If you or your kids are getting orthodontic work, you’ll need this guide to save you a bit of stress (and hopefully money!).
Do I need to see an orthodontist to claim orthodontic benefits?
Peoplecare pays orthodontic benefits toward treatment performed by both orthodontists and dentists.* Common orthodontic work includes traditional braces and clear aligners like the commonly known Invisalign brand.
I already have orthodontic cover with Peoplecare
Here are the steps to make an orthodontic claim.
Step 1. Serve your full 12-month waiting period
Nobody loves waiting. But all health funds have waiting periods to protect their whole membership from ‘hit and run’ claims from new members, people who might join a health fund to claim after the event and existing members who upgrade to a higher level of cover for services not on their previous cover. Sort of like trying to get car insurance after you’ve already had an accident. (We know you wouldn’t do that, but there are some people out there who do!)
Any orthodontic waiting periods you have served or partly served when transferring from another a similar level of cover with Peoplecare or another health fund within 30 days will be recognised. When upgrading your cover, the full 12-month waiting period applies.
Step 2. Complete an orthodontic treatment plan – we need this BEFORE we can pay your claim
You can’t swipe your Peoplecare membership card to claim orthodontic benefits.
Complete an Orthodontic Treatment Plan (or perhaps your orthodontist has already given you one). This form needs to be completed and sent to us with your first payment – so take it with you and complete what you can yourself.
Value tip: Have Premium Extras or High Extras? Consider maximising your claimable Peoplecare benefits by asking to be billed over 3 financial years. See the last section of this page for how our Extras covers work.
Have our closed Comprehensive Extras? You only have a lifetime limit and not an annual limit, so you can pay in a lump sum.
Step 3. Make your first orthodontist payment
Step 4. Check that each receipt shows:
- patient’s name
- dental item number(s)
- amount and date paid & date of service
- orthodontist’s provider details and address
Otherwise, we can’t pay you benefits.
Step 5. Claim
Take a photo of your receipt & Orthodontic Treatment Plan and send them to us using our app (you can download it from peoplecare.com.au/mobile) or Online Member Services.
Alternatively, if you like filling in forms, you can email or post them to us with a claim form.
P.S. If you’re ever wondering about your benefits & limits, you can check them any time with our app or Online Member Services.
I need cover for orthodontics
Peoplecare has two levels of Extras covers with orthodontic benefits
- Premium Extras: 80% of the cost, up to $1000 per person each financial year. The lifetime limit is $3,000 per person.
- High Extras: 70% of the cost, up to $800 per person each financial year. The lifetime limit is $2,400 per person.
Want more info? Please give us a buzz on 1800 808 690 (existing members) or 1800 808 700 (enquiries) for details.
*To claim orthodontic benefits from Peoplecare, you must have Extras cover with orthodontic benefits, have remaining per person annual and lifetime limits and have served your waiting period.