Dental Provider FAQs

This information is for dental providers. It relates to the termination of all current HBF Member Plus Dental Agreements (Agreements) and the launch of HBF’s new Member Plus Dental Arrangement (New Arrangement).

If you have additional questions relating to the termination of Agreements or the launch event for the New Arrangement, please contact us via AncillaryProviders@hbf.com.au or call us on (08) 9265 8878. We will endeavour to update this page as additional common questions arise.

Please Note: You should ensure that you read the Terms and Conditions of the New Arrangement, along with the Privacy Statement for Practitioners to fully understand your obligations and rights under the New Arrangement. The Terms and Conditions of the New Arrangement and Privacy Statement can be found in the Medipass Provider Portal app.

If you do not already have a Medipass account, register here.

If you already have a Medipass account, sign in here.

Glossary

Agreements means all current HBF Member Plus Dental Agreements.

Eligible Member means a person who:

1. Holds or is covered by an ancillary private health insurance policy issued by HBF that is financial at the time a Service is provided;
2. Receives a Service that is covered under their ancillary private health insurance policy issued by HBF; and
3. Has served all waiting periods applicable to the Service.

HBF Dental Schedule means the schedule of maximum prices for dental services which is located in the Medipass Provider Portal app.

Medipass Provider Portal means the Medipass Provider Portal app available via www.medipass.com.au

Minimum Services means Preventative Services, which must include a scale and clean and/or the provision of mouthguards.

New Arrangement means HBF’s new Member Plus Dental Arrangement, which comes into force on 1 January 2019.

Practitioner means a qualified dentist or prosthetist who:

1. Is registered with AHPRA;
2. Has been issued with a provider number by Medicare Australia; and
3. Provides Minimum Services from the Practice.

Preventative Services is closely aligned with the Diagnostic and Preventative categories in The Australian Schedule of Dental Services and Glossary. Specifically, item numbers D011 to D171 with the exception of item number D118 which falls into HBF’s General Restorative category.

Service means any dental service including an Eligible Service.

Eligible Service means an item set out in the HBF Dental Schedule.

Specialist means a specialist Practitioner such as an oral surgeon or periodontist.

Launch Event

An expanded version of the presentation from the event is available here (PDF).

This presentation should be read with the Terms of the New Arrangement and Privacy Statement for Practitioners which are available via the Medipass Provider Portal.

If you do not already have a Medipass account, register here

If you already have a Medipass account, sign in here

Once signed into the Medipass Provider Portal, select ‘Documents’ on the left-hand side of the home page to access the Terms of the New Arrangement and corresponding HBF Dental Schedule and Privacy Statement for Practitioners.

If you notified us that you were unable to attend the event, you will receive an email on 18 October 2018 with the above instructions.

If you have difficulty registering for or signing into the Medipass Provider Portal, please contact Medipass via support@medipass.com.au.

If you have feedback on the event, please contact us via AncillaryProviders@hbf.com.au.

Termination of Current Agreements

All current HBF Member Plus Dental Agreements will terminate on 31 December 2018. There are no exceptions.

HBF is terminating the Agreements so the new Member Plus Dental Arrangement can come into effect from 1 January 2019. The New Arrangement is designed to be fairer to all dental practices, simpler and more transparent.

HBF has received consistent feedback from dental providers, both in and out of the Agreements, regarding the inconsistent nature of the Agreements. As a result of this feedback and independent member research, HBF has decided to terminate the Agreements so that the New Arrangement, designed to be fairer to all dental practices, simpler and more transparent can be introduced from 1 January 2019.

As all Agreements will terminate on 31 December 2018, a prospective seller or purchaser of a dental practice should not rely on any form of existing HBF Member Plus status.

Providers can be added to a current Agreement between now and 31 December 2018 however, they will have an Agreement end date of 31 December 2018. Registrations to operate under a current Agreement at an existing location must be made via the updated application form. Completed forms must be sent to AncillaryProviders@hbf.com.au.

Yes. You must continue to charge in accordance with your current HBF fee schedule for the formal notification period. This will be 90 days or until 31 December 2018 (whichever is shorter) as per the ‘changing participation status’ clause in the Terms & Conditions of the Agreements.

Yes. You can write to HBF to advise that you wish to withdraw from your Agreement within the formal notification period, however you must continue to charge in accordance with your current HBF fee schedule for 90 days or until the termination date (whichever is shorter) as per the ‘changing participation status’ clause in the Terms & Conditions of the Agreements.

