Claiming for Orthodontia

Claiming for Orthodontia

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How to get the most out of your Extras cover

Orthodontic treatment in Australia isn’t cheap. It can cost $4,000 to $8,000 (or even more). And while the rules vary from state-to-state, things like consultations, diagnostic recording (e.g. x-rays) and orthodontic appliances (e.g. braces) aren’t normally covered by Medicare.

Thankfully, Extras cover can help you out with this big-ticket item!

When you can claim

The waiting period for Orthodontia is 12 months. That means you need to be on Extras cover that includes Orthodontia – Top Extras or Essential Extras – for 12 months before you can use your cover for orthodontic treatment.

Waiting periods apply to people who just got Extras cover and those who upgrade to cover that includes Orthodontia.

If either apply to you, you won’t be able to claim for treatment you have before the 12-month waiting period is up (even if you submit your claim later on).

If you switch to Teachers Health after serving this waiting period at your previous fund, you won’t have to re-serve it when you join us.

What you can’t claim for

You can only claim for face-to-face dental services provided by a registered dentist.

You can’t claim for the kind of home (DIY) dentistry that you may have seen advertised on TV (e.g. whitening kits and aligners), or tele-orthodontia (phone or video consults).

If you’re not sure, contact us to find out whether you can claim for a given service – we’re here to help!

How much you can claim

Here are the Orthodontia limits on Teachers Health Extras cover:

  • Top Extras – up to $2,500 per person in a lifetime

  • Essential Extras – up to $300 per year – up to a lifetime limit of $2,500 per person (Orthodontia is combined with your Major Dental benefit).

If you switch to Teachers Health from another fund, any Orthodontia benefits you’ve already claimed will be deducted from the above entitlements.

Claiming for Orthodontia

Send us your itemised receipts and a completed claim form via:

You can’t claim for Orthodontia via HICAPS or online.

Please note that we can only issue one payment per bill (i.e. we can’t split payments between you and your provider). If the full cost is outstanding, we can send you a benefit cheque to give to your provider. Or, you can pay the amount up front and we’ll reimburse you.