Let us explain how your healthfund works

Let Us Explain How Your Health Fund Works in Dentistry
Navigating the world of health funds can be extremely overwhelming, especially when it comes to understanding how they apply to your particular dental care. At EasyCare Family Dental Clinic, our aim is to simplify this process and help you take advantage of your allocated health fund benefits. Below are some tips on how Health Funds work within the Dental Practice and we also provide some expert guidance on how to maximise your coverage.
Understanding Health Funds
Health funds, also known as private health insurance, provide coverage for various medical and dental services. There are two main types of health insurance and these are Hospital Cover and Extras Cover.
While Hospital Cover is for in-patient treatments in hospitals, Extras Cover (also referred to as General Treatment Cover) includes services like dental, optical, physiotherapy and much more.
How Extras Cover Works for Dental Care
1. Types of Dental Services Covered
Extras Cover is designed to help cover the costs of routine and preventative dental care, as well as some major dental treatments. These services are generally divided into three categories.
  • GENERAL DENTAL – Includes routine check-ups, scale and clean, x-rays, fillings, and minor extractions.
  • MAJOR DENTAL – Covers more complex procedures, for example crowns, bridges, dentures, root canals, and orthodontics
  • ORTHODONTIC TREATMENT – Some health fund policies provide separate coverage for orthodontic treatments such as braces and Invisalign.
2. What are Annual Limits?
Health funds typically set an annual limit on how much they will pay for dental services within a calendar year. These limits vary depending on the level of cover you have chosen. For example, your policy might have an annual limit of $500 for general dental and $1,000 for major dental procedures. These limits also vary across different Health Funds.
3. What is the Waiting Period?
A waiting period is the time you need to wait after purchasing your health insurance before you can claim benefits for certain services. These waiting periods for dental services can range from 2-12months, depending on the treatment and your individual health fund.
4. Benefit Percentages
Health funds usually cover a percentage of the cost of dental treatments, which can vary between 30% to 100%. The remaining balance is known as the out-of-pocket expense, which you are expected to pay.
How to Maximise Your Health Fund Benefits
1. Understand Your Policy
Familiarise yourself with the details of your health insurance policy. Know what dental services are covered, the annual limits, waiting periods, and benefit percentages. This information will help you plan your dental visits and treatments more effectively.
2. Regular Check-ups
Regular dental check-ups and cleanings are essential for maintaining oral health and can prevent more serious (and costly) issues in the future. Utilising your health fund for preventive care can help you make the most of your coverage.
3. Plan Major Treatments
If you need major dental work, it can be beneficial to plan these treatments over two calendar years to maximise your annual limits. For example, you might start a treatment in December and complete it in January, utilising two separate annual limits.
At EasyCare Family Dental, we are committed to helping you understand and make the most of your health fund benefits. Regular dental care is crucial for maintaining a healthy smile, and knowing how your health fund works can make dental treatments more affordable and accessible.
If you have any questions about your health fund or need assistance with claims, our friendly team is here to help. Book an appointment today and let us take care of your dental health while you make the most of your health fund coverage.
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