Health Funds

At MGA Dental Clinic, we accept all private health funds. Private Health Insurance helps cover some of the costs of your health treatments, so that you don’t have to pay the entire bill yourself.

Private Health Insurance cover is usually divided into:

Hospital cover
General or Ancillary cover (e.g. Dental, Physiotherapy, etc…)

The amount covered by your private health fund depends on:

The health fund you are a member of
The type of cover you have
The level of your cover
Your cover’s annual limit

What is a Gap Payment?

If your dental treatment fees exceed the rebate that your private health insurance provides, you will have to pay the “GAP”, or excess. This can be done by cash, credit/debit card, or an interest-free payment plan.

Again, the rebate you receive from your private health insurer will vary depending on your insurer’s policy, your level of cover and your cover’s annual limits for dental treatment.

To find out the amount of rebate you will receive, you will have to contact your private health insurer directly.

When does my health fund benefit reset?

Your annual limit is the maximum amount you can claim for a specific extras service. It resets at the start of a new year.

So when does your annual limit reset?

In general, the annual limit resets at one of the following times, depending on your health fund’s policy:

1st of January
1st of July
The anniversary of your policy

Any unused benefits will not be rolled over to the next year when your annual limit resets.

Lifetime Limit

You should also be aware of your health fund’s lifetime limit policy. The lifetime limit is the dollar limit they will rebate for certain services during the entire time you are enrolled in their plan. Lifetime limit does not reset annually.

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What is HICAPS?

HICAPS stands for Health Industry Claims and Payments Service. If you’re a member of a health fund that uses HICAPS, the service can process your health claim automatically on the day of your treatment.

At MGA Dental, our staff use a HICAPS machine to process electronic claims on the spot for the convenience of our patients. Depending on the level of cover you have, your health fund may cover your whole bill or you may have to cover a gap payment yourself.

Check your health fund’s website to find out whether they offer HICAPS payments.

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