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One of the major areas of health treatment for adults which is not covered by Medicare in Australia is dental treatment. This is where private health insurance comes in, which can offer full or partial cover for the cost of any dental treatment included under your policy. However, it isn’t always easy to determine which health insurance policy will offer you the best cover for dental work.
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What is dental health insurance and how does it work?
Dental health is one area of health treatment which is not generally covered by Medicare, with the exception of basic dental health care for children whose parents receive certain government benefits. For this reason, most dental treatment in Australia is carried out at private dental clinics, with the cost of included treatment either wholly or partially covered by private health insurance.
However, dental health insurance is not usually available as a standalone type of insurance. Instead, it can either be covered by an extras policy for more minor, routine dental work or by a hospital insurance policy in some cases for more major dental surgery performed in a hospital (such as wisdom tooth extraction).
Some health insurers have developed their own network of private dental clinics which can offer extras members dental treatment with a high benefit rate. This means that if you are a member of certain health funds, you may be able to receive dental treatment at these affiliated private clinics with little or no gap to be paid for your treatment. These are commonly known as ‘no-gap’ extras providers. The ‘gap’ describes the difference in cost between the health fund benefit and what the dentist charges for treatment.
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What is usually included and excluded in health insurance for dental treatment?
All dental treatment is classified as either general or major dental work.
- Routine or general dental treatment is covered by extras health insurance policies
- Major dental work can either be covered by an extras policy (if it is delivered outside of a hospital setting) or by a hospital policy (if hospital admission is required)
In addition, there is another classification of dental work called orthodontics, which is a specialist branch of dentistry and involves ensuring the correct alignment of teeth within the jaw bone, particularly as children’s teeth emerge.
General dental
Covered by an extras health insurance policy:
- Dental examinations
- Preventative treatments including scale and clean, plaque removal and polishing
- Fluoride treatments
- Fissure sealing
- Basic extractions
- Basic fillings of cavities
- X-rays of the mouth and jawbone
Major dental
Also covered by an extras policy (although can be covered by a hospital policy if hospital admission is required):
- Endodontic services – procedures relating to the soft tissue and gums (for example, major root canal work and wisdom teeth removal)
- Periodontics – the treatment of gum disease
- Crowns, bridges, dentures and dental implants (if these are covered)
- Major restorative fillings, including treatments such as inlays, onlays and caps
- Oral dental appliances to treat sleep apnoea and other jaw-related sleep disorders
Orthodontics
Treatment usually covered by higher-level extras policies:
- Treatment concerned with the correct alignment of teeth
- Includes bands, braces and aligners
- Also includes complex teeth alignment treatments such as plates, palate expanders and invisible fitted aligners
Some extras policies will include orthodontic treatment in the same category as major dental, while other policies include it as a separate treatment category with its own waiting periods and annual limits.
What are some of the exclusions on dental cover?
The exclusions which may apply to dental treatment vary from one insurer to another, but possibly may include:
- Cosmetic procedures without the presence of adverse medical symptoms, illness or injury
- No cover for treatment deemed unreasonable or inappropriate (such as cosmetic tooth filling)
- Treatments within your policy’s waiting period
- Claims made either a year or two years after the treatment has been provided
How do I compare health insurance policies for dental treatment?
Some of the factors to consider when comparing extras policies which include dental benefits are:
Cost
Extras policies vary in cost depending on the benefits they provide. The higher the claimable limits and the more treatments that are covered, the more the policy is likely to cost. If you choose a cheaper, more basic extras policy, you could expect the rebate percentages you can claim and annual limits to be lower. The more you pay for the policy, the more coverage you may receive and the less you might have to pay in out-of-pocket expenses, so look for a policy that offers the coverage you need at the most affordable price when comparing.
Rebate levels
Some cheaper extras policies may offer a 50% to 60% rebate on the cost of dental treatment, whilst more expensive policies may offer a rebate of 75% to 100%. The 100% ‘no-gap’ treatments are often provided by dentists who are aligned to a particular health fund and offer ‘no-gap’ treatment to members of that fund. For example, HCF has an extensive ‘no-gap’ provider network, where customers can receive a 100% rebate on the cost of their dental check-ups (and their first visits to a physio, osteopath or chiropractor too).
Category limits
As mentioned above, dental treatment can be divided into two or three categories. An extras policy will allow a certain limit on how much can be claimed for treatment in each category per financial year. For example, a budget extras policy may allow you to claim up to $500 a year for general dental work, whereas a more expensive policy may allow you to claim up to $2,000.
Waiting periods
When you buy a new extras policy for the first time or upgrade the level of cover you have, there will be a dental treatment waiting period before you’re able to make a claim on your policy. Unlike hospital cover waiting periods, these can vary between insurers, so it’s worth carefully comparing them with different policies. Waiting periods may be:
- 2 months for general dental
- 12 months for major dental
- 12 months or more for orthodontics
Types of health insurance
What factors will affect the cost of my private health insurance?
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The type of policy you choose
The cost of your private health insurance will depend on whether you choose a hospital cover policy, an extras policy or a combination policy which offers both types of cover in one bundle. There’s no requirement to have your hospital and extras cover with the same insurer; you can take out policies with two different insurers if you feel this will offer you the best combination of health cover.
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The level of cover you opt for
For hospital cover policies, you can choose between four levels of cover: basic, bronze, silver and gold. The higher the level of policy you choose, the more the insurance will cost. For example, a basic hospital cover policy will only offer very limited cover for a few basic clinical categories, whereas a more expensive gold policy will provide cover for all applicable categories. The same applies to extras cover: the higher level of cover you opt for, the more you’ll pay.
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The excess on your policy
An excess is an initial amount you may have to contribute as part of your hospital treatment. For hospital cover, you’ll be able to choose an excess you feel comfortable paying if you do need to be admitted to hospital. This can range from zero up to a maximum of $750. There are no excesses which apply to extras cover but do consider the benefit limits on offer. For example, an extras policy which offers to refund 50% of the cost of your dental treatment will be less expensive than one that offers a 75% rebate, but you’ll have to pay more out of pocket when receiving treatment.
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The government rebate you’re entitled to
The Australian Government assists most Aussies with the cost of their health insurance through the Private Health Insurance Rebate. This is an amount you can either claim back annually through your tax return or you can ask your insurer to reduce your premiums by your rebate amount, so you’ll pay less for your health cover each month. The rebate is income tested so not all Australians are eligible. The rebate you’re entitled to will increase once you’re over 65 years old, depending on your income
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Your location in Australia
There are different regulations which apply in different states of Australia, and these, together with different claiming rates may affect the cost of your extras cover. For example, some states cover the cost of ambulance cover for their residents, while others don’t. Therefore, the cost of your health insurance will vary from state to state.
