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Administered by: Health
Published Date 28 Jul 2015


Health Insurance (Prescribed Dental Patient) Determination 2015


I, Catherine Rule, authorised officer of the Minister for Health, make this determination under paragraph 3BA(3)(a) of the Health Insurance Act 1973.




Dated      6 July 2015










Catherine Rule

First Assistant Secretary

Medical Benefits Division

Department of Health




PART 1            PRELIMINARY                                                                                                               3


1.              Name of Determination                                                                       3

2.              Commencement                                                                                   3

3.              Revocation                                                                                           3

4.              Schedule                                                                                               4




Part 1        Preliminary


1.               Name of Determination


This determination is the Health Insurance (Prescribed Dental Patient) Determination 2015.


2.                      Commencement


This determination commences on 6 July 2015.


3.                      Revocation


 The Health Insurance (Prescribed Dental Patient) Determination 2009 is 



4.                      Schedule – Eligible conditions under the Cleft and Craniofacial Anomalies Scheme


  For paragraph 3BA(3)(a) of the Health Insurance Act 1973, the definition of

  a ‘prescribed dental patient’ applies to a condition specified in the Schedule

  to this determination. 



Specification of eligible conditions under the Cleft Lip and Cleft Palate Scheme

Conditions to which the definition of ‘prescribed dental patient’ applies:

1. Oral and/or facial clefting

Limited to


Cleft lip, alveolus and/or palate

Tessier facial cleft

2. Congenital or hereditary craniofacial malformation, deformation or disruption

Limited to


























Branchial arch disorders including:

Hemifacial/craniofacial microsomia, Goldenhar syndrome, DiGeorge syndrome, Velocardiofacial syndrome

CHARGE syndrome

Congenital hemifacial hyperplasia

Congenital lymphatic and/or vascular malformations of the head & neck, cystic hygroma, Sturge-Weber syndrome, excluding haemangiomas, birthmarks, and naevi.

Craniofacial Neurofibromatosis Type 1

Craniometaphyseal dysplasia

Ectodermal dysplasia

Hemifacial atrophy (Parry Romberg syndrome)

Mandibulofacial dysostosis (Treacher Collins syndrome)

Maxillonasal dysplasia (Binder syndrome)

Oral-facial digital syndrome Type 1

Pierre Robin sequence

Rubinstein-Taybi syndrome

Shprintzen-Goldberg syndrome

Solitary median maxillary central incisor syndrome

Stickler syndrome

Syndromic craniosynostoses including:

Apert, Crouzon, Pfeiffer, Saethre Chotzen, and Muenke syndromes

Trichorhinophalangeal syndrome Type 1

3. Hereditary conditions presenting with the absence of 6 (six) or more permanent teeth, excluding 3rd molars

4. Hereditary conditions  where the presence of supernumerary teeth is a major feature

Limited to

Cleidocranial dysplasia

Gardner syndrome

5. Hereditary conditions affecting the formation of enamel and/or dentine of all teeth

Limited to


Amelogenesis imperfecta

Dentinogenesis imperfecta

Regional odontodysplasia