Health Fund Information

If you have private health insurance with dental coverage, you’re entitled to benefits to help cover the cost of dental care. As a preferred provider for major health funds, Happy Tooth can claim directly to your fund, making it simple and affordable.

Preferred Provider Status

We are a preferred provider for the following health funds:

• HCF
• CBHS

Preferred provider status means:

• We have agreements with these funds
• We can claim directly to them (no need for you to claim later)
• Benefit payments are typically higher than for non-preferred providers
• Your gap amount (what you pay) is usually lower

If you’re with one of these funds, bring your card to your appointment.

Direct Claiming

How It Works

1. You come in for your appointment
2. We check your health fund coverage
3. We provide treatment
4. We claim directly to your fund
5. You only pay the gap amount (the difference between our fee and the fund’s benefit)

This is much simpler than paying in full and claiming later. You know your cost upfront.

Example Scenario

Your check-up and clean costs: $150 Your health fund benefit: $120 You pay (gap amount): $30

This is significantly cheaper than paying the full $150 out of pocket.

Understanding Your Health Fund Benefits

Check Your Policy

Before your appointment, it’s helpful to understand your coverage:

• Does your policy include dental? Not all policies do
• What’s your annual benefit limit? Most funds provide $300-$2,000+ per year
• What percentage does the fund cover? Typically 50-100% for preventive care, 50% for major treatment
• Are there waiting periods? Some plans have waiting periods before major treatment is covered
• Are there restrictions? Some funds exclude certain treatments or limit how often you can access services

Finding This Information

• Check your membership booklet — Your full policy details are there
• Contact your health fund — Call or email them with questions
• Visit their website — Most funds have online benefit calculators
• Ask us — Call 02 4936 2011 and we can help interpret your benefits

Service Coverage by Health Fund

Different health funds cover different services. Generally:

Preventive Services (Usually Well-Covered)

• Check-ups and examinations
• Professional cleans
• X-rays
• Fluoride treatments

Most funds cover these at 100% or with minimal gaps.

Restorative Services (Usually 50% Covered)

• Fillings
• Root canals
• Extractions
• Gum treatment

These are typically covered at 50-60%, with you paying the gap.

Major Services (Often Limited)

• Crowns
• Bridges
• Dentures
• Implants
• Orthodontics

Coverage varies widely. Some funds limit the number of major services per year or require pre-authorisation. Check your specific policy.

Maximising Your Health Fund Benefits

Use Preventive Services

Annual check-ups and cleans are well-covered. Use these to catch problems early and avoid more expensive treatment later.

Know Your Annual Limit

If your fund provides $1,000/year, use it strategically. Don’t let your benefits expire—plan significant treatment before year-end.

Plan Major Treatment

For crowns, bridges, or implants, check your fund’s coverage limits and plan treatment across calendar years if beneficial.

Request Pre-Authorisation

For expensive treatment, ask your fund for pre-authorisation. This confirms they’ll cover a certain amount, preventing surprise bills.

Ask for Estimates

Before treatment, we can provide an estimate of:

• Our fee
• Your fund’s likely benefit
• Your gap amount (what you pay)

If You’re Not With a Preferred Provider Fund

If your health fund isn’t on our preferred provider list:

• You can still be treated at Happy Tooth
• You’ll pay our full fee at your appointment
• You can then claim from your fund
• You’ll likely receive a lower rebate than preferred provider patients

Discuss this with your health fund if you’d like to know about their preferred provider agreements.

Health Fund Comparison

Common Questions

“Will my health fund cover my implant?”

Some funds cover implants, but often with limits. For example: “We’ll cover the crown portion but not the surgical placement.” Check your specific policy.

“Is there a waiting period for major work?”

Some funds have 6-month or 12-month waiting periods before major treatment is covered. Check your policy documents.

“Can I claim for cosmetic treatment?”

Most health funds don’t cover purely cosmetic work (like whitening). However, if treatment is necessary for function or health (like a crown on a damaged tooth), it’s usually covered.

“Do I need pre-approval from my health fund?”

For expensive treatment, it’s helpful to get pre-authorisation. This confirms they’ll cover a certain amount. We can help coordinate this.

Questions About Your Cover?

If you’re unsure about your health fund coverage:

1. Check your policy documents — Full details are there
2. Call your fund — They can explain your specific cover
3. Ask us — Call 02 4936 2011 and we can help interpret your benefits
4. Check online — Most funds have online benefit estimators

Make the most of your health fund benefits. We’ll claim directly to HCF or CBHS so you only pay the gap. Call us on 02 4936 2011 to book an appointment and start getting the dental care you need.