Great news! From 1 Jan 2020, we’ll be improving individual rebates for periodontics, dentures, crowns and bridges on Super and Premium Options. Please
contact us if you’d like more info or if wish to receive a benefit estimate.
How much is covered by HIF for our most popular dental services
General Dental
| Item Name1 | Item# | Visit/Service | Extras Benefit Payable |
|---|
| | | | Basic Extras | Value Extras | Simple Extras | Essential Extras | Advanced Extras | Top Extras |
| Oral Examination | 012 | First Visit | 50% of each treatment or service | $54.352 | 60% of each treatment or service | $54.352 | $54.352 | $54.352 |
| Dental x-ray | 022 | First Visit | 50% of each treatment or service | $22.70 | 60% of each treatment or service | $23.95 | $25.85 | $28.65 |
| Scale and clean | 114 | First Visit | 50% of each treatment or service | $110.352 | 60% of each treatment or service | $110.352 | $110.352 | $110.352 |
| Fluoride treatment | 121 | First Visit | 50% of each treatment or service | $33.202 | 60% of each treatment or service | $33.202 | $33.202 | $33.202 |
| Surgical tooth extraction | 322 | First Visit | 50% of each treatment or service | $127.05 | 60% of each treatment or service | $139.75 | $152.45 | $165.15 |
| Filling/tooth restoration | 531 | First Visit | 50% of each treatment or service | $78.55 | 60% of each treatment or service | $83.90 | $91.55 | $97.20 |
1Limits apply to the number of times some items (such as bleaching) attract a benefit. You may also not be able to claim benefits for services performed with another item in the same course of treatment.
2Subsequent visits for these item numbers are paid at a lower benefit
Major Dental
| Item Name | Item# | Visit/Service | Extras Benefit Payable |
|---|
| | | | Basic Extras | Value Extras | Simple Extras | Essential Extras | Advanced Extras | Top Extras |
| Filling of one root canal | 417 | First Visit | Not included. | Not included. | 60% of each treatment or service | $129.15 | $142.05 | $155.00 |
| Full crown - non-metallic | 613 | First Visit | Not included. | Not included. | 60% of each treatment or service | $758.85 | $842.70 | $927.95 |
| Full crown - veneered | 615 | First Visit | Not included. | Not included. | 60% of each treatment or service | $720.25 | $799.80 | $911.85 |
| Dentures - complete3 | 719 | First Visit | Not included. | Not included. | 60% of each treatment or service | $984.30 | $1,000 | $1,279.40 |
3Benefits for replacement dentures and partial dentures are not paid within three years of previous supply.
HIF's cover for braces and other Orthodontic services
For eligible Extras cover, HIF will pay a benefit per orthodontic item. In these instances, HIF will pay 100% of the cost up to your annual limit on your initial claim.
If your orthodontic treatment continues across multiple calendar years and you maintain orthodontic cover under your Extras policy, we may pay benefits up to your annual limits each calendar year, until your lifetime limit.
To be eligible to claim benefits in the next calendar year you must.
- Ask your dental provider for an updated letter which details your treatment for the current year, along with the expected treatment duration, item codes, fees and outstanding balance.
- Submit your letter to claims@hif.com.au
- We will then assess the benefits payable and pay 100% of the eligible cost up to your annual lifetime limit.
- For each subsequent calendar year that your orthodontic treatment continues, steps 1 and 2 will be repeated.
To learn more about Orthodontic treatment and benefits, please read our Health Cover Guide.
Important, please note: For members on Special, Super or Premium Options cover HIF will pay a set benefit per orthodontic item as an immediate benefit (claimable when your braces are fitted), subject to your annual and lifetime orthodontic limits. Please contact us prior to your dental treatment for more info on how to claim for Orthodontics or if you wish to receive a benefit estimate.
How to avoid waiting periods and start claiming straight away when you switch to HIF
You can use your HIF dental cover to claim straight away for any services that were covered by your previous health fund when you switch to HIF, making the dental insurance switch seamless. Here's what you need to know:
- To ensure that all your existing benefits and previously served waiting periods are recognised by HIF, you must switch within two months of leaving your previous health fund and provide a valid Clearance Certificate.
- If you switch to HIF while waiting periods were still being served with your previous fund, you'll need to complete the remaining periods with HIF before claiming.
- You can join HIF with a higher level of cover than you held at your previous fund and still claim without having to wait – HIF will simply pay benefits based on our equivalent of the cover you held at your previous fund, until you have served the upgraded waiting periods on the higher level of cover.
Want us to handle the paperwork for you? No worries!
Click here for more information about switching health funds.
No surprise out-of-pocket costs with HIF's dental benefit estimates
We always recommend contacting us for a benefit estimate before you receive any dental treatment, so we can let you know exactly what you have cover for and the amount we’ll pay.
To get started, simply ask your dentist to provide an itemised dental estimate – this should include a list of the items you’ll be billed for, the fee for each item, and the provider number of the dentist who will be performing the treatment.
Then, send us the details using our dental estimate online form. You can also obtain an Extras estimate using our Online Member Centre. Alternatively, give us a call on 1300 134 060 and we can provide you with a dental benefit estimate over the phone.
Important, please note:
- Benefits are paid only on accounts rendered by a registered Dentist or Dental Prosthetist. The Dentist or Dental Prosthetist must be in private practice.
- Benefits for replacement dentures and partial dentures are not paid within three years of previous supply.
- There are some items within item code ranges for which the fund does not pay a benefit, or if they are performed with another item in the same course of treatment.
- Limits apply to the number of times some items, such as bleaching can be claimed.
- Dental Prosthetists are allowed to perform a limited range of services for benefit purposes.
- Waiting periods apply, please see product factsheets for more detail.
Search more FAQs here
View related information about HIF dental cover
Dental cover is an important part of any Extras health insurance policy, which is why, in 2024, we are making some changes to ours.
From 1 January, we’re increasing benefits across 77 of our most claimed General and Major Dental services, meaning less out-of-pocket costs for members.
Find out more about HIF Extras Cover.
Use the panels below to learn more about our most popular health services.