Child Dental Benefits Schedule
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Child Dental Benefits Schedule Albury
The Child Dental Benefits Schedule is a dental benefits program for eligible children aged 2-17 years that provides up to $1,000 in benefits to the child for basic dental services.
The Child Dental Benefits Schedule replaces the Medicare Teen Dental Plan from 1 January 2014.
Services that receive a benefit under the program include examinations, x-rays, cleaning, fissure sealing, fillings, root canals, extractions and partial dentures. Many of these services have claiming restrictions.
Services can be provided in a public or private setting. Benefits are not available for orthodontic or cosmetic dental work and cannot be paid for any services provided in a hospital.
As with the Medicare Teen Dental Plan, the payment of benefits under the Child Dental Benefits Schedule will be administered through the Department of Human Services. (Medicare).
Which children are eligible for dental services?
A child’s eligibility for the Child Dental Benefits Schedule is assessed by the Department of Human Services. A child is eligible if they are aged between 2-17 years at any point in the calendar year and receive a relevant Australian government payment, such as Family Tax Benefit Part A, at any point in the calendar year.
When are patients assessed as eligible?
The Department of Human Services assesses a child’s eligibility from the start of each calendar year and sends a notification to the child or the child’s carer.
This notification may be done electronically or in the form of a letter, which may be presented by the patient to the practice.
Routine checks are performed throughout the year to determine newly eligible children. Most children will be informed of eligibility at the beginning of the year.
How long does eligibility last?
Once a child has been assessed as eligible, they are eligible for that entire calendar year even if they are turning two that year, turn 18, or stop receiving the relevant government payment.
Can private health insurance be used for Child Dental Benefits Schedule services?
Patients with private health insurance covering dental services cannot claim a benefit from both the private health insurer and the Child Dental Benefits Schedule for the same dental service.
Patients cannot use private health insurance to top up the Child Dental Benefits Schedule benefit they have received for a service.
However, private health insurance can be used for any services not provided under the program, but these items must be billed separately.
How does the patient’s benefit cap of $1,000 work?
The amount of dental benefits available to eligible patients is capped at $1,000 per eligible patient over two consecutive calendar years. This maximum amount of dental benefits is known as the benefit cap, and the two consecutive calendar years is known as the relevant two year period.
The relevant two year period commences from the calendar year in which the patient first receives an eligible dental service. For example, if the patient’s first dental service is on 15 May 2014, the relevant two year period will be the entire 2014 calendar year and, if the patient is eligible the following year, the entire 2015 calendar year. If the patient is eligible in 2016 or a later year, they will then have access to a new benefit cap.
A patient’s entire benefit cap can be used in the first year if needed. If the entire benefit cap is not used in the first year, the balance can be used in the next year if the child is still eligible.
Any balance remaining at the end of the relevant two year period cannot be used to fund services that are provided outside that period. A new benefit cap will become available only if the relevant two year period has elapsed and the child is eligible in the following year.
A patient’s benefit cap can only be used for eligible services provided to that patient: family members cannot share their entitlements.
The relevant two year period of a patient who receives their first service in 2014.
What happens when the benefit cap is reached?
Once a patient reaches their benefit cap of $1,000 in benefits over the relevant two year period, no further benefits are payable in that benefit cap period.
This means that where a patient is charged a dental service that would take the patient over the benefit cap, only the amount of unused benefits will be paid for that service.