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Because dental procedures in Australia are relatively expensive, many health insurance companies include dental coverage in their plans. They aim to help their members to easily avail of preventative dental procedures and avoid more expensive dental treatments in the future. Let us take a closer look at the dental insurance Australia provides, know how it works, and how it benefits patients in getting dental services in Australia.

 

Dental insurance Australia: Kinds of dental insurance coverage

Health insurance companies in Australia in the earlier times did not include coverage for dental procedures and treatments, so dental insurance was a nonsense subject before. But now, private health insurance providers offer different levels of dental insurance coverages, depending on the patient’s needs.

General dental covers all basic and necessary dental procedures used to prevent further dental issues. An Insurance provider pays for dental treatments like scaling and cleaning, basic dental fillings, tooth extractions, as well as general exams like routine check-ups and x-rays.

Major dental procedures are those more complex treatments that would relatively cost more. This type of coverage may include procedures like the use of dental veneers, emergency treatments, wisdom tooth surgery or extraction, orthodontic (very rare), and endodontic or gum disease procedures.

 

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Dental insurance Australia: Are the procedures fully covered?

Well, it depends on the dental coverage you availed yourself of and the procedures you wish to undergo. For instance, general dental procedures are fully covered since they are preventative in nature and they will help prevent the use of your insurance benefits for more complicated (and expensive!) dental procedures in the future. However, if you wish or need to undergo complicated dental procedures like the placement of dental bridges, crowns, or dentures, a percentage of the total cost may be shouldered by the insurance provider, and you can expect that the remaining balance is an out-of-pocket fee charged to you.

 

Dental insurance Australia: How much is a dental procedure with insurance coverage?

According to the website of the Australian Government’s Private Health Insurance Ombudsman, you can assume to pay for the following dental services while having a private insurance policy:

Dental Procedure

Average out-of-pocket

Regular oral examination

$53

Initial consultation

$63

X-rays (per exposure)

$42

Plaque removal

$57

Removal of calculi

$104

Fissure sealing (i.e., fillings) – per tooth

$52

Oral surgery (e.g., wisdom tooth removal)

$159

Full crown (dental veneers)

$1440

 

Note that the estimated cost mentioned above is still dependent on the dental clinic you visit, the dentist, your dental insurance coverage type (DHMO, DPPO, or Dental Indemnity Insurance plan), and the complexity of the dental procedure you need to avail of.

 

Dental insurance Australia: Points about the insurance policy you need to consider

Annual limits. This is the total amount your insurance policy covers within a one-year period. Once you maximised this amount, the remaining expenses for the entire year cannot be covered anymore.

Waiting period. This is the time set by the insurance company before you can use your dental benefits. Typically, the waiting period for general dental procedures (preventative in nature) is 2-3 months. You would have to wait for one year to pass before being allowed to use your dental insurance for major dental procedures like bridges and crowns. Furthermore, expect to wait 1-3 years before getting your insurance provider’s approval to have your orthodontic procedures covered.

Gaps.  While having a private insurance coverage, you may still find out that there are expenses that need to be paid on top or beyond what your health insurance covers. This out-of-pocket expense is what they call a gap. Some insurance policies have an extra benefit called no-gap policy where no out-of-pocket charge is needed for selected preventative procedures. Discuss this with your insurance agent so you can fully maximise your insurance benefits.

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