6 things to consider when choosing the right health fund for you.

HF Maze




The announcement that health fund premiums will increase on April 1st 2014, has many people looking at their current coverage.  Paltoglou dental has decided to give our blog readers a few points to consider when choosing a Health Fund for your extras coverage.




                    1. Avoid funds with “preferred provider” schemes

These schemes can take away your right to choose our own health care providers. Additionally you are often “penalised” by the funds for not attending one of their network of providers. (Note there is nothing “preferential” about these providers, they simply agree to the funds restrictive terms and conditions which can often impact on your treatment options).  The ethics of this are questionable and currently the Australian Dental Association is in discussion with the Health minister about this very issue.

                         2. What limits does the fund set?

Often Funds will state they pay a certain percentage of your treatment cots. Check the fine print. Is this based on what your health care provider actually charges or is it based on a “set” fee that the fund has determined themselves? These set fees are generally way below the accepted national average for fee scheduling but allow the fund to advertise high rebate amounts.

Funds also impose annual limits for various health services, for dental it is generally split into minor and major dental. Major dental is usually limited to crown and bridge work, Implants and Root Canal. Minor dental covers most remaining treatments.  Make sure you check what these limits are if you are a person who seeks regular treatment for Major dental for example it would be wise to make sure your fund had sufficient limits for your needs.

                       3. What is covered by the fund and when?

Make sure you check what the limits are on your coverage. Some funds do not cover some treatment, or impose set limits for certain items within a time frame. For example a mouthguard may only be able to be provided every two years, or the fund may set limits on the number of hygiene visits you are allowed to claim. This would not ideal be ideal if your child required regular mouth guards due to a changing dentition or  if you are required to see the Hygienist every 3 months.

                          4. The cost

It might seem an obvious thing to consider but there really is a huge difference in costs for similar products between different funds. Of course you need to make sure that the cover is adequate for you (and your family) but compare your apples with apples and make sure you get the best price. Generally most funds have shared insurance underwriters and are really just different “products” with different “packaging”. For example an “online” health fund may offer you lower premiums versus larger funds with member’s centres in large shopping centres due to the difference in running costs of the fund.

                          5. Do you even need Extra’s Cover?

Crunch some sums and have a look at what you spend on your health throughout the year (extras services like, dental, optical, podiatry etc.)  Is this amount greater then what you would get back from the Health Fund if you had extras coverage? (Remember the imposed limits that all health funds set) If not then it may not be economical to have extras cover.

                        6. Be careful how you “compare” funds

We recommend that you visit www.privatehealth.gov.au to look at compared funds. This is a government website where all funds are required to provide their product information and conditions of insurance. Unlike some of the commercial comparison sites, the funds MUST provide all information and there are no advertising tricks to steer you in the wrong direction. 


Remember if you have any questions relating to fund choices we are always happy to help.


Keep Smiling!


Megan (Practice Manager)

Posted on March 26, 2014 | No comments | Categories: General Dental, Healthfund, Insurance, Latest News, Preferred Providers | Tags: , ,

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APPOINTMENTS : (03) 9824 7722 - 1007 Malvern Road, Toorak Melbourne VIC 3142

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1007 Malvern Road
Toorak, Melbourne 3142
APPOINTMENTS 03 9824 7722


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