Great news! From 1 Jan 2020, we’ll be improving individual rebates for periodontics, dentures, crowns and bridges on Super and Premium Options. Please
contact us if you’d like more info or if wish to receive a benefit estimate.
Here's your at-a-glance guide to our top dental services and benefits. [UPDATE#101]
General Dental
| Item Name1 | Item# | Visit/Service | Extras Benefit Payable |
|---|
| | | | Basic Extras | Value Extras | Simple Extras | Essential Extras | Advanced Extras | Top Extras |
| Oral Examination | 012 | First Visit | 50% of each treatment or service | $54.352 | 60% of each treatment or service | $54.352 | $54.352 | $54.352 |
| Dental x-ray | 022 | First Visit | 50% of each treatment or service | $22.70 | 60% of each treatment or service | $23.95 | $25.85 | $28.65 |
| Scale and clean | 114 | First Visit | 50% of each treatment or service | $110.352 | 60% of each treatment or service | $110.352 | $110.352 | $110.352 |
| Fluoride treatment | 121 | First Visit | 50% of each treatment or service | $33.202 | 60% of each treatment or service | $33.202 | $33.202 | $33.202 |
| Surgical tooth extraction | 322 | First Visit | 50% of each treatment or service | $127.05 | 60% of each treatment or service | $139.75 | $152.45 | $165.15 |
| Filling/tooth restoration | 531 | First Visit | 50% of each treatment or service | $78.55 | 60% of each treatment or service | $83.90 | $91.55 | $97.20 |
1Limits apply to the number of times some items (such as bleaching) attract a benefit. You may also not be able to claim benefits for services performed with another item in the same course of treatment.
2Subsequent visits for these item numbers are paid at a lower benefit
Major Dental
| Item Name | Item# | Visit/Service | Extras Benefit Payable |
|---|
| | | | Basic Extras | Value Extras | Simple Extras | Essential Extras | Advanced Extras | Top Extras |
| Filling of one root canal | 417 | First Visit | Not included. | Not included. | 60% of each treatment or service | $129.15 | $142.05 | $155.00 |
| Full crown - non-metallic | 613 | First Visit | Not included. | Not included. | 60% of each treatment or service | $758.85 | $842.70 | $927.95 |
| Full crown - veneered | 615 | First Visit | Not included. | Not included. | 60% of each treatment or service | $720.25 | $799.80 | $911.85 |
| Dentures - complete3 | 719 | First Visit | Not included. | Not included. | 60% of each treatment or service | $984.30 | $1,000 | $1,279.40 |
3Benefits for replacement dentures and partial dentures are not paid within three years of previous supply.
No Preferred Providers here
At HIF, we don’t restrict you to ‘contracted suppliers’ like some of the other big private health funds do. So, as long as your preferred dentist is legally qualified to practise in Australia (and therefore recognised by HIF), you’re free to see whichever one you want. Find out more.
Annual limits
IMPORTANT: Before commencing any dental treatment, please contact us with full details of the necessary dental service (as provided by the dentist) and we'll provide you with an estimate of your benefit. Alternatively, you can complete our online dental benefit estimate form. If you are an existing HIF member you can also log-in to our Online Member Centre to obtain an accurate dental estimate.
| General Dental |
|---|
| | Basic Extras | Value Extras | Simple Extras | Essential Extras | Advanced Extras | Top Extras |
| Annual Limit per person | $400 | $750 | $600 | $1,250* | $1,000 | No limit |
| Annual Limit per policy | $800 | No limit | $1,200 | No limit | No limit | No limit |
| Major Dental |
|---|
| Annual Limit per person | Not included | Not included | $600 | $1,250* | $1,000 | $1,500 |
| Annual Limit per policy | Not included | Not included | $1,200 | No limit | No limit | No limit |
| Orthodontics |
|---|
| Annual Limit per person | Not included | Not included | Not included | $1,250* | $800 | $1,000 |
| Annual Limit per policy | Not included | Not included | Not included | No limit | No limit | No limit |
| Lifetime Limit | Not included | Not included | Not included | $1,250^ | $2,000^ | $2,500^ |
*The above annual limit is combined for General Dental, Major Dental and Orthodontics
^The Orthodontic limit is a lifetime limit and forms part of the overall annual limit.
Benefits for Orthodontic Treatment
For eligible Extras cover, HIF will pay a benefit per orthodontic item. In these instances, HIF will pay 100% of the cost up to your annual limit on your initial claim.
If your orthodontic treatment continues across multiple calendar years and you maintain orthodontic cover under your Extras policy, we may pay benefits up to your annual limits each calendar year, until your lifetime limit.
To be eligible to claim benefits in the next calendar year you must.
- Ask your dental provider for an updated letter which details your treatment for the current year, along with the expected treatment duration, item codes, fees and outstanding balance.
- Submit your letter to claims@hif.com.au
- We will then assess the benefits payable and pay 100% of the eligible cost up to your annual lifetime limit.
- For each subsequent calendar year that your orthodontic treatment continues, steps 1 and 2 will be repeated.
Important, please note: For members on Special, Super or Premium Options cover HIF will pay a set benefit per orthodontic item as an immediate benefit (claimable when your braces are fitted), subject to your annual and lifetime orthodontic limits. Please contact us prior to your dental treatment for more info on how to claim for Orthodontics or if you wish to receive a benefit estimate.
Important, please note:
- Benefits are paid only on accounts rendered by a registered Dentist or Dental Prosthetist. The Dentist or Dental Prosthetist must be in private practice.
- Benefits for replacement dentures and partial dentures are not paid within three years of previous supply.
- There are some items within item code ranges for which the fund does not pay a benefit, or if they are performed with another item in the same course of treatment.
- Limits apply to the number of times some items, such as bleaching can be claimed.
- Dental Prosthetists are allowed to perform a limited range of services for benefit purposes.
- Waiting periods apply, please see product factsheets for more detail.
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