How to Claim Dental Services Covered by the Child Dental Benefits Schedule

How to Claim Dental Services Covered by the Child Dental Benefits Schedule (CDBS)

How to Claim Dental Services Covered by the Child Dental Benefits Schedule

Check Your Eligibility

Ensuring your child’s eligibility is the crucial first step in accessing CDBS benefits:

  1. Age Requirement: The programme covers children from 0 to 17 years old. This wide age range ensures that dental care is accessible from infancy through adolescence.

  2. Medicare Eligibility: Your child must be eligible for Medicare. This typically means they are an Australian citizen, permanent resident, or covered under a Reciprocal Health Care Agreement.

  3. Government Payment: Either you or your child must receive an eligible government payment. This could include Family Tax Benefit Part A, Parenting Payment, or other specified benefits.

Confirm Your Benefits

Before proceeding with any dental treatment, it’s essential to verify your available benefits:

  1. Online Verification: Access your Medicare online account through my.gov.au. This platform provides a convenient way to check your child’s CDBS balance and eligibility status.

  2. Phone Enquiry: If you prefer speaking with a representative, call the Medicare general enquiries line on 132 011. They can provide detailed information about your benefits.

  3. Benefit Balance: The CDBS provides up to $1,095 per child over two consecutive calendar years. It’s important to know your remaining balance to plan dental treatments effectively.

Select a Dental Provider

Choosing the right dental provider is crucial for a positive experience:

  1. Public Dental Clinic: These clinics often bulk-bill, meaning there are no out-of-pocket expenses. They can be an excellent option for families looking to maximise their CDBS benefits.

  2. Private Dentist: Many private dentists participate in the CDBS programme. They may offer more flexible appointment times and a wider range of services, but it’s important to confirm their participation and billing practices.

Schedule Your Appointment

Booking your appointment is straightforward:

  1. Contact Provider: Reach out to your chosen dental provider via phone or their online booking system.

  2. Mention CDBS: When booking, explicitly state that you intend to use the Child Dental Benefits Schedule. This ensures the clinic is prepared to process your claim correctly.

Attend the Appointment

Preparation is key for a smooth appointment:

  1. Essential Items: Bring your child’s Medicare card. This is crucial for verifying eligibility and processing the claim.

  2. Accompaniment: A parent or legal guardian must be present. This is not only for consent purposes but also to discuss any treatment plans or concerns with the dentist.

Receive Treatment

During the dental visit:

  1. Examination: The dentist will conduct a thorough check-up, assessing your child’s oral health and identifying any issues.

  2. Treatment Plan: Based on the examination, the dentist will discuss any necessary treatments. This may include preventive measures, fillings, or other procedures covered by CDBS.

  3. Consent: You’ll need to provide informed consent for the proposed treatment plan. Don’t hesitate to ask questions about the procedures, their necessity, and any alternatives.

Claiming Process

The claiming process varies depending on your provider:

Public Dental Clinics:

  • Bulk-Billing: These clinics typically bulk-bill, meaning they submit the claim directly to Medicare.
  • No Action Required: You won’t need to submit a claim or pay any out-of-pocket expenses, simplifying the process for families.

Private Dentists:

  1. Bulk-Billing Enquiry: Ask if the dentist bulk-bills for CDBS. If they do, the process is similar to public clinics.
  2. Upfront Payment: If they don’t bulk-bill, you may need to pay for the service and then claim the rebate from Medicare. Keep all receipts and documentation for this purpose.

Monitor Your Balance

Keeping track of your CDBS balance is crucial:

  1. Track Usage: Regularly check your Medicare account or ask your dentist about the remaining balance after each visit.
  2. Two-Year Period: The $1,095 benefit cap applies over two consecutive calendar years. Understanding this helps in planning more extensive treatments that might span across years.

Utilise Services as Needed

Make the most of the CDBS benefits:

  1. Regular Check-ups: Schedule routine check-ups and cleanings to maintain your child’s oral health.
  2. Eligibility Period: Continue using the benefit until it’s exhausted or your child turns 18, whichever comes first.

Service Limitations

Be aware of the programme’s constraints:

  1. Frequency Restrictions: Some services, like check-ups, may be limited to once per year under CDBS.
  2. Consult Your Dentist: Discuss which services are essential and covered. Your dentist can help prioritise treatments within the CDBS framework.

Maintain Records

Good record-keeping is beneficial:

  1. Documentation: Keep a file of all dental visits, treatments, and any correspondence related to CDBS.
  2. Future Planning: These records help in tracking usage, planning future care, and resolving any discrepancies.

Be Aware of Your Rights

Understanding your rights ensures you get the best care:

  1. Request Quotes: You’re entitled to ask for a detailed quote before any treatment. This helps in making informed decisions about your child’s dental care.
  2. Second Opinion: If you’re unsure about a proposed treatment plan, it’s your right to seek a second opinion from another dental professional.

Plan for Transition

Preparing for the end of CDBS eligibility is important:

  1. Approaching Adulthood: As your child nears 18, start considering options for dental care beyond CDBS.
  2. Explore Options: Look into private health insurance with dental cover or familiarise yourself with public dental services available for adults.

Stay Informed

Keeping up-to-date with the programme is crucial:

  • Programme Updates: Regularly check the Services Australia website for any changes to CDBS. The programme may evolve over time.
  • Benefit Changes: Be aware of any updates to benefit amounts, covered services, or eligibility criteria. These changes could affect your child’s dental care planning.

Step by Step Instructions

Tap or click on each step to view more details

1. Check eligibility

  • Child 0-17 years old
  • Eligible for Medicare
  • Receive eligible government payment

2. Confirm benefits

  • Check Medicare account: my.gov.au
  • Or call 132 011
  • Verify $1,095 benefit balance

3. Choose provider

Select public clinic or private dentist in CDBS program

4. Book appointment

  • Contact chosen provider
  • Mention CDBS usage

5. Attend appointment

  • Bring Medicare card
  • Parent/guardian must accompany

6. Receive treatment

  • Examination and discussion
  • Consent to treatment plan

7. Claim process

Public: Automatic bulk-billing

Private: Ask about bulk-billing or pay and claim later

8. Monitor balance

Track remaining balance of $1,095 over two years

9. Repeat as needed

Use CDBS until exhausted or child ineligible

10. Service limitations

Some services have frequency limits; discuss with dentist

11. Keep records

Maintain records of all visits and treatments

12. Know your rights

  • Ask for quotes
  • Seek second opinions

13. Plan for transition

Plan for care after CDBS eligibility ends at 18

14. Stay informed

Check Services Australia for CDBS updates

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