According to the Private Health Insurance Administration Council (PHIAC), dental costs are a huge contributor for people seeking to take out extras cover.
Health funds pay more benefits for dental services than any other type of general treatment, and this highlights the need for dental cover for many individuals and families across Australia.
More information on maintaining good dental health
When taking out extras cover, there are four different types of dental cover features to select from, and they each cover specific dental procedures:
General dental includes diagnostic and preventative procedures like check ups, scale and cleans, fillings, x-rays and fluoride treatments. There is generally a 2 month waiting period on general dental, however for pre-existing conditions and certain specialist procedures (such as sleep apnoea devices or wisdom tooth extraction), the waiting period can be extended to 12 months.
Major dental includes services for complex dental work such as restorations, crowns, bridge work, implants, dentures and oral surgery. The waiting period for major dental is 12 months.
Endodontics covers root canal therapy and treatment of exposed tooth nerves. It's important to have this cover if you have tooth decay or damage that could lead to infection. The waiting period for endodontic is 12 months.
Orthodontics covers services that prevent and treat facial issues, most often the straightening of crooked teeth. This usually involves fixed appliances (braces) or removal appliances (retainers) to treat teeth, jaw and bite misalignments. Orthodontics is particularly popular with families with young children. The waiting period on orthodontics is 12 months.
When you are making a claim, simply use your health fund membership card to claim your benefits on the spot, after you've received treatment. Your practitioner will receive your benefits directly from the health fund, and all you need to do is pay the difference.
Many health funds have their own dental centres or have dental practitioners who participate in a 'no gap' scheme. This means most preventative and diagnostic services are offered at 'no-gap', so you won't have to pay out of pocket for these services. Other dental treatment will often be at a reduced cost to members.
View a list of dental centres for moneytime's participating health funds.
Like other extras features, you must be covered for dental under your health insurance plan if you wish to claim benefits for treatment. If you are required to serve waiting periods, they must be completed before your claim is valid. Usually, general dental only has a 2 month wait, with major dental, endodontic and orthodontic having a 12 month wait. These waiting periods may be waived in the form of a special offer from the health fund, or if you are making the switch from health cover that had dental benefits.
It should be noted that in more complex cases, a general dental procedure may be considered major dental, and simpler major dental procedures can be considered general dental. Your dentist should be able to provide information prior to your treatment. For orthodontic benefits, the treatment plan usually needs to be approved by your health fund prior to services being provided.
Health funds generally require that practitioners are not related to you, in order for your claim to be eligible.
The amount that your health fund will pay depends on the level of cover you have with them. Health funds have different item numbers for different elements of dental treatment, and they pay a maximum benefit for each item number. These are then tallied together to create the maximum claimable amount in any 12 month period. That amount may be higher on a more expensive health cover plan, and lower on a more basic plan.
Please note: This information is provided as a general guide only, and should not be used as a substitute for advice provided by a medical professional or your health fund. We highly recommend you consult a doctor if you are concerned about your health, and speak with your health fund for specific health insurance-related queries.
