The ins-and-outs of health fund extras

Are you covered?

Private Health Insurance (PHI) can be a complex area to navigate. There are so many health funds offering a variety of policy options – sometimes choosing your insurance or understanding your current policy can be overwhelming.

In Australia, around 47% of the population has a private health insurance policy that covers private hospital treatment alone, while almost 56% have an extras health insurance policy for things like dental, optical, physiotherapy and other allied healthcare.

Dental is a great extras benefit offered by health funds. Whether you are trying to understand your policy better, or change your policy, we’ve put together some key considerations:

Check your level of cover

The level of cover and inclusions with each policy is different. It is important to check this at renewal time as you may be paying for a policy that doesn’t provide the level of benefits you need or are expecting. Vote with your feet and shop around for a great deal.

Mind the Gap

Contrary to popular belief, the amount of out-of-pocket costs for dental care is not dependent on the dentist, but the on the level of rebate your health fund offers. This is why it’s important to choose a policy that provides maximum benefit to you. Pacific Smiles Dental is a preferred provider for a number of private health funds which means you get the maximum benefit and reduced gap payments.

General and Major Dental

Dental Extras are split into categories such as general or major dental. General dental usually covers things like dental check-ups, cleaning visits, fluoride, x-rays and fillings. Major dental includes dentures, crowns, bridges, root canal treatment, implants and orthodontics. Some health funds limit how much they cover or place a limit on how many times you can receive a particular treatment each year. Waiting periods for major dental can be anywhere from 2 months to 12 months. Check your health fund for limits and waiting periods on your policy.

Use it or lose it

At the end of each year, any unused benefits you are entitled to, will be reset. To make maximum use of your policy, make regular appointments throughout the year.

Things to look out for when looking in to extras cover for dental include:

  • annual limits on treatments
  • percentage of benefits paid
  • exclusions and lifetime limits
  • waiting periods

So the big question for you if your policy includes Health Fund Extras is – are you making the most of your cover by using your benefits to support overall health?

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