Use Your Health Fund Benefits With Ease
Health Funds
Understanding How Health Funds Support Dental Care
Health funds can help reduce out-of-pocket costs for dental care, depending on the level of cover. Benefits may apply to services like check-ups, cleans, fillings, or dental crowns. Each policy varies, so it’s worth checking what’s included before planning treatment. Knowing what’s available allows patients to manage costs more easily and arrange care that aligns with their needs and circumstances.
How to Use Your Health Fund at Our Clinic
We’ll assist with on-the-spot claiming where available. Some claims may require follow-up with your fund.
How Health Funds Work
How to Claim Through Your Health Fund
Check your health fund policy details.
Dental cover varies depending on your health fund policy. Reviewing what’s included ahead of time helps prevent declined claims, unexpected fees, or confusion during your appointment.
Bring your health fund card.
Bringing your card allows on-the-spot claiming through systems like HICAPS. This can lower your upfront cost and means you won’t need to submit a manual claim.
Find out what’s claimable first.
Not all services are covered by every policy. Ask the provider which treatments can be claimed to avoid issues when settling payment after your visit.
Keep a copy of receipts.
Some health funds need you to submit claims manually. Keeping itemised receipts provides the necessary details to lodge your claim successfully if it’s requested later.
ELIGIBILITY
Who Can Use a Health Fund
1 Individuals with an active and valid health fund membership
2 People whose policy includes dental care or treatment
3 Patients receiving dental care from approved local providers
Health funds usually require services to be provided by approved dental providers. The provider must be properly registered with the appropriate authority. Overseas-based dental professionals are not recognised for claiming.
4 Members who have completed health fund waiting periods
USEFUL INFORMATION
Frequently Asked Questions About Health Funds
What health funds do you accept?
Afterpay is a third-party payment platform. Patients who meet Afterpay’s criteria may use it to pay for specific dental treatments in four instalments. Beyond Smiles Dental does not influence approval decisions.
The first payment is made on the day of treatment, and the remaining three payments are automatically deducted from the linked debit or credit card every two weeks.
To use Afterpay, you must be at least 18 years old, have a valid Australian debit or credit card, and create an Afterpay account. Approval is determined solely by Afterpay and is based on factors such as account history, available balance, and spending limits. It is not a credit card or a loan, and approval is not guaranteed.
Patients considering Afterpay should review the provider’s terms and conditions before deciding. Beyond Smiles Dental can provide general information about the process, but all approvals are managed by Afterpay.
Can I use Afterpay for all treatments?
We accept a wide range of private health funds across our clinic locations. Participation varies but commonly includes the following:
- nib
- Bupa
- Medibank
- ahm
- CBHS Health Fund
- Defence Health
- HCF
- HBF
- HIF
Claiming on the spot through HICAPS may be available, depending on your fund, policy inclusions, and the clinic location. We recommend contacting your health fund and chosen clinic to confirm eligibility and whether same-day claiming is available.
Can I claim my visit through HICAPS?
Yes, HICAPS allows eligible patients to claim directly through their private health fund at the time of payment. Here’s how the process usually works:
- Bring your physical or digital health fund card.
To claim through HICAPS, your membership card—either physical or stored in a digital wallet—must be available at the time of payment. Without it, the system can’t access your fund details, and the claim may need to be submitted manually later. - Check that your dental service is covered.
Not all treatments are included in every health fund policy. Before your appointment, it’s a good idea to confirm with your fund whether the planned service is eligible for benefits. This helps avoid unexpected out-of-pocket costs on the day. - Swipe your card after your appointment.
Once your treatment is complete, your card is swiped through the HICAPS terminal. The system automatically sends the claim to your health fund, and the approved benefit is applied straight away. You’ll only be charged for the remaining balance. - Receive an immediate benefit reduction from your fund.
HICAPS processes your claim in real time. The amount covered by your health fund is deducted instantly, and you pay any gap payment on the spot at reception. This makes claiming quicker and avoids the need for follow-up paperwork.
What is a “gap payment,” and when is it due?
A gap payment is the out-of-pocket cost that remains after your health fund benefit is applied. It’s usually due at the time of your appointment.
Below are key things to know about gap payments:
- Gap amounts vary between funds and policies.
Each health fund sets specific rules for how much it pays towards specific dental services. The gap you pay will depend on your policy, including your level of cover and the agreed benefit for the treatment being provided. Even for the same procedure, the gap can differ between patients with different policies. - Gap amounts depend on your treatment type.