  • If a practice applies for and receives acceptance onto the New Arrangement before 31 December 2018, the practice can continue to state in any information or promotional material after 31 December 2018 that they are an HBF Member Plus Dental Practice.
  • If a practice applies for the New Arrangement before 31 December 2018 but is declined participation, the practice has until 31 December 2018 or 7 days from being notified that the application is declined (whichever is longer) to remove any information or promotional material that states they are an HBF Member Plus Dental Practice.
  • o If a practice does not intend to apply for the New Arrangement before 31 December 2018, the practice must remove any information or promotional material by 31 December 2018 that states they are an HBF Member Plus Dental Practice. If the practice applies for and receives acceptance onto the New Arrangement after 1 January 2019, the practice can reinstate any information or promotional material that states they are an HBF Member Plus Dental Practice after they have received acceptance.

Where HBF has previously granted consent to a practice to use the HBF trademarks under the Agreement for a specific promotional purpose, HBF will allow the practice to continue to use its trademark for this purpose, in accordance with that consent post 31 December 2018, provided the practice is accepted by HBF onto the New Arrangement by 31 December 2018. If the practice is declined participation or does not apply for the New Arrangement by 31 December 2018, consent automatically ceases on 31 December 2018.

New Member Plus Arrangement

The New Arrangement between HBF and a dental practice focuses on Preventative Services. All Practitioners at a practice that applies for and is accepted onto the New Arrangement agree to charge Eligible Members no more than the maximum fee for all services on the HBF Dental Schedule. Furthermore, HBF agrees to fully cover one scale and clean per Eligible Member per calendar year when delivered at a practice on the New Arrangement.

Practices on the New Arrangement will be able to promote themselves as an HBF Member Plus Dental Practice.

Independent research commissioned by HBF has shown that, for members, the value of dental cover is clearest in relation to services they need most frequently – preventative services. Furthermore, HBF has focused its New Arrangement on Preventative Services as it seeks to encourage members to visit the dentist regularly for these services with the aim of reducing and/or delaying the need for more complex treatment later on.

From 1 January 2019, the dollar amount that HBF pays in benefits on all dental services (including Preventative Services) will be the same, regardless of whether the member visits a Member Plus Dental Practice. This is fairer for dentists and addresses common feedback from our members that the dentist they choose should not be determined by a difference in benefits between providers.

Whilst the benefit dollar amount will be the same, research has shown that members still highly value the advantages of visiting a Member Plus Dental Practice which are:

  • Known out-of-pocket costs on Preventative Services and, on some products, a no gap experience on Preventative Services. This is achieved by setting the maximum fee that Member Plus Dental Practices can charge for Preventative Services
  • One fully covered scale and clean per Eligible Member per calendar year
  • Instant, electronic claiming

As the maximum fee is set, HBF will promote benefits for Preventative Services at a Member Plus Dental Practice as a percentage of the maximum fee. From 1 January 2019, these percentages are 75%, 85% or 100% back depending on the member’s level of cover and up to their annual limit. The use of percentages makes it easier for members to understand their level of cover and the associated benefits.

There are a number of advantages to joining the New Arrangement:

  • Ability to promote percentage benefits to Eligible Members for Preventative Services and a no gap experience on Preventative Services to Eligible Members on the highest level of extras cover. These percentages are 75%, 85% or 100% back depending on the member’s level of cover and up to their annual limit
  • Ability to promote and provide one fully covered scale and clean to Eligible Members per calendar year
  • Ability to promote the practice as an HBF Member Plus Dental Practice and ability to promote Practitioners at the practice as HBF Member Plus Dental Providers
  • Inclusion in HBF’s Member Plus provider online directory
  • Promotion via HBF marketing campaigns

No. Those who do not provide the Minimum Services (such as Periodontists and Oral Surgeons) are not eligible to be Practitioners under the New Arrangement (as defined in the Glossary) and are therefore not eligible to join or subject to the New Arrangement.

Having specialists at the practice who are not eligible to be Practitioners under the New Arrangement, will not prevent that practice from applying for the New Arrangement, assuming all Practitioners who are eligible provide the Minimum Services and the practice meets all other criteria required by HBF.

