Orthodontia information – effective 1 April 2013
In Australia, the fee for orthodontic treatment involving upper and lower braces can vary from $4000 to more than $8000. This fee usually covers the entire treatment including the fitting of braces, adjustments at regular intervals, the removal of braces and the retention and observation periods that follow. This fee does not usually cover the initial consultation, records, photographs, removal of any teeth or other steps to prepare for the fitting of the braces (these fees also attract a benefit under Top Extras Dental Cover). Your orthodontist should discuss the treatment options and the fee with you before your treatment is commenced.
At Teachers Health Fund, benefits are payable for orthodontic treatment if you hold Top Extras Cover and have served the 24 month waiting period. We will pay 100% of the cost up to the level of your benefit entitlement. Your benefit entitlement will increase dependant on the number of years that you have held continuous Top Extras Cover.
| Increasing limits | |
| Year 3 | $1500 |
| Year 4 | $2000 |
| Year 5+ | $2500 |
You also have a lifetime limit of $2500 for orthodontic treatment. Once you reach this lifetime limit you are unable to make any further claims for orthodontia.
How to claim for your orthodontic treatment
1. If you are considering orthodontic treatment, please contact Teachers Health Fund so we can discuss your benefit entitlements with you.
2. Send us a copy of your treatment plan. We can use this to quote you an accurate benefit based on the payments you are required to make and the length of your treatment.
3. Send us your receipts with a completed claim form after the treatment commences. Don’t forget to send your treatment plan if you haven’t already done so.
4. Orthodontia cannot be claimed using your Teachers Health Fund membership card via HICAPS at your orthodontist.
5. Orthodontia cannot be claimed using online claiming through online member services.
Important points to remember:
- Orthodontic benefits are only payable for members on Top Extras Cover.
- No benefit will be paid for services received during the 24 month waiting period
- No benefit is payable before the treatment commences, even if you choose to pay for your orthodontic treatment in advance. The benefit can only be paid once the braces or aligners are in place.
- If you pay for your orthodontia up front, you can continue to claim for orthodontia in the following years as long as you are still undergoing active orthodontic treatment (that is, your braces are still on). We will continue to pay your orthodontic benefits up to your annual limit and the lifetime limits that are applicable to your policy.
- If you transfer from another health fund and have received orthodontic benefits during the last 5 years this will be deducted from your benefit entitlement with Teachers Health Fund. Orthodontic benefits paid in the previous 5 years of cover are recorded on your transfer or clearance certificate from the health fund you have left.