If you have private health insurance and extras cover, don’t waste your benefits! The vast majority of private health funds calculate your annual maximum limits for services over a calendar year.
With November in full swing, it means you have just over a month to use what is left of your cover! Don’t throw away what could be hundreds-of-dollars worth of benefits because you didn’t know.
How It Works
The world of insurance Product Description Statements (PDS) can get really really confusing, really really quickly. But before you give up, feeling like your banging your head against a wall of words that don’t make sense. Let us simplify things just a little.
The exact amounts of cover and benefits you receive will depend on your circumstances and your PDS – dread, the mountain of words – but, there are some basics principles that apply to everyone.
If you have extras cover your private health insurers will offer benefits up to a maximum value, calculated per person, per year. This is the money that you are paying to your insurer over the course of the year.
Depending on your plan, you will be allocated different maximums to different services. Then as you move up in the value of your policy so too will your benefits and the treatments that are covered.
For example, you might have a plan that offers you and your family general dental services to the value of $500, per person, per year. That’s pretty good value and can definitely go towards maintaining your pearly whites.
Alas, the fine print: per year! Because of the annual contracts, if you don’t use these benefits each year you are going to loose them!
You can think of that $500 as money you’ve given to your insurer and deserve to spend, or as a gift. Either way, you should definitely use it. This money won’t roll over to next year, if you don’t use it you will loose it!
What is the Gap?
The Gap is the difference between the price of the treatment and what your insurer pays. You pay the Gap out-of-pocket. For example, your treatment might be $200, your insurer will pay $150, so you’re left to pay $50 at the time of the treatment.
It can get pretty complicated because each insurer will pay a different amount of each treatment. Also, insurers will often do bundle deals, which means the more treatments you get at once, the less your Gap will be per treatment.
It’s one complicated world we know. What you should know, however, is that on average, Australians pay a Gap of $45 per trip to the dentist.
Rejoice! Because at Hamilton Dental we have a NO GAP policy for check-ups and cleans, yes that’s right, $0 out-of-pocket for check-ups and cleans!
This is where things get really complicated. There are a lot of options out there, and unfortunately, the only way to really get the best for you and your family is to dive into the world of PDS.
We suggest knowing exactly how much you are willing to spend, and what it is you really need to be covered. If your family is growing you might want to look to a plan that has basic dental and an option for orthodontics. It’s often a lot more constructive to start orthodontics early.
A general dental plan will typically cover, 6 monthly examinations, scale and clean and fluoride treatment, X-rays, sometimes Mouth guards, some Fillings, Simple extractions and Surgical extractions (such as removal of impacted wisdom teeth).
A more comprehensive plan will often cover general dental, plus, orthodontics and major dental. Major dental encompasses things such as; periodontal treatment, complex oral surgery, root canal therapy, fillings (those that have to be made outside the mouth e.g. in a laboratory or by a special machine), crowns and bridges, implants and dentures.
Use What You’re Paying for!
Regular check-ups and cleans are the keys to great dental health and pearly whites. If you’re paying insurance premiums you should use the benefits to your advantage. Not to mention that letting your dental health maintenance fall to the wayside gives nasty decay a chance. What was once an inexpensive, simple treatment can quickly become an extensive and expensive program to get your dental health back on track.
Use what you are paying for in a basic plan before you’re forced to upgrade to major dental cover!
Something to Sink Your Teeth Into
If you’ve got some ongoing problems, or you’re looking to start orthodontic treatment. The end of the year is the perfect time to use up what is left of your benefits to kick start your treatment. Remember there is often an advantage to getting multiple treatments at once.