Major dental insurance Australia

Many mid-level extras policies include major dental. The exact dental treatments and services covered under the ‘major dental’ category will depend on the insurance provider. For example, some providers may include tooth extraction under ‘major dental’, but you’re likely to find many policies have this under ‘general dental’ instead.

The exact benefit amount you’re able to claim for each dental treatment and service will also depend on your policy, but typically you’ll be able to claim either a dollar amount or percentage amount of the dental service or treatment cost.

For example, for a major dental policy that allows for a 70% claimback of up to $600 per service, the policy will only cover $595 for an $850 veneer treatment. Keep in mind that major dental insurance covers will also likely have a benefit limit, which caps the amount you can claim under that category over a certain period of time.

Although the exact dental services covered under major dental will differ across providers and policies, you will may find the following services are not covered by the major dental category:

• Teeth whitening: since it’s considered a cosmetic procedure, you’ll find most health funds do not cover for teeth whitening procedures.
• Surgical tooth extractions: you’ll find most providers will consider tooth extractions as a ‘general dental’ treatment instead of major. However, keep in mind that if you are admitted to hospital for a length of time, your extras policy will not cover you for any hospital-related costs.
• Orthodontics: often in its own category of coverage (although some providers do include it in ‘major dental’). Orthodontics cover includes services such as braces and invisalign.
• Endodontics: may be in its own category (although often covered under major dental). Endodontic services include root canal treatments.

You’ll also have to keep in mind that health funds typically do not allow claims for dental services that are not done in person or by a dental physician that is not registered or a recognised provider.

The best insurance cover for major dental will depend on your individual situation and circumstances. Factors to consider when comparing major dental health insurance include:

• Benefit: For major dental, the ‘benefit amount’ (how much you’ll be able to claim) will typically be shown as a dollar amount or as a percentage of the total cost. Whether the benefit amount will cover the total cost of your dental appointment will depend on the health fund, the policy you choose, the treatment you’re receiving, and, potentially, even the dental clinic. You can find the exact benefit amount you’re able to claim in the policy’s product disclosure statement and terms and conditions.
• Costs (Premium): How much a policy costs (also called the ‘premium’) will vary depending on a variety of factors, but keep in mind that cheapest is not always better. It’s worth thoroughly comparing different policies and reading through the product disclosure statement and terms carefully for any additional requirements and restrictions before committing to a policy.
• Waiting period: Most extras health insurance policies have a waiting period you must serve before you’re able to make a claim. The period for each type of medical service will vary depending on the fund and policy so it’s worth taking this into account, particularly if you require cover for major or complex dental services relatively soon.
• Annual and additional limits: Most policies will have an annual limit on how much you can claim each financial year.

Although you could potentially obtain an exclusive general and major dental private health insurance policy, it’s also worth considering and factoring in any other health concerns or needs that Medicare does not cover for in your policy search, such as physiotherapy, prescription lens or remedial massage.

Generally, most health insurance policies have a waiting period for major dental services. Based on standalone extras health insurance policies on Canstar’s database, the waiting period for major dental can range from two months to 12 months.

But, if you can’t wait, there are specific scenarios where it could be possible to have your waiting period waived, such as:

• changing to a different policy with a similar or lower level of cover, and
• special offers to waive policy waiting periods.

Explore: Can I waive my waiting period for health insurance?

Most private health policies will have a benefit limit for each service covered, which means that you can only claim back up to a certain amount of money for certain things. This is typically an annual time limit. However, there could be other types of ‘limits’. For example, there may be a ‘lifetime’ limit, which means you can only ever claim up to a certain amount on that policy for a certain group of health treatments or services. This depends on the health fund, policy and specific treatment or service you’re looking to claim.

Typically most insurance policies have an annual benefit limit for most services and treatments that fall under major dental, but some services and treatments may have separate or additional limits.

For example, you may find some providers have a 3 or 5 year limit for things such as dentures, crowns or veneers. With that in mind, it’s always important to read the insurance policy product disclosure statement (PDS) and terms and conditions in detail to see what exactly you’ll be covered for and how much you can claim back when picking a private health insurance policy for major dental.

Medicare offers dental care rebates for adults in certain scenarios. But even if you’re eligible, each state and territory will have limitations and restrictions on the dental services that can be covered under Medicare, particularly when it comes to major dental and orthodontics.

Learn more: Does Medicare cover dental?