Dental procedures are grouped into categories, such as general and major dental. More complex or higher-cost treatments, such as crowns or bridges, often require larger gap payments. Basic treatments, such as check-ups or cleans, may incur smaller gaps or none at all, depending on your cover. - Gap payments are usually due on the day.
Once your health fund benefit is processed through the HICAPS terminal, any remaining balance is paid directly at reception. This allows you to finalise payment during your visit and avoids the need for follow-up billing. - You can request an itemised quote beforehand.
If you have questions about your out-of-pocket costs, your dental provider can prepare a detailed treatment plan with item numbers and estimated fees. You can share this with your health fund to check how much they’ll contribute and what your gap payment will be.
How do I know what my health fund covers?
Health fund policies vary widely, especially when it comes to dental services. Here are a few simple steps you can take to understand what’s included in your cover:
- Contact your health fund directly.
Your health fund can explain what your current policy includes and whether specific dental services are eligible for benefits. They can also advise on any conditions that may apply, such as exclusions or claim restrictions. - Request item numbers before your visit.
Every dental procedure is linked to an item number. Your provider can give you these codes in advance. When you give them to your fund, it allows them to review the services in question and clarify whether they’re included in your policy. - Ask about waiting periods and annual limits.
Some policies have rules regarding the waiting period before claiming certain services, as well as yearly caps on the amount that can be claimed. These conditions can affect the timing of your treatment or the amount reimbursed. - Check if general and major dental are both included.
Dental cover is often divided into categories. General dental care usually includes check-ups, cleans, and basic fillings. Major dental care can include treatments like crowns, dentures, or root canal therapy. It’s essential to verify whether your policy covers either one or both.
How do I know what my health fund covers?
Health fund policies vary widely, especially when it comes to dental services. Here are a few simple steps you can take to understand what’s included in your cover:
- Contact your health fund directly.
Your health fund can explain what your current policy includes and whether specific dental services are eligible for benefits. They can also advise on any conditions that may apply, such as exclusions or claim restrictions. - Request item numbers before your visit.
Every dental procedure is linked to an item number. Your provider can give you these codes in advance. When you give them to your fund, it allows them to review the services in question and clarify whether they’re included in your policy. - Ask about waiting periods and annual limits.
Some policies have rules regarding the waiting period before claiming certain services, as well as yearly caps on the amount that can be claimed. These conditions can affect the timing of your treatment or the amount reimbursed. - Check if general and major dental are both included.
Dental cover is often divided into categories. General dental care usually includes check-ups, cleans, and basic fillings. Major dental care can include treatments like crowns, dentures, or root canal therapy. It’s essential to verify whether your policy covers either one or both.
What happens if I miss a payment?
If a scheduled Afterpay instalment is missed, Afterpay may apply a late fee and suspend your ability to make new transactions until the overdue amount is cleared. The missed payment may also be retried after a short period, depending on Afterpay’s policy.
Repeated missed payments can affect your eligibility to use Afterpay in the future. These decisions are managed entirely by Afterpay and are not influenced by the dental clinic.
To reduce the risk of missed payments, it’s important to check that your linked card has sufficient funds on the due date. Payment schedule, due dates, and any fees can be viewed directly in the Afterpay mobile app or through the online account.
For the most accurate details, please review Afterpay’s official terms and conditions.
Do I need to bring my card every time?
If you plan to claim on the spot using HICAPS, you’ll need to bring your health fund card. This applies to every eligible appointment.
Here’s why your card is needed at every visit:
- HICAPS claims require your physical or digital card.
The claim can’t be processed unless your health fund details are entered at the time of payment. This applies even for repeat visits. - Some funds don’t allow retroactive claims through HICAPS.
If you forget your card, you may need to pay the full fee on the day. Depending on your fund’s rules, you can then submit your claim manually at a later time. - Your card helps link your membership to your visit.
This connection is especially important if multiple family members share the same policy. It helps avoid confusion when processing claims.
Can I use my health fund for cosmetic treatments?
Health funds usually do not cover cosmetic dental procedures unless they are clinically necessary. Here’s how to find out what your fund will cover:
Ask your dentist if the treatment has a clinical purpose.
- Not all cosmetic procedures are purely aesthetic.
If a treatment addresses issues like bite alignment, enamel erosion, or structural damage to teeth, it may be considered clinically necessary. Your dentist can assess whether there is a functional reason for the proposed dental work, which could influence eligibility for health fund benefits. - Request item numbers for your proposed treatment.
Dental services are identified by specific item codes. Ask your provider for the item numbers relevant to your treatment plan. These codes are essential for your health fund to evaluate whether the service is claimable under your policy. - Contact your health fund with the item codes.
