Smiles Fund is our flagship dental membership programme aimed at providing all your required dental treatment with no out-of-pocket cost.
For a small annual fee, your dental health is taken care of!
Unlimited as clinically necessary and reasonably required:
*Limits and waiting periods may apply. See full T&Cs below for details.
*Fees scaled according to government-defined income tiers.
We work with third-party organisations to manage your health insurance for you, ensuring that the insurance companies pay for your treatment.
The best part is, you don’t pay the premiums!
Preventative and general dental
|Service type||Limits||Price||Initial waiting period|
|Preventative dental and teeth whitening||Unlimited where clinically necessary and reasonably required||Included in membership fee||None|
|General dental including fillings||Unlimited where clinically necessary and reasonably required||Included in membership fee||2 months|
Major dental – Waiting dates
You are entitled to one major dental treatment type at a time. If you need to have another major dental treatment, you will need to wait a certain amount of time after the first has been completed. This time is measured by the number of “waiting dates” passed.
The waiting dates are 1 January and 1 July each year.
|Membership entitles you to only one major dental treatment type at a time||Waiting dates between treatments||Price||Initial waiting period|
|1 or more Root Canal Treatments (Endodontics)||1||Included in membership fee||6 months|
|1 Complete Gum Disease Treatment (Periodontics)||1||Included in membership fee||6 months|
|1 Crown / Veneer||1||Included in membership fee||12 months|
|1 Bridge (maximum length 4 teeth)||2||Included in membership fee||12 months|
|1 Implant||3||Included in membership fee||12 months|
|More complex treatments (e.g. longer bridges, implant-retained bridges such as all-on-4)||3||30% discount on standard price||12 months|
These Membership Terms govern your Smiles Fund Membership.
The membership service is provided by Smiles Fund.
You only deal with two entities – Smiles Fund for membership services and Insight Dental for dental services.
Please contact Smiles Fund if you have questions regarding your membership and benefits.
Dental services will be exclusively provided by the team of dentists and staff at Insight Dental, 395 Hawthorn Road, Caulfield South.
For dental services within your Membership entitlement, Insight Dental will be paid by Smiles Fund (eg Smiles Fund submitting a claim to Insurer) or directly by the Insurer (eg via HICAPS). You must pay Insight Dental directly for dental services outside your Membership entitlement.
A Smiles Fund Membership does not cover the cost of attending other dental clinics.
A fundamental condition of Smiles Fund Membership is that you must obtain private health insurance (dental cover) policies (“Dental Policies”) from registered private health insurers chosen by Smiles Fund as it sees fit (“Insurers”).
The Dental Policies will be held alongside any existing private health insurance (eg hospitals or extras cover) (“Existing Policies”). Smiles Fund will not have authority to change or cancel Existing Policies. The only exception is if you wish to cancel an existing dental or extras policy to reduce waiting periods (see section 7 below).
You appoint Smiles Fund as your agent and representative to liaise with the Insurers on your behalf. You authorise Smiles Fund to use its postal address to receive communications from the Insurer. You authorise Smiles Fund to obtain, change or replace the Dental Policies. Smiles Fund may require you to sign documents or provide assistance to give effect to these requirements.
Smiles Fund will pay the premiums for the Dental Policies in return for you assigning to Smiles Fund and/or Insight Dental all claim benefits under the Dental Policies.
Smiles Fund will pass to the Insurers details of your income for the purposes of claiming the private health insurance rebate. Please inform us if your private health insurance tier changes due to income changes. You might have to repay us or the Australian Taxation Office if you claim the wrong tier.
YOUR DUTY OF DISCLOSURE
A “family” membership subscription covers the following family members:
(a) the primary adult on the application form;
(b) husband/wife/partner and children (under 18) who live with the primary adult;
(c) single dependent adults living with the primary adult. “Dependent adult” typically means adults between 18 and 23, and adults under 25 engaged in full-time study.
