insurance and handles some of the costs that aren’t hospital related and not covered by Medicare. Some of the most common services and treatments included in Extras covers are:
- Preventative dental treatments in the form of check-ups and cleans
- Optical products such as prescription glasses and contact lenses
- Physiotherapy, chiropractic, podiatry, naturopathy and remedial massage
- Prescription pharmaceuticals (non-PBS) prescription-only items that are not supplied under the PBS (Pharmaceutical Benefits Scheme) but are rebate applicable by your private health fund
If you are a new member of your private health fund, waiting periods may apply for some extras. You can check this in your private health fund policy.
What do your private health fund Extras cover at the dentist?
The amount of benefits and your annual limits per person will vary depending on your cover. Most health funds have different levels of Extras and split dental in General and Major dental.
General dental often includes regular 6-monthly check-up and cleans, scale and fluoride treatment, preventative treatment, mouthguards, simple extractions, simple fillings, x-rays, and surgery to remove wisdom teeth.
Major dental usually includes root canal, periodontics (gum disease treatment), complex fillings, crowns, dentures (false teeth), bridges, veneers and orthodontics.
In your membership overview, you can exactly see what you are covered for and how much your private health fund will contribute towards the treatment.
By seeing a preferred provider for your health fund, you are guaranteed to receive a fixed percentage back on the service up to your annual limits Some health funds also negotiate capped prices with their preferred providers so that you as a patient won’t be charged more than the agreed price.
Our Coastal Dental Care practices are preferred providers for several private health funds including bupa, HCF, medibank, CBHS, and nib First Choice network. Please check the individual practice pages to see which health funds they are preferred provider for.
When does your Extras cover get reset?
Most private health funds run their Extras cover by calendar year which means that it resets on January 1st of each new year. However, there is some providers using the financial year as benefit period. Below is an overview of health funds and their most common limit reset times. Please note that some treatments may vary. Please check your cover and benefit time frames before undergoing treatment of any kind.
See our list below for full details.
| Health Fund | Main Items of Extras Cover* |
|---|---|
| AHM | Financial Year1 |
| Defence Health | Financial Year2 |
| Peoplecare | Financial Year3 |
| Australian Unity | Calendar Year4 |
| Bupa | Calendar Year5 |
| CBHS | Calendar Year6 |
| Frank (GMHBA) | Calendar Year7 |
| GMHBA | Calendar Year8 |
| HBF | Calendar Year9 |
| HCF | Calendar Year10 |
| Health.com.au | Calendar Year11 |
| Medibank | Calendar Year12 |
| Nib | Calendar Year13 |
| TUH | Calendar Year14 |
*Most of the Extras of these health funds are expiring as stated in the table; however, single items may differ. Please check your private health insurance extras table to find out more.
Are you with AHM, Peoplecare or Defence Health? Book in online now at one of our Coastal Dental Care practices or give our team a call to use your dental benefits before they expire on June 30th 2018!