Eligibility for HCi orthodontic claims

HCi provides orthodontic cover as part of eligible extras cover policies. The following items will help you determine if you are covered for orthodontic claims.

• Waiting periods: a 12-month waiting period for orthodontic treatments means you must have held private health insurance for at least a year before receiving orthodontic treatment/services.
• Level of cover: Orthodontic benefits are only included in higher-tier extras policies which provide cover for Major Dental. For instance, HCi Healthy Extras provides lifetime cover of up to $1,800 per person (generally claimed over 3 years)
• Annual and lifetime limits apply: Specific limits apply to orthodontic treatments, varying by policy type. Orthodontic benefits often have a lifetime cap, separate from annual limits. It’s essential to review your policy details or contact HCi directly to understand these limits before you undertake significant orthodontic treatment to ensure you’re covered, and to obtain a quote for what you can claim.

Important things to know about orthodontic cover

Orthodontics can take a long time and have high costs, so it is important to understand how extras cover works and applies in your situation.

• Excluded services: Certain orthodontic treatments, especially those deemed cosmetic, may not be covered so contact us to be sure of your entitlements
• Non-Registered providers: HCi may not provide benefits if the orthodontist is not recognised by us, or the treatment is not provided in Australia. Ask us to be sure before you book treatments.
• Out-of-pocket costs: Despite having cover, you may incur out-of-pocket expenses – understanding your policy can help minimise unexpected costs.
• Appliances: removable appliances, retainers, and aligners like Invisalign may not be included in your cover so you may want to discuss your options with the orthodontist

Not all orthodontic treatments involve braces. If you submit a dental claim, we will use your orthodontic claim limits for all relevant services so make sure you know if any treatment is counted as orthodontics.

Tips to maximise your orthodontics claims

• Review your policy: Ensure your extras cover includes orthodontic benefits that meet your needs.
• Plan ahead: Schedule treatments after completing the waiting period to fully utilise your cover.
• Consult HCi: Reach out to your HCi team for personalised advice on maximising your orthodontic cover.
• Ask for discounts: Some orthodontists offer discounts for upfront payments or extended payment plans which can give you a significant saving.

Steps to claim orthodontic treatments from HCi

1. Pre-treatment
   • Policy confirmation
2. During treatment

1. • Initial payment: Determine if initial consultation fees are claimable under your policy.
   • Progressive claims: For treatments like braces, HCi may allow claims in instalments over the treatment period, subject to the provision of appropriate documentation.
2. Claim submission

• • Required documents: Submit the orthodontist’s treatment plan and receipts, including relevant items codes. For following years in a plan, submit evidence of continued attendance (eg an account statement or a letter) as well as the original or an updated receipt.
  • Claim methods: HCi offers multiple claim submission options:

• • Online claims: Submit claims and treatment plans electronically via OMS, the HCi online portal, available via our website.
  • Email or post: Complete a claim form and send it, along with supporting documents, to HCi via email or postal mail.

  Note that on the spot claiming is not available for orthodontic treatment plans paid up front. These plans can be claimed over 3 years by submitting receipts and evidence of attendance in subsequent years.

  • Processing time: Subject to us receiving all required documentation, claims are typically processed within a few business days. submission