Applications for the New Arrangement can only be considered if the practice representative undertakes that all Practitioners will charge Eligible Members no more than the maximum fee for all services on the HBF Dental Schedule.

The aim of this is to reduce member confusion regarding which practitioners within a practice are Member Plus Dental Providers. If there are Practitioners at a practice that do not want to be on the New Arrangement, then that dental practice is not eligible to apply for the New Arrangement.

All Practitioners at the practice who provide the Minimum Services must agree to be on the New Arrangement for the practice to be eligible to apply for the New Arrangement.

The HBF Dental Schedule focuses on Preventative Services as defined in the Glossary. It is closely aligned with the Diagnostic and Preventative categories in The Australian Schedule of Dental Services and Glossary (i.e. item numbers D011 to D171). The only exception is item number D118 which falls into HBF’s General Restorative category.

The maximum fees have been determined following a detailed review of current Agreement fees, ADA average fees and fees identified from HBF’s claims history. A copy of the HBF Dental Schedule is available via the Medipass Provider Portal.

No, but all Practitioners at the practice must offer the Minimum Services.

HBF will review the HBF Dental Schedule at its discretion, and when doing so will keep in mind the cost effect of fee changes on member’s premiums. At a minimum, HBF will review the item numbers and maximum fees on the HBF Dental Schedule when there is a change to those item numbers in The Australian Schedule of Dental Services and Glossary.

The Minimum Services are a scale and clean and/or the provision of mouthguards. All Practitioners at the practice must provide the Minimum Services for the practice to be eligible to apply for the New Arrangement.

Yes. All Practitioners must provide the Minimum Services.

Practice level means that all Practitioners at the practice must charge Eligible Members no more than the maximum fee for all services on the HBF Dental Schedule. The aim of this is to reduce member confusion regarding which practitioners within a practice are Member Plus. It also means that practitioners do not need to apply for the New Arrangement individually, unless they are a single trader.

When applying for the New Arrangement via the Medipass Provider Portal, the practice representative will make an undertaking that all Practitioners will charge Eligible Members no more than the maximum fee for all services on the HBF Dental Schedule.

Yes. If you own multiple practices, you are required to apply for each practice individually and HBF will review and consider each practice in its own right.

To be eligible to apply for the New Arrangement the practice must meet the following criteria:

  • All Dentists and Dental Prosthetist’s at the practice must be registered with AHPRA and HBF
  • The dental practice must provide and intend to continue to provide Preventative Services at a minimum of scale and clean and/or the provision of mouthguards
  • The dental practice must be registered for electronic claiming
  • The intended practice representative who will agree to the Terms of the New Arrangement must be authorised to act for and sign on behalf of all Practitioners at the practice.

To be eligible to apply for the New Arrangement, all Practitioners at the practice must meet the eligibility criteria.

Applications to join the New Arrangement open on 1 November 2018 via the Medipass Provider Portal. All practices in Western Australia have equal opportunity to apply for the New Arrangement as there is no restriction on the number of practices that will be accepted.

Applications must be made via the Medipass Provider Portal, provided by Medipass Solutions Pty Ltd. You will need to register for use of the Medipass App. Please ensure that you read and understand the terms and conditions and the privacy statement that apply to use of Medipass. Applications can be made from 1 November 2018. Once signed into Medipass, select ‘Documents’ on the left-hand side of the home page and follow the instructions provided.

HBF will email the practice representative within 5 business days of receiving the application to advise whether the application is accepted or declined.

No. There will be no restriction on the number of practices in Western Australia that can be on the New Arrangement. Furthermore, all practices will have equal opportunity to apply for the New Arrangement.

The New Arrangement lasts until 31 December of the third calendar year from the start date.

Applications accepted prior to 31 December 2018 will have a start date of 1 January 2019. Applications accepted post 1 January 2019 will have a start date of 14 days from HBF’s notification of acceptance.

For practices with a start date in 2019, the New Arrangement is valid until 31 December 2021, after which date there are two one year extensions to the term. Each one year extension will automatically apply, unless HBF advises otherwise. As a result, unless HBF advises otherwise the term of the New Arrangement will be five years.

No. Acceptance onto the New Arrangement is not guaranteed. Practices that wish to be accepted onto the New Arrangement need to apply and meet the eligibility criteria.

