Beginning 1 January 2015, there have been some changes in the rules governing children’s dental insurance coverage. The CDBS, or Child Dental Benefits Schedule, is the fruit of two legislative pieces. The Dental Benefits Act 2008 (The Act) is the main piece of legislation. Subordinate to The Act is another piece of legislation, Dental Benefits Rules 2014, known as “The Rules.”
The Rules: Changes for 2015
Dentists will no longer put their names and addresses on CDBS claiming forms or invoices. The dentist’s Medicare provider number is sufficient to allow the Department of Human Services to access necessary details.
Eligibility for dental benefits by a Territory or State dental clinic under the CDBS has been extended to 30 June 2015.
To further clarify the requirement a dentist must obtain consent before providing any item covered by the Dental Benefits Schedule, Rule 15 (1) (a) no longer contains a reference to “treatment.”
If a child has zero cap balance remaining, the DHS is no longer required to notify the parent or child of any eligibility under the CDBS. This change was made because many recipients become confused when receiving this information.
Patients must be eligible for Medicare at the time any covered dental care is provided.
Changes to Dental Benefits Schedule
Item 88412 has been added and is defined as incomplete endodontic therapy. It applies if a root canal cannot be finished and is limited to one claim per tooth. If Item 88412 has been claimed on a tooth, no other endodontic service claims can be made on that tooth.
What it Means to You
For most patients, it will be business as usual. Changes were made to streamline the process and make it easier for patients.
The most important takeaways for you and your child are that a bit more transparency and a few more safeguards have been added to help us serve you better.
Call 1300 Great Smile today to learn more or to schedule an appointment:(08) 9404 9500