How Does Dental Health Insurance Work in Australia?
Understanding how dental health insurance works can help you make informed decisions about your dental care and manage the cost of treatment. For patients in Hobart and across Tasmania, private health insurance can help reduce the cost of many dental treatments when used alongside the right level of cover. However, knowing what your policy includes, how dental rebates work and what out-of-pocket costs to expect can sometimes be confusing.
Depending on your provider and level of cover, many people with dental extras are eligible for 2 gap free check ups and cleans per year. Additionally, dental insurance also provides benefits towards eligible treatments including minor and major dental, depending on your level of cover.
At Moonah Dental Centre, we understand that every patient's dental needs and circumstances are different. With three convenient locations across Greater Hobart, including Moonah, Claremont and Hobart CBD, our team helps patients understand their available options and make the most of their
health fund benefits.
What Is Dental Cover?
Dental cover is often referred to as ‘extras’ and is a private health insurance benefit that helps reduce the cost of eligible dental treatments.
The amount of benefit you receive depends on your individual health insurance policy.
Dental cover may contribute towards:
- Preventative dental care
- General dental treatments
- Major dental procedures
- Orthodontic treatment
In all of our clinics, we are able to provide you an estimated benefit amount or we can provide treatment plans that you can share with your health fund.
What Does Extras Cover Include?
Dental treatment for adults in Australia is not covered by Medicare. Many extras covers provide gap free preventative dental cover (check up and clean) and a capped amount of usable benefit for general and major dental treatment. Others provide partial benefit to all treatments and or may exclude major.
Different health funds offer different levels of cover, so the amount you can claim will depend on your specific policy.
Preventative Dental
Preventative dental focuses on maintaining good oral health and identifying potential problems early.
This may include:
- Dental examinations
- Dental X-rays
- Professional cleans
- Fluoride treatments
Regular preventative dental care can help identify issues early and reduce the need for more complex treatment.
General Dental
General dental refers to common treatments that help maintain and restore your oral health.
This may include:
- Fillings
- Simple tooth extractions
- Root canal treatment
- Other restorative procedures
Major Dental
Major dental generally refers to more complex treatments that restore or replace teeth.
This may include:
- Crowns
- Bridges
- Dentures
- Some surgical dental procedures
Major dental treatments often have different limits and waiting periods compared with general dental services.
General vs Major Dental Cover
Understanding the difference between general and major dental cover can help you better understand your health insurance benefits.
General dental usually covers routine treatments such as:
- Check-ups
- Cleans
- Fillings
Major dental usually relates to more complex treatments such as:
- Crowns
- Bridges
- Dentures
- Other restorative procedures
Every health fund is different, so it is important to confirm your level of cover before proceeding with treatment.
How Do Dental Rebates Work?
Dental rebates are the amount your health fund contributes towards eligible dental treatment.The rebate you receive depends on:
- Your level of private health insurance cover
- The type of treatment provided
- Your available annual limits
- Any waiting periods that apply
Our clinics use HICAPS, allowing eligible patients to claim their health fund rebate immediately after treatment and only pay the remaining balance. All of our dental clinics accept a large range of private health funds.
Annual Limits Explained
Most dental extras policies have annual limits. This means your health fund will only contribute up to a certain amount each year for eligible treatments.
Your policy may include separate limits for:
- General dental services
- Major dental procedures
- Orthodontic treatment
Once you reach your annual limit, you may need to cover additional treatment costs until your benefits reset.Checking your available benefits before treatment can help you understand your expected out-of-pocket expenses.
Waiting Periods
Some private health insurance policies require you to complete a waiting period before claiming certain dental benefits.
Waiting periods commonly apply to:
- Major dental treatments
- Orthodontic treatment
- Higher-cost procedures
If you have recently joined a health fund or upgraded your policy, it is worth checking whether waiting periods apply before booking treatment.
Choosing a Dentist That Accepts Your Health Fund
Choosing a dentist that accepts your health fund can make managing your dental care easier and simplify the claiming process. All of our clinics offer the following to make your booking stress free:
Before booking your appointment, consider:
- Accepts your health fund
- Offers HICAPS claiming
- Assists you in confirming your required treatment is covered
- Updates you with your remaining health fund benefits
