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Dental

Orthodontics explained

Orthodontics covers treatments that use various appliances to straighten teeth and correct problems with biting, chewing, and jaw alignment. This includes treatments like:

Braces: Uses bands and brackets to align and straighten teeth.

Sequential plastic aligners: Involves a series of clear, custom-made removable aligners to gradually move teeth without the use of metal wires and brackets.

Palatal expanders: Are appliances that widen the upper or lower jaw to prevent crowding of teeth and cross bites.

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A course includes the fitting, adjustment and removal of the braces/appliance, along with any additional removable or fixed appliances. A course is deemed to be completed when retention retainers are issued.
An annual limit is the maximum amount of money you can claim for a service within a calendar year. Each person on your policy has their own annual limits.
A lifetime limit is the total amount you can claim for a service over the course of your lifetime; each person on your policy has their own lifetime limit. At HBF, lifetime limits only apply to orthodontics on select covers. This means that once you’ve claimed up to your lifetime limit, either at HBF or through claims at another health insurer, you won’t be able to claim benefits again even if you change your cover or leave and re-join us in the future.
A dental item is a number assigned to a dental clinical procedure outlined in the Australian Dental Association schedule. When you are getting orthodontic treatment, your dental provider will perform a range of dental procedures and each procedure will have a corresponding dental item number depending on the type of orthodontic treatment you receive.

A Treatment Plan is a document provided by your dental provider and includes the estimated length of treatment time, the dental item numbers used to identify the treatment, the total cost and how you intend on paying for the treatment i.e. upfront lump sum payment or monthly instalments over the duration of treatment.

Once you have your Treatment Plan, you should provide a copy to us so that we can provide you with a benefit quote based on your treatment and level of cover. Getting a benefit quote is important as it will detail your entitlements and any out-of-pocket costs that you may incur.

The way we pay benefits for orthodontics will depend on your extras cover.

Benefits per orthodontic item

If you have either Complete 60 or Top 70 extras cover, we will pay a benefit per orthodontic item. For these covers, we will pay 100% of the cost, up to your annual limit and or lifetime limit, on your initial claim. If your orthodontic treatment continues across multiple calendar years and you maintain cover for orthodontics, we may pay benefits up to your annual limits each calendar year, until you reach your lifetime limit.

To be able to claim benefits up to annual and/or lifetime limit for continuing treatment each calendar year you must:

  1. Request a treatment plan: Ask your dental provider for a letter setting out your treatment for the current year, along with the expected treatment duration, item codes, fees and total outstanding balance.
  2. Submit your treatment plan to HBF: We will assess your entitlements and pay 100% of the eligible costs up to your annual and lifetime limits.
  3. Repeat (if required): For each subsequent calendar year that treatment continues, repeat steps 1 and 2.

Benefits per course of treatment

On some closed covers (no longer available for sale), we will pay a benefit per course of orthodontic treatment. A course includes the fitting, adjustment and removal of braces or appliances, along with any additional removable or fixed appliances. For these covers, we will pay benefits up to your annual limit and/or lifetime limit for that course on the date of diagnostics or fitting. Benefits are paid once, even if treatment continues for multiple years. A lifetime limit may apply.

Remember to contact us for a benefit quote before commencing treatment to understand what your entitlements are, how benefits will be paid and which limits apply to your product.

Orthodontics lifetime limits
If you reach your lifetime limit, either with another fund or with HBF, we will not pay any further benefits towards orthodontic treatment for the duration of your membership, even if you cancel your policy and re-join in future.

No. We will only pay benefits on services provided by HBF approved providers for orthodontic treatment received in clinic.

At HBF, you can get cover for Orthodontics on HBF Complete 60 and Top 70 extras covers. You will need to serve a 12-month waiting period before you can claim on Orthodontics.

When you buy extras insurance for the first time, there will generally be a waiting period you need to serve before you can claim if you haven't had continuous cover, or if you've just upgraded to a higher level of cover.

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