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Let's get to the tooth of the matter: Dental Cover is basically any Extras policy that covers you for dental procedures. We're talking cleaning, checkups and lots more stuff to help those pearly whites sparkle!
Dental usually covers a range of procedures, including: general dental treatments, major dental treatments, endodontics, and orthodontics.
Exact coverage will depend on your health policy and provider, so it's very important to check what you're covered for.
This can include basic things like routine cleanings, fluoride treatments, x-rays, teeth bleaching and small fillings. General dental is included in most Extras policies. Note this is sometimes referred to as ‘Routine Dental’.1
This covers more involved treatments such as dental implants, crowns, bridges and dentures. The surgical extraction of teeth (e.g. wisdom teeth removal) are also usually covered by this category.
Endodontics refers to treatments and surgery for the inside of the tooth, root canals being the most common example. Periodontics covers root planning, jaw injuries and non-tooth related surgery. Depending on the policy, endodontics and/or periodontics might be covered by the ‘major dental’ category or it might stand alone as its own category. It is also sometimes referred to as ‘Complex Dental’.2
Orthodontics refers to surgery and procedures that help correct the alignment of a person’s teeth and jaw. Dental braces are usually regarded as an orthodontic treatment. Orthodontics is normally considered a separate category and is generally only included in more comprehensive and expensive extras policies. There is also usually a 12 month waiting period before you can claim on orthodontics services.3
You’ll usually be able to find out what an Extras policy covers by checking out the insurer’s website or reading the policy product summary (usually a PDF document).
For example, let’s say you want to get coverage for a dental crown. Many insurers will list this under the ‘major dental’ category, so check it's included. If it’s not specifically listed as an example, it might be worth checking with the insurer, just to make sure the policy covers it!
And of course, iSelect’s health consultants can also answer your questions around dental cover and help you understand what is and isn’t covered under a particular policy. Give us a call on 13 19 20.
Yes! But this depends on your policy.
While any Silver or Gold policy must cover dental surgery in a private hospital,4 dental surgery is often included in Bronze Plus policies and even some Basic policies. This means treatment for surgery to the teeth and gums, including dental implants surgery and surgery to remove wisdom teeth.
Remember, certain dental procedures can require you to have both Hospital and Extras cover. The most obvious example of this is getting your wisdom teeth removed. Because this is sometimes done in a hospital setting, you may be required to have Private Hospital Cover even though the removal of themselves will be covered under your Extras Policy.
That’s why it’s always a good idea to speak with your insurer to double-check which dental procedures will be covered under your hospital policy. The amount they’re able to cover might also depend on the hospital where you get treated as to how much you’ll need to pay. Some might charge you significant out-of-pocket costs while other ‘no gap’ providers might not charge any extra costs.
Many funds offer a full cover option for preventative treatments. These plans are known as ‘no gap’ insurance and will generally cover 100% of the cost of preventative dental treatments such as fluoride treatment, check ups, and routine cleaning.5 But keep in mind you’ll often have to go to a certain dental practices that are affiliated with your health fund to receive non-gap treatments.
However, while some insurers offer ‘no gap’ cover for preventative dental treatments, this is a much rarer find for procedures like fillings, crowns and orthodontics. Still, even if these procedures come with out-of-pocket expenses, a suitable policy can likely help you claim back part of the cost.
As part of your health insurance policy, your dental cover will probably come with a waiting period. Waiting periods are there to make sure people don’t only take out insurance policies when they need to pay for larger procedures. To avoid having to endure a painful wait for dental treatment, it can make sense to take out cover well before you need to head to the dentist for a big procedure.
How long you have to wait to use your dental cover will depend on the type of Extras coverage you have. Generally the waiting periods for new customers are two months for preventative and general dental treatments,6 and 12 months for more major work like crowns and bridges.7 So it’s important to plan ahead.
Waiting periods for major dental plans will vary depending on the type of treatment. The more intense a category of treatment is, the longer you’ll usually need to wait before you can use your dental cover under your Extras policy.
The least intensive type of treatment is preventative dental work which includes preventing, diagnosing, and treating tooth diseases. Because this type of care is less intensive, it generally has a shorter waiting time of two months or less. Some funds don’t have a waiting period on this kind of preventative dental,8 while others will sometimes waive the waiting period to attract new customers.
Most major dental and endodontic work such root canals and crowns generally have a much longer waiting period of 12 months.9 There is also generally a 12 month waiting period on orthodontic services, when they are included in an Extras policy.10
Knowing the type of dental care you may need in the future can help you determine the most suitable level of Extras coverage to take out. For example, someone who has already had braces may choose a plan without orthodontic care. However, it’s important to keep in mind that you can’t always plan ahead for dental emergencies.
Ummmm, not really, no. It is common for insurers to offer Basic policies that just cover a few essentials such as general dental treatment, emergency ambulance services and not much else.
Unfortunately, it’s much rarer to find a policy that only covers general dental treatments, major dental work and orthodontics. However, there are definitely some flexible extras policies11 which let you choose the treatments you want covered, but even these can require you to choose a minimum number of treatments. Keep in mind this means you still might end up paying for more than just dental coverage.
Yes. Unfortunately, all Extras insurance policies come with limits on how much you can claim. That includes extras policies that offer dental cover.
Different medical treatments will be subject to different kinds of limits. Usually, one (or all!) of the following will apply:12
For some policies, certain limits might also increase each year. For instance, you might only be able to claim $1,100 for major dental work during the first year of your policy, but this might increase to $1,300 once you’ve held the policy for more than three years.13 If you’re curious whether this might be the case for your policy, check the policy brochure to find out!
If you’ve never purchased an Extras policy that covers dental procedures before, you might not be used to the way it works. While your hospital cover policy is there just in case something happens to you, Extras cover can be designed to work as a budgeting tool that helps you reduce the cost of things like dental treatments.
Depending on your insurer, there are two ways they might cap your dental treatment discounts:
Keep in mind that many insurers use a combination of set and percentage benefits. So as always, make sure you read the policy brochure to understand exactly how your covered for dental.
Children could be able access dental coverage through Medicare under the Child Dental Benefits Schedule. To access this benefit, children must be eligible for Medicare, between two and 17 years of age, and they or a parent must be receiving a Centrelink payment or other benefit like the Family Tax Benefit A. This benefit is capped at $1,052 per child every two years and can cover many preventative dental treatments.16 Orthodontic care and other intensive treatments are not covered.17
Adults with a Health Care Card, Pensioner Concession Card or a Commonwealth Seniors Health Card may also be covered for dental work under Medicare.18 The level of coverage and treatments covered will vary by state. For example, public dental cover in Victoria will cover general dental care and some special services for those who are eligible.
Let's face it, dental work can be painful enough without having to comb through dozens and dozens of policies. And who needs a headache when they already have a toothache?
So, here's how you can make it a little bit easier. Just consider the following when weighing up your options:
iSelect is also here to make the whole rigmarole of comparing and choosing a lot easier. After all, it shouldn’t be like pulling teeth! Instead, you can weigh up dozens of policies from a range of different providers* with our online comparison tool. That way, you can check out the different prices and benefits on offer at a glance. Now that’s enough to put a smile on anybody’s face!