How does dental cover work with extras cover?
Private health insurance extras and dental cover
Dental treatment in Australia is generally paid out-of-pocket or covered through private health insurance extras cover.
With extras cover, your health fund can contribute towards eligible dental services, either by paying a percentage of the cost or a set benefit amount, up to your benefit limits. Dental benefits are typically grouped into general dental, major dental, and orthodontics.
Because dental care sits outside Australia's public healthcare system, Medicare generally doesn't cover routine dental treatment, particularly for adults. There are some limited exceptions to Medicare’s dental cover, including the Child Dental Benefits Schedule.
What does extras cover include for dental?
Depending on your level of cover, dental benefits may include:
| General & preventative dental | Routine dental check-ups, X-rays, professional teeth cleaning and fillings. |
| Major dental | Full and partial dentures, crowns and bridgework, root canal treatment (endodontics), gold fillings, indirect restorations, and surgical tooth extractions, including wisdom teeth removal. |
| Orthodontics |
Treatment to diagnose, prevent and correct issues with the alignment of teeth and jaws. This may include braces, clear aligners and retainers. Available on selected mid- and high-tier extras policies only. |
Some hospital covers may help with hospital costs for eligible dental surgery, but they generally do not cover routine dental treatment.
How much will my health insurer pay for dental?
The amount you get back for dental treatment depends on your level of cover, benefit limits and your fund’s benefit schedule. Your health fund usually pays a set benefit, or a percentage of the schedule fee, for eligible services. This may not cover the full fee charged by your dentist, so you may still have some out-of-pocket costs.
Benefits are paid according to your fund’s rules and the type of treatment you receive. GMHBA uses Australian Dental Association (ADA) guidelines and Fund Rules to help determine any restrictions or limitations on services. For example, some dental item numbers may not be able to be claimed with another service during the same visit, and service limits may apply to certain dental items.
SmartCare vs ClassicCare dental benefits
The way your annual limits work can differ depending on your policy:
| Feature | SmartCare Extras | ClassicCare Extras |
|---|---|---|
| Limit structure | Flexible overall annual limit | Separate limits by category |
| Annual limit rollover | Available when taken out with eligible hospital cover | Not available |
| Dental use | Can use more of the annual limit towards eligible dental services |
Dental claims depend on category limits and service sub-limits |
| Major dental/orthodontics | Available on selected levels of cover | Available on both Mid Extras covers (all open ClassicCare Extras) |
| Best suited to | Members wanting flexibility | Members wanting predictable category limits and a choice of percentage back or set benefits |
How does GMHBA extras work for dental treatment?
SmartCare Extras can give you 100% back on preventative dental* and 60% back on other general dental, major dental or orthodontics services, up to your available annual Smart Limit or sub-limit amount. Depending on your cover, that's up to $500 (Starter), $1,000 (Everyday) or $1,500 (Complete) each year. You can use this flexible limit across eligible services included on your cover. This flexible limit lets you use more of your benefits on the services you need most
ClassicCare Extras work differently with a combined $1,500 annual limit for general dental, major dental and orthodontics, and service sub-limits. You can choose whether to get a percentage back on claims (with Mid Extras 65%) or fixed benefits (Mid Extras Set Benefits).
*Annual/sub-limits & waits apply. Excludes major dental & orthodontic. Registered providers only.
GMHBA members can save even more on dental costs through our partnership with smile.com.au. Eligible GMHBA members receive at least 15% and up to 40% off dental fees at more than 4,000 approved dentists across Australia. The discount is applied to the dentist's fee first, then eligible GMHBA benefits can be claimed, helping to reduce out-of-pocket costs.
Before claiming, check your cover for any waiting periods, annual limits and benefit conditions that may apply.
GMHBA members with dental cover get 100% back on preventative dental* at GMHBA Dental Care. This includes services like check-ups, scale and cleans, helping members get more value from their cover while looking after their oral health.
*Annual limits, sub-limits and waiting periods apply. Includes item numbers, comprehensive oral examination (011), periodic oral examination (012), oral examination – limited (013), consultation (014), removal of plaque and/or stain (111), removal of calculus – first visit (114), removal of calculus – subsequent visit (115), topical application of remineralising and/or cariostatic agent, one treatment (121).
Dental waiting periods with extras cover
| Service | Waiting period |
|---|---|
| General & preventative dental | 2 months |
| Major dental | 12 months |
| Orthodontics | 12 months |
Understanding dental waiting periods
If you’re new to private health insurance or upgrading your cover waiting periods apply before you can claim dental benefits. If you switch from another health fund and have already served equivalent waiting periods, you generally won’t need to serve them again. Your served waiting periods can transfer with you.
Find out more about switching to GMHBA
What can you do during your waiting period?
While you're waiting to access your benefits, as a GMHBA member you can still access smile.com.au member discounts on eligible dental treatments, with no waiting period.
Ready to switch?
Already have extras cover elsewhere? Your waiting periods can transfer, so you may not need to start again. See how to switch to GMHBA without losing cover.
FAQs about dental and extras cover
Dental cover works through extras private health insurance. You pay an extras cover premium, then claim benefits towards eligible dental services such as check-ups, cleans, fillings, crowns or orthodontics, depending on your level of cover. Waiting periods, benefit limits and benefit rules apply.
General and preventative dental usually covers routine care, such as check-ups, professional cleans, X-rays and fillings. Major dental usually covers more complex treatment, such as crowns, bridges, root canal treatment, dentures and surgical tooth extractions. General dental typically has a shorter waiting period than major dental.
Medicare generally does not cover routine dental treatment for adults in Australia. Most adults pay for dental care out-of-pocket or use extras cover to claim benefits for eligible dental services. Limited government programs may apply in specific circumstances, such as the Child Dental Benefits Schedule.
GMHBA extras cover generally has a 2-month waiting period for general dental and a 12-month waiting period for major dental and orthodontics. If you switch from another health fund and have already served waiting periods for an equivalent level of cover, you may not need to serve them again.