Dental questions · Fees and health funds
How Does Health Fund Dental Cover Work?
Extras cover can help with the cost of dental care, but limits, gaps and waiting periods can be confusing. Here is a plain-English guide to what your health fund pays and how to make the most of it.
- Claim on the spot with HICAPS
- Medibank, CBHS and HIF preferred provider
- CDBS and DVA accepted
- Zip payment plans
Want to check your cover?
Call our team for the item numbers of your planned treatment, then check your benefit with your fund.
Call now →The basics
What does extras cover pay for dental?
Dental is part of extras cover, not hospital cover. Your fund pays a set benefit for each service, identified by an item number, and you pay the gap between the fee and that benefit.
Most policies split dental into general dental, such as check-ups, cleans, X-rays and fillings, and major dental, such as crowns, root canals and orthodontics. Each category usually has its own annual or lifetime limit, and what you get back depends on your level of cover.
Key terms
Item numbers
Every dental service has a code. For example, 011 is a comprehensive exam, 012 is a periodic exam and 114 is a scale and clean.
The gap
The difference between the fee and what your fund pays. It depends mostly on your policy.
Annual limits
The most your fund pays in a year for a category. Many reset on 1 January, others on your policy anniversary.
Waiting periods
New or upgraded policies usually have a waiting period before you can claim, often longer for major dental and orthodontics.
At Dental Seasons
Claiming your health fund at our Sandgate clinic
We accept all private health funds and have HICAPS, so eligible claims are processed at your appointment and you only pay the gap on the day.
We are a preferred provider for Medibank, CBHS and HIF. Depending on your policy, members of these funds may receive higher benefits or lower out-of-pocket costs.
Get an estimate first
For larger treatment we give you a written estimate with item numbers, so you can check your benefit with your fund before you go ahead.
Other ways to help with costs
Child Dental Benefits Schedule
We bulk bill eligible children under the CDBS, subject to eligibility and available benefits.
DVA
We accept DVA for eligible Veteran Card holders.
Zip payment plans
Zip Pay and Zip Money are available. They are provided by Zip and subject to Zip's approval, terms, fees and charges.
No health fund?
You are still welcome. We give you a clear estimate before any treatment.
Tips
How to get the most from your dental extras
Unused extras limits usually do not carry over. If your fund resets on 1 January, benefits you have not used by 31 December are generally lost.
Planning treatment around your limits can help. For example, a course of treatment can sometimes be split across two calendar years so you can use two years of limits. We are happy to talk through timing when we give you an estimate.
Four simple steps
Know your reset date
Check whether your limits reset on 1 January or on your policy anniversary.
Book regular check-ups
Many policies pay well toward exams and cleans, and they help catch problems while they are small.
Ask for item numbers
Quote them to your fund to find out your benefit before treatment.
Book early in December
December is one of our busiest months, so book ahead if you want to use this year's limits.
Meet your dentists
Experienced, highly qualified and genuinely kind
All of our dentists are registered with Ahpra and keep learning well beyond their degrees, so you get thoughtful, up-to-date care.
Dr Andrew Bachour
Principal Dentist
BDSc (Hons, UQ). Master’s degrees in Orthodontics & Dentofacial Orthopaedics and in Sleep Medicine. Special interest in TMJ, orofacial pain and airway health.
Dr Michael Au
Dentist
BDSc (Hons, UQ). Known for his gentle touch and clear explanations, with advanced training in restorative dentistry and full-mouth rehabilitation.
Dr Pei San Chan
Dentist
BDS (Adelaide), GradDip Orthodontics (JCU), DipOrtho (UJI). Warm, calm care for patients of all ages, including children and orthodontics.
Use your extras before they reset
Claim on the spot with HICAPS at our Sandgate clinic. Book online or call our team on (07) 3269 2064.