You must notify Smiles Fund if there are any changes to your family.
By becoming a Smiles Fund Member, you and your family members will each be entitled to the dental services from Insight Dental set out in the table above.
These benefits apply for the current membership period, and may change for future membership periods.
Dentists cannot provide dental services which are excessive, unnecessary, not reasonably required or beyond their capabilities. Insight Dental will be obliged to refuse service in those cases.
For example, a root canal treatment may be refused if the tooth is too broken to be restored afterwards.
The waiting periods for selected dental services is set out above. If you currently have private health insurance (extras cover) and are willing to transfer out of the policy, you may be entitled to reduced or no waiting periods. Contact Smiles Fund for more information.
There are no out-of-pocket costs for dental services within your Membership benefits.
You will be required to pay out-of-pocket costs in the following situations:
(a) You claim the wrong income tier for the private health insurance rebate. The Australian Taxation Office will seek repayment when you lodge your tax return.
(b) You or a family member requires onsite treatment from a medical or dental specialist (eg anaesthetist, orthodontist).
(c) You or a family member requests dental services during a waiting period – in that case you must pay Insight Dental’s standard price. The Member discount will not apply.
(d) You or a family member requests treatment beyond the limits of your Membership benefits – in that case you must pay Insight Dental’s standard price. The Member discount will not apply.
(e) Major dental treatment is beyond Insight Dental’s capability. You will be referred to a practitioner who will charge separate fees.
(f) A Dental Policy or a benefits payment claim is invalided, reduced or refused due to something you or a family member does or fails to do (eg pre-existing conditions not disclosed).
(g) You otherwise do not comply with these Membership Terms.
Any out-of-pocket costs must be paid immediately to Insight Dental.
All members of Smiles Fund must:
(a) have an extensive initial examination to develop a comprehensive treatment plan within 2 months of obtaining membership;
(b) undertake all treatments and checkups as agreed to in the treatment plan in a timely manner as recommended by Insight Dental; and
(c) attend scheduled appointments according to the comprehensive treatment plan. If you cannot attend, replacement appointments should be scheduled as soon as possible.
Repeated non-compliance might result in the termination of your Membership.
You must apply to become a Smiles Fund Member. Please complete the application form and pay the first year’s membership fee. Your membership does not commence until the Dental Policies are in place. Membership is personal and cannot be transferred.
Smiles Fund reserves the right to decline your membership application in its absolute discretion.
The first year of Smiles Fund Membership commences when Smiles Fund accepts your application and the Dental Policies are in place.
You may cancel your Smiles Fund Membership early, however you will not be entitled to any refund of membership fees.
You must pay an annual membership fee before your membership can commence. Membership renewals are due on each anniversary of becoming a member. Membership will cease if the membership renewal fee is not paid by the due date.
Smiles Fund may increase future membership fees.
Smiles Fund may end your Smiles Fund Membership by written notice if:
(a) You or a family member repeatedly fails to attend scheduled appointments agreed to in the comprehensive treatment plan;
(b) A Dental Policy or a benefits payment claim is invalided, reduced or refused due to something you or a family member does or fails to do (eg pre-existing conditions not disclosed);
(c) You fail to pay any out-of-pocket expenses to Smiles Fund or Insight Dental;
(d) Smiles Fund decides to end the Smiles Fund dental membership programme on 30 days’ notice or if Insurers will not insure you and your family. In these two cases, you will receive a pro-rata refund of your membership fee.
You acknowledge that Smiles Fund is a provider of a dental membership service. It is not a general or private health insurer or a provider of any financial product. Smiles Fund does not provide you with financial advice nor advice regarding private health insurance policies.
Complaints regarding the dental services should be directed to the dentist who served you.
All other complaints must be resolved in accordance with Smiles Fund’ complaints policies.
613 Dental Services Pty Ltd ACN 614886467 as trustee for the Big Smiles Trust ABN 29 545 753 218 trading as Smiles Fund