Dental cover in Australia

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 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 policies can help pay towards in-hospital dental treatment and operations like wisdom tooth extraction.

With a combined hospital and extras health insurance policy, you could be covered for dental treatment both inside and outside of hospital. This might be the best option if you need complex dental work that requires surgery in a hospital and follow-up appointments in the dentist’s office. Even if you don’t require follow-up appointments in the dentist’s office, you may still need an extras policy with the appropriate level of dental cover 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.

Each health fund sets its own waiting periods for extras policies, but here’s 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 those 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 straight from an old to a new 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 sits outside of a private health insurance policy. It’s a service run by the Australian Government that provides eligible children up to $1,026 towards dental treatment over two calendar years. The eligibility criteria is based on families who are receiving selected government payments through Centrelink.

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 dental, 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
• 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, 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.

The practice of 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 and jaws that aren’t in the right position, usually with braces or Invisalign. 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 their own 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 need to pay some out-of-pocket costs. As a more expensive service, you will also typically have to serve a longer waiting period before you can claim for dental implants.

Yes, provided that adequate cover is taken out, extras health insurance can cover cosmetic dentistry to improve your appearance. Extras policies can potentially include dental cover for:

• 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. Check your policy brochure or call up your insurer to determine what cosmetic dental treatment it covers.

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 will have to serve the waiting period for orthodontics.

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