Once you have the item numbers, contact your health fund by phone or email to verify if benefits are applicable. They can tell you whether the procedure is included in your cover and explain any waiting periods, annual limits, or exclusions that may apply. - Get a written quote before proceeding.
A detailed treatment plan, including costs and item numbers, allows you to confirm your out-of-pocket expenses ahead of time. This helps you plan financially and reduces the risk of unexpected expenses once treatment begins.
Will my health fund cover check-ups and cleans?
Many health funds offer benefits for preventive care, but cover varies between providers and policies. A clear way to find out what’s included is to check directly with your fund.
Below are factors that can affect your cover for check-ups and cleans:
- Your level of dental cover and provider:
Some policies include general dental services like exams, scale and cleans, while others don’t. Cover depends on what’s included in your plan. - Whether you’ve served any applicable waiting periods:
New policies may have a waiting period before you can claim for preventive treatments. Check how long you’ve held your policy before booking. - Annual limits and fund-specific conditions:
Some funds cap the number or value of preventive services per year. Once that limit is reached, you may need to pay the full fee. - How your health fund classifies the treatment:
Exams and cleans may fall under general dental, depending on the fund. Item codes can help clarify eligibility before your appointment.
Can I combine health fund use with payment plans?
In many cases, patients can claim through their health fund and utilise a payment plan to cover any remaining balance. This depends on your fund and the clinic’s billing process.
Here are some key details to know about combining claims with payment plans:
- Health fund claims are usually processed first.
If your fund contributes towards the treatment, that amount is usually applied on the day, either through HICAPS or an upfront payment. - Any remaining balance can be paid through a plan.
Some clinics offer flexible payment options for out-of-pocket costs. Ask about eligibility and terms before starting treatment. - Not all services are eligible for claims or plans.
Certain cosmetic or elective procedures may not qualify for either option. It’s important to clarify this during your consultation. - Payment plans are subject to approval and setup.
Application steps, deposit requirements, or third-party providers may apply. The clinic can explain the process and refer you if payment plans are available.
Is there a limit to how often I can claim?
Yes, health funds may restrict the frequency of dental service claims, depending on your policy. These limits are influenced by several key factors related to your cover and past claims, such as the following:
- Your policy’s annual limits and service categories:
Health funds often set yearly caps for types of treatment, such as general or major dental. Once the limit is reached, you’ll need to wait for the next benefit year. - Time-based rules specific to each service type:
Certain treatments, such as cleans or X-rays, can only be claimed once within a specified period. These restrictions are defined by your fund and not your provider. - Whether you’ve served waiting periods or plan resets:
If your policy is new or has changed, a waiting period may apply before benefits are claimable again. These are common for more complex or high-cost services. - Your previous claims history for the same items:
Past use of benefits may reduce what’s available now. Health funds track usage, and repeated claims may not be accepted again until the start of a new claiming period.
Do I still need to pay anything on the day?
In many cases, yes. Even if you’re claiming through your health fund, a payment may still be required at the time of your appointment. What you pay depends on several factors, including the following:
- The amount covered by your health fund:
Many policies do not cover the full cost of treatment. You’ll usually need to pay the difference between the total fee and your health fund benefit. - The type of treatment you’re receiving:
Preventive care may be partially covered, while major or elective treatments often have higher out-of-pocket costs. Your policy limits will affect this. - Whether your claim is processed on the day:
On-the-spot claiming through HICAPS helps reduce upfront costs. However, if the system is unavailable or the claim is submitted later, you may need to pay first. - Your health fund’s limits and claiming rules:
If you’ve reached your annual limit or the service isn’t included in your policy, full payment may be required. It’s a good idea to confirm with your fund beforehand.
Are health fund claims processed instantly?
Some health fund claims may be processed immediately through HICAPS at the time of your appointment. However, several factors can affect whether your claim is finalised on the day. These include the following:
- Whether HICAPS is available at your dental clinic:
Many clinics offer HICAPS for on-the-spot processing, but not all do. Check in advance if this is important for your visit. - The type of treatment and item codes used:
Some item numbers may require manual assessment by the fund. Complex or less common services may not be processed instantly. - The status of your health fund membership:
Claims may be delayed if your membership has lapsed, reached its limit, or has pending updates. Fund verification occurs in real time. - Any technical or system-related issues on the day:
Even if the clinic has HICAPS, network outages or card problems can prevent instant claiming. In that case, you may need to pay upfront and claim later.
