What is Dental Insurance?

Dental insurance is a broad term that describes private health insurance that covers you for dental treatments and services. The coverage will depend on what sort of policy you have. 

Types of Dental Cover 

An extras policy can cover you for up to four different categories of dental services depending on your policy:

• General Dental
• Major Dental
• Endodontic
• Orthodontics

How Dental Cover Works?

Depending on the policy, people can be covered for general dental care, major dental care, and orthodontics. When people go to the dentist, every piece of work that is done has a dental item number attached to it. According to your policy, some extractions will be covered under major dental, and some will be covered under general dental, and the item number will determine all these. For example, if you go to the dentist for a check-up, clean and fluoride treatment, this would mean your health insurance would have to pay for item numbers 011 or 012, 114 and 121, all of these are associated with preventative dental, which the vast majority of extras policies will cover. When you finish your dental work in the chair, you’ll go to the reception, swipe your health fund card, and the HICAPPS machine will read your extras policy, know the rebates and yearly limits you have available, and deduct the correct amount. 

Following are the services that are typically covered under extras insurance:

Preventative Treatments 

These treatments include check-ups, cleanings, X-rays, and fluoride treatments. Here are a few item numbers associated with preventative treatments:

011 or 012 –— Consultation

022 — Xrays of the teeth

071 — Models of the teeth

072 — Photographic imaging

114 — Dental cleaning

121 — Flouride treatment

221 — Gum measurements

General Dental Procedures

These procedures include cavity fillings and tooth extractions. Here are a few item numbers associated with general dental procedures:

531, 532, 533, 534, 535 — White-coloured fillings in rear teeth

521, 522, 523, 524, 525 — White-coloured fillings in front teeth

Major Dental Procedures

These procedures include root canal therapy, dental implants, crowns and bridges. Here are a few item numbers associated with major dental procedures:

415, 416, 417, 418 — Root Canal Treatment 

661, 663, 664, 665, 666, 668, 669, 671, 672, 673, 678, 679, 684, 688, 689, 691 — Dental Implants 

611 — Resin Crown

613 — Full Porcelain or Ceramic Crown

615 — Porcelain Crown with metal base

618 — Full Metal Crown (alloy cost may be additional for Gold)

643 — Ceramic Pontic (to replace a missing tooth)

672 — Ceramic Crown for a Dental Implant

Orthodontic Services

These services include correcting the alignment of teeth and the jaw. 

There are quite a few costs and benefits associated with dental cover, which are as follows:

Annual Limits and 

These limits are the total coverage that you can claim within a year. For example, if you have an annual limit of $600 for general dental treatment, you cannot claim more than $600 for general dental treatments in that year. Most health funds, like nib, Bupa, and Australian Unity, follow a calendar year. However, a handful of health funds follow the financial year, such as ahm. 

Lifetime Limits 

There are also a few treatments with a lifetime limit on them, which means that you can only claim these services once in your entire lifetime. This will only apply to orthodontics from a dental perspective, as you don’t get lifetime limits on general dental or major dental. People need to be careful about their lifetime limit when it comes to claiming braces. If you switch health funds, what you’ve claimed on your lifetime limit will follow you across to your new lifetime limit. For example, if you have claimed $2500 on braces with health fund A and you switch to health fund B, with a lifetime limit of $2,500. You won’t be able to claim anything. However, if you switched to a policy with a lifetime limit of $3,000, you could claim the extra $500 once you have served a 12-month wait period for access to higher limits on orthodontics.

Out-of-Pocket Expenses 

Out-of-pocket expenses are a fact of life. However, there are numerous policies on the market where you can have NO out-of-pocket expenses for checkups and cleans, so make sure that before you settle on a health fund, you have shopped around. Health funds like Bupa, Westfund, Australian Unity, nib, and ahm have a wide dental network filled with heaps of dentists where you can get “no-gap” check-ups and cleans. 

