No Gap Dentist in North Sydney: How No-Gap Check-Ups Work

A no gap dentist is a practice where eligible health fund members can have certain services, such as a check-up and clean, without paying anything out of pocket, because the fund’s benefit covers the fee for those items. Whether you qualify depends on your fund, your level of extras cover, waiting periods and how much of your annual limit is left.

At our North Sydney practice, new patients can have a check-up and clean with no gap for eligible health fund members, depending on your level of cover. For details of what the visit includes, see our guide to dental check-ups, and for current terms, see our new patient specials.

What does no gap actually mean?

The gap is the difference between the practice’s fee for a service and the benefit your health fund pays. If your benefit covers the whole fee, there’s no gap, so you pay nothing on the day for that item. If the benefit is lower than the fee, you pay the difference.

No-gap arrangements usually apply to specific preventive items, such as the examination, scale and clean, and fluoride, rather than to every treatment. They also depend on you being eligible under your policy on the day of your visit.

How preferred provider arrangements work

Many health funds have agreements with selected dental practices, often called preferred provider or members’ networks. The practice agrees to set fees for certain items, and in return fund members may receive higher benefits, or no gap for eligible services, depending on their cover.

North Sydney Dentistry is a preferred provider for Bupa Members First, Medibank Members’ Choice and nib First Choice. If you’re with another fund, you can usually still claim if your extras cover includes general dental; your gap will depend on your fund’s rebate.

Who is eligible for a no gap dentist visit?

Eligibility comes down to the details of your policy. Before you book, it helps to understand these four things.

Your level of cover

You generally need extras cover that includes general dental. Hospital-only cover doesn’t usually pay benefits for check-ups and cleans, and lower levels of extras may pay smaller benefits.

Waiting periods

If you’ve just joined a fund or upgraded your cover, a waiting period often applies before you can claim for general dental, and it’s often around 2 months. Check your policy, as terms vary between funds and products.

Annual limits

Each policy caps how much it will pay for dental in a year. Once you reach that limit, you pay the full fee until it resets. nib’s annual limits reset on 1 January, but other funds may use different dates, so check with your fund.

How often you can claim

Some policies limit how many check-ups or cleans they’ll pay for within a set period. If you’ve already had a check-up elsewhere recently, your fund may not pay a benefit for another one yet.

How HICAPS on-the-spot claiming works

We have HICAPS, so eligible members can claim at the desk rather than lodging a claim afterwards. The process usually goes like this:

1. Bring your health fund card to your appointment.
2. After your check-up, we process the claim for the items you’ve had through the HICAPS terminal.
3. Your fund assesses the claim, and the benefit is usually confirmed while you’re still at the desk.
4. You pay any gap, or nothing for eligible items if your cover means there’s no gap.
5. You receive a receipt showing each item and the benefit paid.

What a no-gap check-up doesn’t cover

No gap applies to eligible check-up and clean items, not to everything that might come up during your visit. Keep in mind:

• Treatment found at the check-up, such as a filling, crown, root canal treatment or extraction, is quoted first, and your fund may pay a benefit towards it with a gap for you to cover.
• Extra visits, such as a deeper clean spread over more appointments, may have their own fees.
• Services during a waiting period or after you’ve reached your annual limit aren’t covered by your fund.
• If you don’t have private health insurance, the new patient check-up and clean is $219 in total. Returning patients pay $199 for a check-up and clean, with the gap depending on their health fund rebate. See our new patient offer for details.
• Medicare doesn’t generally cover routine dental check-ups for adults. For children, ask us whether the Child Dental Benefits Schedule applies.

Questions to ask your health fund before you book

A quick call or a look at your fund’s app can save surprises at the desk. Ask:

• Does my extras cover include general dental?
• Have I finished the waiting period for general dental?
• How much of my annual dental limit is left, and when does it reset?
• How many check-ups and cleans will you pay for each year?
• Is North Sydney Dentistry a preferred provider for my policy, and what benefits apply there?
• What benefit do you pay for the specific item numbers for an examination, scale and clean, and fluoride?

Regular check-ups are the heart of preventive dentistry, so using your extras cover each year can help you catch problems early, when treatment is usually simpler. Learn more about professional teeth cleaning.

Frequently asked questions

Book your check-up

North Sydney Dentistry is at Level 1, Suite 102/71 Walker St, North Sydney, a two-minute walk from North Sydney station. We’re open Monday to Friday, 9am to 6pm. Call (02) 8090 1108 or book online.

This article is general information only and is not a substitute for advice from your own dentist or doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.