Private Health Insurance, Gaps and Bulk Billing

Private Health Insurance, GAPS and Bulk Billing

This page will hopefully demystify some questions you may have about the various terms about payment options you may have heard when you visit the dental office.

There are two ways the cost of your treatment can be subsidised:

  • Private Health Insurance (PHI)
  • Bulk Billing – with MEDICARE

Private Health Insurance

Private Health Insurance helps cover the costs for some of your health treatments, so that you don’t have to pay out the entire bill yourself. Private Health Insurances are usually divided into:

  • Hospital cover
  • General or Ancillary cover (e.g. Dental, Physiotherapy, etc…)
  • Some cover the whole cost of your treatment, and others have a limited cover.

The amount covered by your private health fund depends on:

  • The health fund you are with
  • The type of cover, and
  • Level of your cover

What is a GAP?

If your Private Health Insurance covers you for dental treatment, there will usually be a limit on the cover every year. Different private health insurance covers differently for different items/codes of treatment. If the dental practice charges more than your cover, you will need to pay the GAP, or excess.

Some companies determine the price of the treatment, and can have a different cover if they have a certain contract with the dental practice. You may know this as a ‘Preferred Provider’. Different health covers may use different terms for it.

Always be careful to check your limit, and know what your PHI covers, as not all items may be covered. Usually, YOU will need to call your private health provider to find out the amount covered for each item for your treatment.

Aperture Dental Practice is a Preferred Provider for NIB and HCF.

Bulk billing – with Medicare

There can be some confusion between the terms ‘NO GAP’ and ‘BULK BILLING’. As mentioned above, the GAP is usually associated with the excess payment when using a Private Health Insurance.

A procedure or treatment is bulk billed when it is subsidised completely by Medicare. In dentistry, bulk billing only occurs in public dental clinics, unless a scheme exists to outsource the treatment to private dental clinics. Aperture Dental Practice is a Private Dental Clinic.

The following are the current bulk billing schemes outsourced to Private Dental Clinics:

You must also be eligible to receive this benefit.

Am I eligible?

For adults to be eligible, you must be a Queensland resident, and where applicable, in receipt of benefits from:

  • Pensioner Concession Card issued by the Department of Veteran’s Affairs or Centrelink
  • Health Care Card
  • Commonwealth Seniors Health Card
  • Queensland Seniors Card

If you are eligible, all of your dependents named on the card are also eligible for free public dental care. Also eligible is any child in the guardianship of the Director-General, Department of Families, Youth and Community Care.