WORDS: Dr Daniel De Angelis, Transform Orthodontic Care

One of the most common questions we get is – is orthodontics covered by private health insurance? Here are some FAQ’s!

Does private health insurance cover orthodontic treatment?

Yes! Many health insurers cover part of your orthodontic treatment under ‘extras’ cover. You’ll also be claim some of the cost of the X-rays needed at your initial consultation under general dental cover.

What if I choose not to see a Specialist Orthodontist for my or my kiddo’s orthodontic treatment?

Some health funds don’t cover orthodontics unless the treatment is being delivered by a Specialist Orthodontist. Keep this in mind when choosing your orthodontic provider.

How much can I claim?

All extras have a limit on how much you can claim – an annual limit over a 12 month period or a lifetime limit. Lifetime limit is the maximum amount you can claim throughout your lifetime. In most cases, orthodontics carries lifetime limits.

What’s my Lifetime Limit?

Most health funds offer between $1,400 to $3,000 in lifetime orthodontic cover.

How do I claim?

We have HICAPS terminals available at our three clinics (Modbury, West Lakes and St Peters) where you will be able to claim at the time of your consultation.

What is my benefit eligibility?

Some health funds don’t pay benefits until treatment has commenced. For clear aligner treatment, you will most likely be eligible for your benefits once you have received your first set of aligners which can take up to 8 weeks to be manufactured and delivered.

Is there a waiting period?

Extras cover typically includes a 12 month waiting period if you are new to private health insurance. If you’ve been with your health fund for a while a waiting period may not apply.

What am I covered for?

We encourage our patients to check what benefits and rebates they are entitled to directly with their health fund. Due to privacy, only your health fund will be able to give you this information so we recommend giving them a call.

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