How dental cover actually works in Australia
There is no such thing as dental insurance in Australia. There is extras cover, it has annual limits, and those limits reset whether you used them or not. Here is how to read your own policy.
Start with the thing that confuses almost everybody.
There is no such thing as dental insurance in Australia. You cannot buy a policy that only covers your teeth. Dental sits inside the extras part of private health cover, alongside optical, physio and the rest.
That one fact explains most of the confusion people arrive with, so it is worth having straight before you read your own policy.
The two halves of dental extras
Nearly every fund splits dental into two categories, and they behave differently.
General dental is the everyday work. Check-ups, scale and clean, x-rays, fluoride, and usually simple fillings.
Major dental is the bigger work. Crowns, bridges, root canal treatment, dentures, surgical extractions, and on some policies orthodontics as a third category again.
The trap is assuming that having dental cover means having all of it. Plenty of policies include general dental generously and major dental barely, or not at all. They also carry separate waiting periods, and the wait on major dental is usually much longer, often a year.
If you are considering a crown or an implant, look at the major dental line specifically. The general dental figure on the front of the brochure tells you nothing about it.
Annual limits, and the part that costs people money
Every extras policy caps what it will pay per person per year.
That cap resets, and here is what matters: unused benefit does not carry over. If your policy allows a certain amount of general dental a year and you never went, that money is simply gone when the year turns. Nobody sends you a reminder.
Two things follow from that.
First, if you have been putting off treatment, find out when your limit resets. For some funds it is 1 January, for others it is your policy anniversary. If a reset is coming, there is sometimes a sensible way to stage treatment across two benefit years, and we are happy to plan it that way when the clinical timing allows.
Second, the two check-ups a year that most policies cover generously are the cheapest dental care you will ever have. Skipping them does not save money. It just converts a covered small problem into an uncovered large one later.
What you actually pay on the day
You do not need to pay in full and then chase your fund for a refund.
We use HICAPS, which claims your fund at the front desk while you are standing there. You pay the gap, if there is one, and you walk out. Bring your card.
We are an nib preferred provider and an HCF More for Teeth partner, and we also work with Westfund and Latrobe. Preferred provider arrangements matter because they change what the fund pays and therefore what your gap is. If you are on nib or HCF, it is worth asking us what that means for your specific treatment.
Reading your own policy without going mad
Four things to look for, in this order.
- The annual limit for general dental, and separately for major dental.
- The waiting periods, especially on major dental if you have joined or upgraded recently.
- Whether there is a per-item cap as well as an annual one. Some policies cap what they pay for a single crown regardless of your remaining limit.
- Whether we are a preferred provider for your fund.
If that sounds like a lot, ring us with your fund and your policy name before your appointment. Our team does this every day and can usually tell you roughly where you will land.
If you do not have cover
Then you pay a fee, and the only thing that should never happen is finding out what it is afterwards.
Our check-up and clean is a fixed $249, covering the exam, the scale and clean, fluoride and any bitewing x-rays you need. For anything larger you get an itemised written quote before we start.
For bigger treatment there are 0% interest payment plans, on approval: Bitesize, our own in-house plan, and DentiCare. Some people also qualify to use early release of super on medical grounds through SuperCare. The detail on all three is on our payment options page.
The bottom line
Dental cover in Australia is extras cover, it is split into general and major, and it expires every year whether you used it or not.
The people who get the most out of it are not the ones with the best policy. They are the ones who use the preventive half of it twice a year, every year, so the expensive half rarely gets called on.
Check your limit. Check your reset date. Then book the thing you have been putting off.
Read more: What dental work really costs, and why nobody will give you a number
Dental costs FAQ
Is dental covered by Medicare?
Generally not for adults. Medicare does not cover routine dental care, though eligible children may have limited cover under the Child Dental Benefits Schedule. For adults, dental sits in the extras part of private health cover.
What is the difference between general and major dental?
General dental is the everyday work: check-ups, cleans, x-rays, fluoride and simple fillings. Major dental is the bigger work: crowns, bridges, root canals, dentures, surgical extractions and often orthodontics. They usually have separate limits and separate waiting periods, so having one does not mean you have the other.
Do my limits carry over to next year?
Almost never. On most policies unused benefit disappears when the year resets. Whether that reset is January or your policy anniversary depends on the fund, so it is worth checking, especially if you have treatment you have been putting off.
Do I have to pay and then claim it back?
No. We use HICAPS, so your fund is claimed on the spot at the front desk and you pay only the gap, if there is one. Bring your card to the appointment.
What if I do not have health cover?
Then you pay a fee, and we will tell you what it is in writing before we start. Our check-up and clean is a fixed $249, and for larger work there are 0% interest payment plans, on approval, through Bitesize and DentiCare.
