If you have extras cover, your health fund dental benefits usually come with a yearly limit for general dental care such as check-ups and cleans. When that limit resets, any amount you haven’t used is usually gone. Booking a check-up and clean before your fund’s reset date is a simple way to use cover you’re already paying for.
With the end of the year approaching, now is a good time to check your policy. If you’re not sure what a visit includes, see what a dental check-up involves.
What extras cover usually includes
Most extras policies with general dental cover pay a benefit towards routine care, such as:
- examinations and consultations
- scale and clean
- X-rays, such as bitewings
- fluoride treatment
- fissure sealants for children
- simple fillings, depending on your policy
Your fund pays a set benefit for each item, and you pay the difference, known as the gap. How much you get back depends on your fund, your level of cover and the practice you visit. Major dental work, such as crowns or implants, is often covered separately with its own limits and waiting periods.
How annual limits on health fund dental benefits work
Most policies have an annual limit, which is the most your fund will pay for a type of service in a year. Some policies also cap how many times you can claim a particular item, such as a check-up, in that year.
Limits may apply per person or be shared across everyone on a family policy, and general and major dental may have separate limits. Your fund’s app or member portal usually shows how much you’ve used so far, which makes it easier to plan visits for the whole family before the reset.
The date your limits reset depends on your fund. For example, nib’s annual limits reset on 1 January. Other funds may use a different date, so check with your fund, your member app or your policy documents.
Do unused benefits roll over?
In most policies, unused limits don’t roll over to the next year, so anything you haven’t claimed before the reset is lost. Some policies work differently, so check yours.
Waiting periods
If you’ve recently joined a fund or upgraded your cover, you may need to serve a waiting period before you can claim. For general dental, this is often around 2 months, but it varies, so check your policy before you book. Major dental can have a longer waiting period.
Preferred providers, HICAPS and costs
Some funds have preferred provider arrangements, where members may pay less out of pocket at participating practices. North Sydney Dentistry is a preferred provider for:
- Bupa Members First
- Medibank Members’ Choice
- nib First Choice
We have HICAPS, so eligible members can claim on the spot and pay only any gap on the day.
Check-up and clean costs
- New patients: a check-up and clean with no gap for eligible health fund members, depending on your level of cover, or $219 if you don’t have private health insurance. It includes a comprehensive examination and consultation, bitewing X-rays and a panoramic (OPG) X-ray as needed, a comprehensive scale and clean, and fluoride treatment.
- Returning patients: a check-up and clean is $199 and your gap depends on your health fund rebate.
See the full details on our new patient specials page. If your dentist recommends further treatment, we’ll explain the costs first, and payment plans are available.
Your year-end checklist
- Log in to your fund’s app or website and check how much of your general dental limit is left.
- Confirm when your limits reset. nib’s reset on 1 January, but check the date for your own fund.
- Check any waiting periods if you joined or changed your cover recently.
- See whether your fund has a preferred provider arrangement with us.
- Book your check-up and clean, and bring your health fund card and a list of any medications.
- If further treatment is recommended, ask for the item numbers so you can check your benefits with your fund before going ahead.
A regular visit is the foundation of preventive dentistry, and it gives your dentist the chance to find small problems before they need bigger treatment. Read more about teeth cleaning in North Sydney.
Book early, because December fills up
The weeks before Christmas are usually busy, as many people try to fit in a visit before their limits reset and the holidays begin. Booking in November gives you more choice of appointment times and leaves room for a follow-up visit if you need one.
Our practice is open Monday to Friday, 9am to 6pm, and a first visit usually takes about 45 to 60 minutes. If you feel nervous about the dentist, let us know when you book, as happy gas may be an option.
Frequently asked questions
When do health fund dental benefits reset?
It depends on your fund. nib’s annual limits reset on 1 January, while other funds may use a different date, so check with your fund or your policy documents.
Do unused dental extras roll over to next year?
In most policies, unused limits don’t roll over, so anything you haven’t claimed is lost when your limits reset. Some policies work differently, so check yours.
Can I claim on the spot?
Yes. We have HICAPS, so eligible members can claim their benefit at the end of the appointment and pay only any gap on the day.
Is there a waiting period for general dental?
Often, yes. Waiting periods for general dental are often around 2 months, but they vary between funds and policies, so check yours before you book.
Book your check-up
North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm. Call (02) 8090 1108 or book online.
This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.