Choosing Dental Health Insurance: What You Should Know


Many of our patients choose to take out private health insurance to help cover the cost of dental treatment, which isn’t surprising considering studies in Australia have shown that two thirds of patients delay visiting the dentist due to costs.

This avoidance can become a real problem though, as the consequence of skipping a regular visit to the dentist can cause the health of your teeth to become worse over time, and prevents you from catching issues early on. This causes health problems which end up being potentially more stressful, painful and costly than the original visit would have been, so holding health insurance can be a great incentive to ensure you’re making the most of your dental insurance by getting the treatment you need when you need it!

Navigating the wide variety of health insurance companies and their policies can be confusing though, when trying to work out if health insurance is worth it and which health insurance is the best for dental treatment.

We’ve answered some of the most common questions when it comes to how health insurance works at the dentist, so you can choose the best coverage for your needs.

Article Summary:

  • What is covered under dental health insurance?
  • Does health insurance cover cosmetic dental treatment?
  • What are the waiting periods for health insurance?
  • How much will my health insurance rebate be at the dentist?
  • What is a Preferred Provider?
  • Preferred Provider vs independent dental practice
  • How does the level of health insurance cover affect my dental treatment?
  • Which dental health insurance is the best?

What is covered under dental health insurance?

When taking out private health insurance, their policies will provide either hospital cover, extras cover, or a combination of both, depending on your preference. Ambulance cover may also be an option if your state government doesn’t cover it for you.

Hospital cover helps pay for the costs associated with being admitted to hospital as a private patient. Extras cover helps pay for the costs of health services outside of hospital that are not covered by Medicare. These include physiotherapy, chiropractic treatment, dental treatment, and optometry.

Dental cover within private health insurance is usually separated into general dental and major dental, and you can choose if you’d like to be covered by both depending on your policy and the premium (cost of health insurance) you’re willing to pay.

General dental cover often includes:

  • Examinations
  • Scale & clean
  • Surgical extractions
  • Fillings


Major dental procedures cover usually includes:


What is included will be determined by each health fund, so it’s important to read their policy options carefully to see what’s included. Many funds will also offer 2 free check-ups and cleans each year when you visit a Preferred Provider. Waiting periods and annual limits may also apply.


Does health insurance cover cosmetic dental treatment?

Depending on which cover you choose, some policies do include cosmetic dental treatments to improve the appearance of your smile under ‘major dental’ cover mentioned above, such as crowns, dental implants, veneers, teeth whitening, braces or Invisalign.


What are the waiting periods for health insurance?

Health insurance waiting periods mean when you begin a new private health insurance policy or increase your level of cover, you have to wait for a certain time before you can claim benefits.

Usually, waiting periods vary from 2 – 6 months for services such as general dental, and up to 12 months or more for major treatments such as orthodontics.

Waiting periods protect health insurance members by preventing patients from making a large claim soon after joining and then cancelling their membership, which would end up increasing the premiums for all members.


How much will my health insurance rebate be at the dentist?

When visiting the dentist, your private health insurance rebate is normally determined by three things:

  1. Whether you’re visiting a Preferred Provider dental practice
  2. The fees and conditions fixed by the private health insurance company
  3. The level of cover you’ve chosen within your private health insurance policy

What is a Preferred Provider?

A Preferred Provider is a dental practice or other health clinic who has signed a contract with one or several private health funds, agreeing to comply with the fee criteria that is determined by the private health insurance company. This means that the company gets to decide on the maximum fee that the dentist is allowed to charge for a certain service to members of that health fund.

A dental practice that is not a Preferred Provider is called a ‘non-affiliated’ or ‘independent dental practice’. They are able to decide on their own fees for their services.

It’s important to be aware that the title ‘Preferred Provider’ isn’t an indication that the quality of the dental practice and their level of care, or the skills of their dentists is superior to non-affiliated practices, it purely refers to the fee structure agreed upon by the practice and the health fund. All dentists should be providing a high quality of treatment and care, and be keeping their patients’ best interests in mind regardless of their association with a health insurance provider.


Preferred Provider vs independent dental practice

Choosing whether to visit a Preferred Provider or independent dental practice will usually make a difference to the rebate you receive for your dental treatment. Generally, a private health fund will pay a higher rebate for the same dental treatment with a Preferred Provider than for one that isn’t.

For example, if a health insurance company decides that the fee for a check up and clean is $200, this is the maximum price a Preferred Provider can charge their patients for this treatment. Your level of cover may determine that the health fund pays a rebate of $80, which leaves a “gap” (your out-of-pocket cost) of $120. In contrast, if you visit a non-affiliated dentist who have decided themselves that their check-up and clean fee is also $200, the health fund may only pay a $60 rebate, which leaves a gap of $140, meaning you’ve paid more out of your own pocket, even though the original price of the service was the same.

On the other hand, an independent practice may choose to charge a lower fee, such as $180 for their check up and clean, with a rebate of $60 so the gap could still be the same $120 that you would have paid the Preferred Provider in the first example. In saying this, they could also choose to charge a higher fee for the treatment, such as $220, leaving you with a greater gap.


How does the level of health insurance cover affect my dental treatment?

The gap you have to pay is determined by the rebate that is set by the health fund under the policy you choose. This is often in the form of a percentage, for example a 60% rebate will mean that this is the maximum portion of your treatment that your health insurance wil pay for. In the last example, if the fund pays for 60% of your $200 check-up and clean with a Preferred Provider, you will have a gap of 40% or $80, unless the dentist waives the gap at their own discretion, meaning you will have no out-of-pocket costs.


Which dental health insurance is the best?

As you can see, your premium, rebates, gap and cover will all depend on which policy you choose. The best dental insurance is going to depend on the premium you can afford to pay, with the greatest coverage and rebates, therefore offering more treatment options and a lower gap.


Each health fund will also have a different selection of Preferred Providers, which may impact on your choice of fund depending on whether you already have a dentist that you love visiting!


Oasis Dental Studio accepts all health funds. Our Gold Coast dental studio locations have different preferred HICAPS providers, so you’ll pay less by using the specific providers for your local clinic.

At our Broadbeach dental studio, we are a preferred provider for:


At our Palm Beach dental studio, we are a preferred provider for:


At our Chirn Park dental studio, we are a preferred provider for:

  • HCF
  • NIB
  • CBHS


To learn more about private health funds and other dental payment options to suit your unique situation and needs, please don’t hesitate to contact one of our studios today:


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