If you have private health insurance and you are covered for dental, the cost of your dental treatment can be paid for in 2 parts:
- The benefit amount that your health insurer will pay
- The out-of-pocket amount (referred to as the Gap) that you will need to pay
"No Gaps" means that if you have private health insurance and you are covered for dental, we accept the benefit paid by your health insurer as full payment, which means don't need to pay the out of pocket amount.
You can take advantage of the "No Gaps" as long as
- you have not reached your benefit limits with your health insurer and a full benefit is received for each treatment item (“full benefit” does not mean 100% of the cost of treatment; it is the full benefit amount which your health fund would have typically contributed), and
- you have your current working health fund card with you on the day of treatment. Can be either the physical card, or a digital card.
The ‘Gap’ or 'out of pocket' amount is the difference between the ‘price of the treatment’ and the ‘benefit' paid by your health insurer.
For example;
| Treatment | Price | Benefit paid by health fund | Gap | What you need to pay us |
| Consultation | $70.00 | $40.00 | $30.00 | $0.00 |
| Scale and Clean | $150.00 | $80.00 | $70.00 | $0.00 |
| X-ray | $55.00 | $20.00 | $35.00 | $0.00 |
| X-ray | $55.00 | $20.00 | $35.00 | $0.00 |
| TOTALS | $330.00 | $160.00 | $170.00 | $0.00 |
Under our No Gaps Guarantee, in this example, we will waive the $170 gap payment due.
We have a number of 'no gap' treatments including;
- Dental Check up / examination
- Scale and Clean
- Fluoride treatment
- Small digital x-rays and OPG’s
- Simple Restorative Fillings (white / tooth coloured composite material)
- Children’s (12 years old and under) baby tooth removal
For all other dental treatment, you will need to pay the 'Gap' amount. For more information on what types of payment we accept, see Payment Options.