Health insurance for dental in Australia

Dental cover is a common benefit included on extras health insurance policies. With so many policies offering cover for dental services, it can be hard to decide the right one for you. Here are a few things you should consider when purchasing dental cover:

• Limits. When you claim on your extras insurance policy, there are limits on the total amount you can claim. These limits vary between policies, so it’s important that you choose a policy with limits that suit your insurance needs.
• Level of cover. Extras health insurance policies are typically divided into levels based on their cost and the services they cover. The right level of cover for you will depend on personal circumstances like your budget, healthcare needs and lifestyle.
• Life stage. The right cover for you will also depend on your stage of life. For example, you may want cover for orthodontics if you have young children who might need braces, or you may be an older Australian who wants cover for dentures, implants or tooth removal.
• Who needs cover. If you’re in a couple and/or have children, you’ll want to look into a policy that takes care of all your loved ones. Depending on your situation, you can look into couple, single parent or family policies to meet your health needs.

There isn’t a specific product called ‘dental insurance’ or ‘dental health insurance’, so you’re unlikely to find a standalone policy in Australia that only provides cover for dental treatment. Most dental services are covered by extras policies, which may also include cover for other services like physiotherapy, optical and chiropractic.

Private hospital cover won’t include most dental treatments, as they take place outside of hospital. However, some private hospital policies can help pay towards in-hospital dental treatment and operations like wisdom tooth extraction if, for example, surgical extraction is required. Not all wisdom tooth extractions are performed in-hospital, so hospital cover will only help with very specific procedures, and the type of cover you need will depend on your individual circumstances.

With a combined hospital and extras health insurance policy, you could be covered for dental treatment both in and out of hospital. For example, if you need complex dental work that requires surgery in a hospital and follow-up appointments in the dentist’s office. In this scenario, an extras policy with the appropriate level of dental cover may be beneficial for your in-hospital procedure. For example, if you need to have your wisdom teeth removed in hospital, the rebate for the extractions themselves will be determined by your extras policy.

The length of time you’ll have to wait before being able to claim on dental benefits will vary depending on your health fund, your policy and the treatment you’re claiming for.

Unlike with hospital cover, waiting periods for extras cover aren’t set by the government. Each health fund sets its own waiting periods for each of their extras policies, so there’s more variety between policies than there is with hospital cover. With that in mind, below is how long typical waiting periods might be for dental cover:³

It’s essential to take out cover well in advance so that you’ve served your waiting periods by the time you start experiencing any issues. When comparing and purchasing extras health insurance, make sure you confirm your applicable waiting periods.

If you’re moving health funds and you’ve already served your dental waiting period, you most likely won’t have to wait again for the same treatments and services provided you switch to the same or lower level of cover.

However, if you want to claim a treatment or service you weren’t previously covered for – or you want to enjoy higher claiming limits – you’ll have to serve your waiting period from the start for the additional benefits.

In most instances, you will have some out-of-pocket expenses. However, some funds offer gap-free dental when you see a preferred provider. This refers to a dentist who has agreed to charge no more than your health fund will cover. As such, it’s worth checking your health fund’s website to see if they list any gap-free dentists.

Dental care for kids can get expensive; between braces, wisdom teeth, mouth guards and chipped teeth, you might end up taking your young ones to the dentist more than you think. Luckily, if you’re already on a couples or family policy, you may be able to add your child to it at no extra cost (this will depend on your health fund).

You’ll want to make sure your policy includes appropriate coverage for your child’s needs and review your cover often. There can be waiting periods for any additional coverage or person you add, so change early to serve your waiting periods in time.

There’s also the Child Dental Benefits Schedule (CDBS) scheme to consider, which is a service run by the Australian Government that provides eligible children up to $1,132 towards dental treatment over two calendar years. The eligibility criteria is based on families who are receiving selected government payments through Centrelink. The CDBS can cover dental services including:

• Dental check-ups
• Cleanings
• Fillings
• X-rays
• Root canal treatment
• Tooth extractions.

The CDBS won’t cover orthodontic, cosmetic work or any hospital treatments.

Read more about health insurance for children and dependents here.

If you require dental treatment, private health insurance can provide varying levels of coverage to match your needs and contribute to the cost of dental treatments.

Extras policies typically include a range of services that can be categorised into four main groups: general, major dental, endodontic and orthodontics. Your level of cover and your insurer will determine what exactly is included in your policy.

Usually helps pay for preventative treatments like:

• Oral exams (dental check-ups)
• Scale and cleans
• Simple fillings
• Fluoride treatments
• X-rays
• Tooth extractions (can be general dental or major dental, depending on the item number your dentist uses and the policy you have)

Generally, major dental covers more complex treatments, such as:

• Tooth extraction (can be general dental or major dental, depending on the item number your dentist uses and the policy you’re on).
• Wisdom teeth removal (can be general dental or major dental, depending on the item number your dentist uses and the policy you’re on). This can also be performed in a hospital and so may require private hospital insurance.
• Complex fillings for the treatment of tooth decay and damage.
• Crowns and bridges (dental implants for a single damaged tooth or multiple teeth).
• Veneers (thin implants that cover the front of the tooth for generally cosmetic reasons).
• Dentures.

Treatment for the soft tissue of teeth including:

• Root canal therapy, which is an endodontic procedure to dig into a cracked tooth and extract inflamed tissue.
• Periodontics, which is the treatment of gum tissue diseases like gingivitis, infection and inflammation.

The process of correcting teeth that aren’t in the right position, usually with braces or Invisalign. Orthodontic is usually a separate category to other dental inclusions. Orthodontic treatment is typically only included on higher levels of cover and comes with longer waiting periods.

Yes, health insurance contributes towards the cost of dental work with any qualified registered dentist. However, some health funds offer additional benefits such as no gap payment if you visit dental clinics or healthcare specialists they’ve partnered with or a health fund-owned dental clinic.

You should also check whether your fund accepts claims via HICAPS. This system enables the dentist to process your health fund claim on the spot rather than you paying the bill upfront, then claiming back the benefit from the fund.

Yes, some extras health insurance policies can pay towards the cost of a variety of dental implants, although you will likely still have some out-of-pocket costs. Dental implants are usually covered by the major dental category, so you’ll need to have this as part of your policy to receive benefits.

As a more expensive service, you’ll also typically have to serve a longer waiting period before you can claim for dental implants.

Usually, health insurance will only cover procedures if they’re considered medically necessary. Some extras policies may pay a benefit towards eligible cosmetic treatment, such as teeth whitening; however, your chances of your claim being successful will greatly improve if the treatment also serves a medical purpose.

Treatments that serve a purely aesthetic purpose are unlikely to be covered by your health fund. However, many procedures that can help improve your appearance may also be deemed medically necessary (e.g. implants or veneers), and therefore can be potentially covered.

Under the right circumstances, extras policies can potentially cover:

• Crowns (custom-made tooth cap)
• Implants (replaces lost or missing teeth)
• Veneers (bonding porcelain or resin)
• Teeth whitening
• Orthodontics (e.g. braces, dental aligners).

Your cover will vary depending on your health fund and policy, as well as on the specific circumstances around why you’re getting the treatment. The best way to find out for sure is to check your policy brochure or call up your insurer to determine your eligibility.

Yes, some extras health insurance policies can cover Invisalign treatment (clear aligners for teeth) under orthodontics, as it’s treated similarly to traditional braces. However, not all policies cover Invisalign treatment; even if they do, you’ll have to serve the waiting period for orthodontics.

If you’re taking out health insurance just to get Invisalign treatment, make sure your policy covers it and you’re aware of any limits and waiting periods.