Waiting Periods

The initial duration that starts right after starting an insurance policy during which the policyholder cannot claim or use any benefit of the policy is known as the waiting period for any insurance policy. During this period, the policyholder will have to pay the full amount of any incurred costs for any reason for themselves. The duration of these periods varies from provider to provider and also based on the type of policy you get.

The great thing about health insurance is that you’ll never have to re-serve waiting periods when you switch health funds. You generally only serve wait periods in two circumstances. Firstly, when you take out a policy for the first time, you will likely have to serve a waiting period on your dental work. Secondly, when you are upgrading your cover. If you switch from health to A to health fund B, and on A, you were covered for general dental but not major dental, then when you switch, you’ll gain access to general dental straight away, but you will have to serve a wait on major dental because you didn’t serve the waiting period for major dental on your previous plan. 

The waiting period for general dental work is generally 2 months, and for major dental and orthodontic work, it is always 12 months. Some policies may waive the 2-month wait period in general, depending on joining offers at the time.

Preferred Providers 

A dental cover will offer you a rebate when you get some dental work done. However, you will get a better rebate rate if you go to their preferred providers. Different health funds have different dental provider networks, for example, Bupa has a preferred provider network called Members First, whereas nib’s is called the First Choice Network. Dentists and their clinics can be involved with multiple provider networks and offer services with various health funds. For example, Pacific Smiles Dental, which is one of Australia’s largest dental work chains, has agreements with several different health funds to offer multiple members no gap checks up and cleans)

Choosing the right cover is of utmost importance for your oral health, and here we help you understand how you can do it:

Assessing Your Dental Needs

It is important to assess your present and future dental needs. Ask yourself: How often do you go to the dentist? What are your eating and drinking habits like? How do they affect your dental hygiene? Do you often require fillings? What is your dental hygiene routine like? Based on this, you can decide whether you need dental cover or not or how comprehensive your dental insurance should be.

Comparing Policies

Compare different policies to choose the best one for you according to your needs. You can get help from the Health Deal’s insurance comparison tool. This tool can help you find the best possible insurance provider and policy for yourself while getting the most benefits.

Considering Costs vs. Benefits

Consider your monthly premium and benefits before buying a policy. This will help you narrow down the most cost-effective options and enjoy the services with financial security.

Reading Policy Brochures

Finally, each policy has a brochure that is deeply explained and helps you understand it in detail. Read that brochure thoroughly before you make a decision. 

Extras cover and dental insurance are deeply related, and here we explain how:

How Extras Cover Includes Dental

Extras insurance covers treatments not covered under hospital insurance. There are three main types of extra insurance: basic, medium, and comprehensive. Each insurance provider might name these differently and offer different benefits and covered treatments in each category. 

Standalone Dental Insurance vs. Extras Cover

There are very few chances of a standalone dental insurance policy. Dental care insurance is usually found in conjunction with optical and physiotherapy insurance under an extras insurance policy. 

Combining Hospital and Extras Cover

You can combine your hospital and extras cover to get the most comprehensive coverage. This will include cover for in-hospital and out-of-hospital dental care services. 

Overview of Dental Care System

The dental care system in Australia depends on three pillars: public dental care, private health insurance and self-funds. In public dental care, if a person holds a healthcare or pensioner concession card, or is a dependent on someone who holds a healthcare or pensioner concession card, and is a child between the ages of 0 and 12, they are eligible for public dental care. You will have access to dental services based on the urgency of your situation decided by a health professional. 

Importance of Regular Dental Check-ups

Dental check-ups are as important as regular health check-ups. If you have good teeth and oral health, we suggest you get a dental check-up at least once a year. The number of visits should increase according to your teeth’s health. It is important to note that dental check-ups may vary from person to person, and what might work for someone else might not work for you. However, general dental care might be the same for everyone. 

If you take good care of your teeth, the possibility of needing a dental visit decreases significantly. However, you might still want to go for checkups for preventative care. This will help root out any problem before it becomes a major issue. Ultimately, this will help keep your teeth healthy and save you from paying fees for dental procedures. 

