Health Funds & Preferred Provider Benefits

Your fund

Preferred provider or not: what’s the difference?

A preferred provider has an agreement with a health fund about fees for common items. Members of that fund often pay less out of pocket.

We are a Bupa Members First Platinum, HCF More for Teeth and nib First Choice preferred provider. Eligible members may pay no gap on check-ups. Other treatment may still have a gap, depending on your policy.

We accept all health funds, including Medibank, ahm, CBHS and Australian Unity, claimed on the spot with HICAPS. With these funds, your rebate depends on your cover, and there may be a gap. See what being a preferred provider can save you.

How claiming on the spot works

HICAPS is a card terminal linked to health funds, so you don’t lodge a claim yourself.

• At the end of your visit, we put your health fund card through the terminal.
• The fund replies with your rebate, and you pay only the gap, if there is one.
• You get an itemised receipt showing the item numbers, the fee, the rebate and what you paid.

If you don’t have your card with you, you can usually pay in full and claim later through your fund using the itemised receipt.

What to bring

• Your health fund card. If you only have a digital card, ask us whether it will work.
• Your child’s Medicare card, if they may be eligible for the CDBS.
• Any treatment plans from a previous dentist.

Annual limits, waiting periods and item numbers

Every policy is different, so check with your fund. In general:

• Annual limits. Extras usually have a yearly cap for dental. Once you reach it, you pay the full fee until it resets, often on 1 January or your membership anniversary.
• Waiting periods. New members, and people who upgrade, often wait before they can claim. Major dental, such as crowns, usually has a longer wait than general dental.
• Visit limits. Some policies cap check-ups or cleans per year.
• Item numbers. For larger treatment, ask us for a quote with item numbers. Your fund can then tell you the expected rebate.

Children and the CDBS

Eligible children aged 0–17 can be seen under the Child Dental Benefits Schedule. We bulk bill eligible services, so there is no out-of-pocket for eligible children under the CDBS. Read the CDBS explained to check eligibility.

Fund guides

• Bupa Members First Platinum
• HCF More for Teeth
• nib First Choice
• $199 check-up, clean and fluoride, for patients with or without cover

Common questions

Can I still claim if my fund isn’t one of your preferred provider funds?

Yes. We accept all health funds, including Medibank, ahm, CBHS and Australian Unity, claimed on the spot with HICAPS. Your rebate depends on your level of cover. There may be a gap to pay, so check with your fund for the expected rebate.

Does preferred provider status mean no gap for everything?

No. Eligible members may pay no gap on check-ups. Other treatment, such as fillings or crowns, usually has a gap. What you pay depends on your policy, your annual limits and any waiting periods. Check with your fund.

What if I’ve used up my annual limit?

You can still have treatment, but your fund won’t pay towards it until your limit resets. Some people spread non-urgent treatment across two benefit years. Ask your dentist whether it is safe to wait before splitting treatment up.