Orthodontia Information

In Australia, the fee for orthodontic treatment can range from $4,000 to more than $8,000. This fee usually covers the entire treatment including the initial fitting, regular adjustments and the removal of braces as well as additional retention and observation periods. This fee does not usually cover the initial consultation, records, photographs, removal of any teeth or other steps required to prepare teeth for the fitting of braces (these fees also attract a benefit under Top Extras dental cover).

Teachers Health Fund will pay benefits up to the level of your benefit entitlement if you have our Top Extras cover and have served the 24 month waiting period. Your benefit entitlement will increase depending on the number of years that you have held continuous Teachers Health Fund Top Extras cover and equivalent levels of cover with other health funds, up to the lifetime limit of $2,500. Once you reach this lifetime limit you are unable to make any further claims for orthodontic treatments.

Your orthodontist should discuss the treatment options and fees with you before your treatment is commenced.

Year Period Increasing limits 
 Year 3 $1,500
 Year 4 $2,000
 Year 5+ $2,500

What do you need to do?

1. Discuss any treatment options and fees with your orthodontist before commencing treatment.

2. Send us a copy of your treatment plan so that we can provide you with an accurate estimate on potential out of pocket expenses.

3. Since you cannot make any claims via HICAPS at your orthodontist or through the online members area, you will need to send us all of your receipts with a completed claim (and your treatment plan if you haven’t already done so).

Important points to note:

  • Orthodontic benefits are only payable for members who have Top Extras cover.
  • No benefit will be paid for services received during the 24 month waiting period.
  • No benefit will be paid before treatment commences, even if you choose to pay for your orthodontic treatment in advance. The benefit can only be paid once the braces or aligners are in place.
  • If you pay for your orthodontia up front, you can continue to claim for orthodontia in the following years provided you are still undergoing active orthodontic treatment (i.e. your braces are still on). In this case, we will continue to pay orthodontic benefits up to your annual limit and the lifetime limits that are applicable to your policy.
  • If you transfer from another health fund and have received orthodontic benefits during the last five years, this will be deducted from your benefit entitlement with Teachers Health Fund. Orthodontic benefits paid in the previous five years of cover are recorded on your transfer or clearance of certificate from the health fund you left.