Following are some tips to maximise the use of your dental cover:

Understanding Your Policy Limits

Understanding what is covered by your health fund policy and what is not is one of the most important points in maximising your cover benefits. After your normal check-up at the dentist, if you need any work done, your dentist will make a treatment plan for you. This is a sheet of paper which lists the work you will need, along with the dental item numbers. Once you have this, you can check with your health fund about what you can expect to get back. If you are not happy with what you get back, then this is a sign to compare your health insurance

Timing Your Dental Visits 

Most health funds run on a calendar year, and your limits reset every year on the 1st of January. Knowing this can help you schedule your dental visits, especially if you need to get any major dental work done. For example, if you are due for a root canal, and it is November, make sure you get yourself to the dentist to get that done before the year ends, so you use your limit so that when you get a crown put on afterwards, you can get the crown done in the new year with fresh annual limits. Always speak to your dentist about what treatment is right for you and then decide how you can manage them best with the given dental cover. 

Preventative Care to Reduce Major Expenses

Preventative care is the best care, and you can do it to reduce your major dental expenses. Make sure to brush, floss, and use a mouthwash at least once a day. Following are some steps that you can take as preventative care for your teeth:

1. Limit acidic and sugary drinks 
2. Always brush your teeth twice a day
3. Use a toothpaste with Fluoride content 
4. Do not open bottles or cans with your teeth 
5. Do not forget to floss

The most common dental procedures and their coverage in health funds are as follows:

Wisdom Teeth Removal

Wisdom tooth removal can be general or major dental work, depending on your unique situation. Most of the time, wisdom teeth are removed in the dentist’s chair. However, sometimes, you will need to be admitted to a hospital to have them removed, where you are put under general anaesthetic. If this is the case, you must have dental surgery covered by a hospital policy to claim benefits. 

Root Canal Treatment

Depending on your policy, root canals are either covered by major dental or endodontic dental. Crowns will always be a major dental. The average cost is between $900 and $3500. After this treatment, people often need a crown, which may cost between $500 and $1500. 

Teeth Whitening

Mostly, dental insurance does not cover teeth whitening as it is considered an elective oral health. 

Orthodontic Work

This would come under the orthodontic procedures category, which may be covered under extras insurance by most insurance companies. This category of work will also include braces and Invisalign, which are very popular among children and teens. However, getting braces or Invisalign can be costly. Generally, in Australia, braces cost around $4500 – $8500, and Invisalign can cost you around $6000 – $9000. This amount also depends on the type of treatment you get, the type of braces you opt for, and if some specific teeth alignment issues were dealt with.

Different health funds offer different sorts of dental covers. This is why it is always best to compare dental covers from various providers to assess the one that works best for you. The Health Deal’s insurance comparison tool is a good way to compare insurance. This tool can help you find the best possible insurance provider and policy for yourself while getting the most benefits and accurate information on the basis of coverage options, cost, provider networks, customer service, and claims process. It is important here to mention that Health Deal only provides accurate information at your discretion and does not endorse any insurance policy.

How do annual limits work? 

These limits are the total coverage that you can claim within a year. Most annual limits are reset at the start of the new calendar year, but discuss the reset date with your insurance health fund. For example, if you have an annual limit of $600 for dental cover, you cannot claim more than $600 for a dental service in that year. 

What is covered under major dental?

Under major dental services, root canal therapy, dental implants, crowns and bridges are covered. 

health insurance with optical coverage can be very beneficial for you if you have dental needs, and the best way to choose your insurance provider is to use the Health Deal Insurance Comparison tool. You can compare health insurance with dental cover plans, costs, and providers here. For expert advice, you can contact Health Deal at enquiries@healthdeal.com.au. You can speak to our experts at 1300 369 399 or fill out the online form here. Get in touch now to speak with an insurance expert for tailored advice and support in making viable health insurance decisions. 

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