What is Orthodontics?
Orthodontics is the branch of dentistry that specialises in the diagnosis, prevention and treatment of problems in the alignment of teeth and jaws.
Orthodontic treatment involves the design and use of corrective appliances (such as braces, plates, headgear, and functional appliances) to bring the teeth and jaws into proper alignment.
Which Extras covers include benefits for Orthodontics?
Bupa has a range of Extras covers that include benefits for Orthodontics. Waiting periods, yearly limits, lifetime limits, benefit claiming restrictions, policy and fund rules apply.
To find out if your Extras cover includes Orthodontic services, please go to myBupa and review your policy summary.
What is the waiting period for Orthodontics?
A 12 month waiting period applies to Orthodontics.
For more information on waiting periods please refer to Bupa's Important Information Guide
Does Orthodontics have a Lifetime Limit?
Most covers have a lifetime limit for orthodontics. This is a limit to the amount you can claim for orthodontics for the life of your membership. This will vary depending on your cover. To check this please go to myBupa and review your policy summary.
If you have been a member of another Health Fund, and you have received benefits for Orthodontics, these will count towards your lifetime limit. Similarly, if you move from one level of cover to another with Bupa, any benefits for Orthodontics you have received will count towards your lifetime limit and waiting periods would apply on the upgraded level of cover. For more information on lifetime limits please refer to Bupa's Important Information Guide .
Before you commence any treatment, we recommend you contact Bupa to ensure you are covered for any treatment planned and for a quote which will help you budget for any out-of-pocket expenses. To provide an accurate quote, we'll need some information about your treatment from your dentist or orthodontist. We don't pay benefits towards "online" orthodontic courses which aren't provided by a registered dentist in a dental practice.
What information do I need to ask my dentist or orthodontist for?
- What item numbers will apply to your treatment(s). All Orthodontic items start with an "8". Items 825, 831, 881 and 882 indicate courses of treatment and Bupa will pay for these services differently to all other Orthodontic items, where one benefit only is applicable to the service.
- Total cost of treatment.
- Your dentist's or orthodontist's provider number.
- For items 831, 825, 881 and 882 only - the expected length of active treatment (active treatment is when your teeth are still being moved as opposed to the teeth just being kept in place by retainers).
What payment options are available to you?
We encourage you to discuss all available payment options with your dentist or orthodontist before you commence your treatment.
For a full course of Orthodontic treatment (items 825, 831, 881, 882), you may have the option of paying instalments over an agreed period of time or you may be able to pay in full before your treatment commences.
Important information about claiming
When claiming Orthodontics, we pay benefits up to your yearly limit and your lifetime limit on your level of cover.
Your yearly limit is the amount you receive from Bupa for each calendar for a particular service.
Your lifetime limit is the maximum amount you can claim over the lifetime of your policy. It is measured per individual on your policy, so if you have a partner or a dependant, they will each have their own lifetime limit. Any benefits you or an individual listed on your policy received from other policies or health insurance funds are counted towards your or the relevant individual’s lifetime limit as well.
In some instances, your yearly limit for Orthodontics is combined with your yearly limit for Major Dental.
To find out your yearly limit and lifetime limit go to myBupa and review your policy summary.
How to make a claim for Orthodontics?
You can make your orthodontic claims using your Bupa card at most Bupa recognised providers or submit through myBupa.
If you are paying your course of treatment (items 825, 831, 881, 882) in instalments, after each visit your dentist or orthodontist may process your claim automatically on the spot by swiping or tapping your membership card. There are no forms for you to complete, and you simply pay any balance that is outstanding.
If you get to the end of paying for your treatment and you have any outstanding lifetime limit, please reach out as we can confirm whether or not you may be entitled to a top up to your lifetime limit for your full course of orthodontic treatment.
If you are paying for your course of treatment (items 825, 831, 881, 882) in full upfront, your dentist or orthodontist will need to provide you with a tax invoice/statement that you can provide Bupa when you make your claim. Bupa will keep a copy of this tax invoice/statement to support any yearly claims you have made over the period of your treatment. You'll need to contact Bupa to receive these payments.
How will your benefits be paid?
If you pay for your yearly treatment upfront:
Bupa will pay your benefit spread out over the number of calendar years that your active treatment spans (typically two years). The benefit you will receive will be up to your yearly limit and lifetime limit and will be payable from 1st of January each year. For benefits for following years, you will be required to contact Bupa to receive these payments as they will not be automatically scheduled.
If you pay for your treatment in instalments:
Bupa will pay a benefit for each itemised receipt you provide us, and we will continue to pay benefits up to your yearly limit and lifetime limit. Let us know when you have submitted your last instalment along with your total cost of treatment, and we will assess whether there is a top up benefit available (up to your lifetime limit).
If you require more information call us on 134 135 or drop by your local Bupa store.
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