Yes. Practices that join the New Arrangement can offer discounts on services if they wish, including discounts on Preventative Services on the HBF Dental Schedule. However, any discounts must be subtracted from the fee prior to submitting a claim to HBF.

Note that the dollar amount HBF pays in benefits will be the same regardless of any discounts. This includes Preventative Services at Member Plus Dental Practices where the benefit is promoted as a percentage of the maximum fee. In other words, the benefit dollar amount will be unchanged if the fee charged is less than the maximum fee. The only exception is where the fee is less than the benefit amount.

No. Practices that join the New Arrangement must charge Eligible Members no more than the maximum fee for all services on the HBF Dental Schedule which includes item numbers 151 and 153. The maximum fees for these particular item numbers has been increased to cover different models and modifications such as colours and graphics.

Under the Terms of the New Arrangement this could be seen as a change in control of the practice. If this is the case then the practice representative must inform HBF of any change in control of the practice prior to such change occurring. In these circumstances HBF has a right to terminate the New Arrangement with the practice. There is no guarantee that HBF will continue the New Arrangement with the practice if a change in control of the practice occurs.

Under the Terms of the New Arrangement, the practice representative may terminate the New Arrangement without cause by giving HBF 60 day’s written notice.

The practice representative may also terminate on seven days written notice in certain limited circumstances, for example where HBF proposes to vary the New Arrangement. In the event the practice representative does not agree to the proposed variation, the practice representative may terminate the New Arrangement on seven days written notice.

You should read the Terms and Conditions of the New Arrangement to fully understand your obligations and rights, including your rights to terminate. The Terms and Conditions of the New Arrangement can be found in the Medipass Provider Portal.

At this stage HBF is unable to provide a schedule of benefits for item numbers outside of Preventative Services. Due to the wide range of benefits per item number, which varies depending on the member’s level of cover, this information is not simple to produce. However, HBF does seek to be more transparent and aims to publish this information on the Medipass Provider Portal in early 2019.

No. If you do not provide the Minimum Services, the New Arrangement is not applicable to you. Instead, you define your service fee and HBF will pay a set benefit amount regardless of that fee. Benefits are subject to the service coverage and annual limits of the Extras cover the member holds.

Yes. From 1 January 2019, all benefits for dentists and dental prosthetists will be aligned. Under the New Arrangement, there is only one schedule of maximum fees which applies to all those who join the New Arrangement irrespective of speciality or location in WA.

In line with making things simpler, HBF will be addressing the administrative inefficiency of having different item code prefixes for dentists and dental prosthetists. The ‘P’ prefix currently used for dental prosthetists will be ceased and all claims processed by HBF for both dentists and dental prosthetists will use the ‘D’ prefix.

HBF is removing the No Gap for Kids Preventative Dental Program in response to member feedback calling for better benefits on Preventative Services for everyone, rather than just kids.

From 1 January 2019, Preventative Service benefits will increase for everyone, which we feel is a fairer approach. Furthermore, members of any age (including kids) with a top level of extras cover will be able to access no gap Preventative Services at a Member Plus Dental Practice.

Members and Quotes

Yes. We have commenced communications to HBF members.

By 1 November 2018, all HBF members with dental cover will have been advised that HBF’s current Member Plus Dental Agreements are terminating on 31 December 2018 and a new Member Plus Dental Arrangement will come into effect from 1 January 2019.

Please use your discretion when having conversations with HBF members about the changes prior to 1 November 2018.

Members can visit Extras Cover Changes FAQs, their local HBF branch or phone HBF on 133 423.

Yes. Please note the following:

  • Quotes from HICAPS – HICAPS quotes are only valid for the day the quote is generated. You should always clearly communicate this to your patients.
    Until 31 December 2018, HICAPS quotes will reflect current benefits. From 1 January 2019, HICAPS quotes will reflect new benefits.
  • Quotes from an HBF branch, the HBF call centre or myHBF.com.au – HBF will clearly communicate the validity of dental quotes to members, however details are included below for your reference.
    • Quotes with a date of service between 1 October 2018 and 31 December 2018 will reflect current benefits.
    • Quotes with a date of service beyond 1 January 2019 can be issued from 1 December 2018.

There is the possibility that treatment plans and fee quotes will be affected.

To avoid patient complaints, we recommend you clearly communicate to your HBF patients that the fees and benefits associated with treatment plans and quotes produced between now and 31 December 2018 may change from 1 January 2019.

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