What is “major dental” and is it covered by private health insurance? Find out what procedures are included and which insurers offer it.
Dental health insurance is typically divided into two categories, basic and major. Basic dental covers common procedures such as check-ups and minor fillings, while major dental includes cover for more intensive procedures such as wisdom teeth removal and bridges.
Keep reading to find out what is covered by private health funds in relation to major dental.
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Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
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High Hospital with $0 / $250/ $500 Excess Options
Provides a high level of cover for hospital including pregnancy cover and assisted reproductive services.
Cover starting from $36.22 weekly
Two month waiting period for wisdom teeth
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Top hospital 500
Top hospital 500 provides cover for a comprehensive range of services from psych to obstetrics to the removal of tonsils.
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Mid Hospital with Pregnancy
Mid Hospital with Pregnancy covers you for pregnancy and related services in addition to what the standard Mid Hospital policy covers.
Pregnancy and related services
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12 month waiting period for pregnancy in private hospital
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Premium Family Package
This is GMHBA's most comprehensive policy and providing a range of benefits including a pregnancy option.
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Premium Hospital Cover
Comprehensive hospital protection with complete cover including pregnancy.
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NIB's premier Hospital protection with cover for pregnancy and birth services, obesity surgery and all other benefits covered across other policies.
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Get comprehensive hospital and extras cover and tailor your policy to your needs.
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$1000 general dental annual limit
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Policies from Australian health funds that cover major dental
Health fund
Policies that cover major dental services and the annual benefit limits
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The HIF major dental benefit will increase each year you retain your policy. The increase caps at year five.
Premium Options. Initially $1,500 per person, capping at $3,000 per person.
Super Options. Initially $1,300 per person, capping at $2,500 per person.
Special Options. Initially $1,000 per person, capping at $2,000 per person.
Saver Options. Initially $750 per person, capping at $1,250 per person.
More info
All health.com.au policies except for Extras 50 must be taken out as hospital + extras cover.
High Extras. Shared benefit limit of $750 per person.
Middle Extras. Shared benefit limit of $700 per person.
Basic Extras. Shared benefit limit of $600 per person.
Simple Extras. Shared benefit limit of $500 per person.
Extras 50. Benefit limit of $750 per person.
More info
Super Extras. Benefit limit of $1,100 per person.
Family Extras. Benefit limit of $750 per person.
Lifestyle Extras. Benefit limit of $750 per person and $1,500 per family.
Black 60. Shared benefit limit of $650 per person and $1,200 per family.
More info
Platinum 80%. Benefit limit of $2,100 per person.
Gold Extras. Benefit limit of $1,600 per person.
Silver Extras. Benefit limit of $800 per person.
Bronze Extras. Shared benefit limit of $600 per person.
More info
GMHBA allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Gold Extras
Silver Extras
More info
HCF Platinum and Gold Extras benefit limits for major dental increase each year you retain your policy. The increase caps at year six.
Platinum Extras. Initially $900 per person, capping at $1,300 per person.
Gold Extras. Initially $600 per person, capping at $1,000 per person.
Silver Plus Extras. Benefit limit of $500 per person.
More info
Top Extras. Benefit limit of $1,300 per person.
Core Extras. Benefit limit of $600 per person.
More info
Top Extras. Initial benefit limit of $800 per person, increasing to $1,000 per person after three years and $1,200 per person after five years.
Healthy Choice Extras. Benefit limit of $500 per person and $1,000 per policy.
More info
GMHBA major dental sub-limits by treatment
Gold Extras
Dentures. Benefit limit of $500 per person.
Combined crown and bridgework. Benefit limit of $600 per person.
Indirect restorations. Benefit limit of $400 per person and $800 per family.
Implants. Benefit limit of $600 per person.
Silver Extras
Dentures. Benefit limit of $420 per person.
Combined crown and bridgework. Benefit limit of $450 per person.
Indirect restorations. Benefit limit of $350 per person and $700 per family.
Implants. Benefit limit of $500 per person.
Benefit limit terms explained
Sub-limit. A sub-limit is the largest possible amount you can claim for a specific service, which is then deducted from a larger overall benefit limit. For example, your dental cover might include an overall benefit limit of $900 with sub-limits of $300 being applied to bridgework, endodontics and dentures. In this case, the maximum you could claim for any one of those services is $300.
Shared or combined benefit limit. This means that the benefit limit is shared amongst multiple services, rather than applying a limit to each one individually. While you are not restricted to claiming a capped amount like you are with sub-limits, your total overall benefit amount is spread over a wider range of treatments, so be sure not to claim excessively on one service and leave yourself without cover for others.
Lifetime benefit limit. This is the maximum amount you can claim for a service throughout your lifetime. Be aware that if you've reached your lifetime benefit limit with one insurer and switch to a new one, they may deduct that amount from your new policy. It is recommended that you check with your new provider to find out if these penalties apply.
Contents of this article
Which health insurance policies cover major dental?
What services are classed as major dental procedures?
How does private health insurance cover major dental and orthodontics?
Are there any limits or waiting periods?
Is there any major dental specific exclusions?
How do I claim dentistry from my health insurer?
Which health insurance policies cover major dental?
Major dental procedures are covered by either your extras policy or a dedicated dental plan.
Health insurance extras. If you want cover for major dental you’ll generally need a comprehensive extras (ancillary) policy, as basic policies won’t cover you.
Dental health insurance plans. These policies are specially designed to provide cover for dentistry and oral health issues.
What services are classed as major dental procedures?
Wisdom teeth removal. This may be required if the tooth damages or pushes aside other teeth or the gums as it emerges.
Tooth extraction. Tooth extraction is when a tooth is removed entirely due to extensive damage or decay. Whether this is a basic or major dental procedure generally depends on the tooth, how many are being removed and your fund. Wisdom tooth extraction is generally classified as major dental.
Dentures. Dentures are removable prosthetic teeth that can be fitted to replace any number of missing teeth. In some cases dentures might replace an entire row of teeth, such as the top or bottom, with a single prosthetic device, or might replace as few as one or two.
Dental crowns and bridges. Dental crowns and bridges are two different but very closely related types of dental implant. The main functional difference between them is that a dental crown is for a single tooth while a dental bridge is for multiple teeth. If a tooth has suffered partial damage such as chipping, decay, or damage from repeated replacement of fillings then a crown or bridge is installed. These act like partial fake teeth permanently installed on top of damaged existing teeth.
Dental veneers. Dental veneers are very thin, specially made dental implants that are placed over the front of existing teeth. Costs vary depending on material and manufacture, and they are typically used for cosmetic rather than medical purposes. As such, most major dental insurance policies don’t cover veneers.
Root canals. Root canals are a fairly common endodontic procedure. If a tooth has fissured or cracked then it is possible for the interior pulpy tissue to become infected and inflamed. A root canal involves digging into the tooth with very fine tools and extracting the inflamed tissue.
Periodontics. Periodontics encompasses a variety of fairly specific treatments focused on the gums, such as treatment of gingivitis and attention to infection, inflammation or other oral tissue problems. Periodontic procedures are generally only covered by major dental plans, although you may be required to have been referred by a dentist.
How does private health insurance cover major dental and orthodontics?
Complex and major dentistry
Orthodontics
Complex and major dentistry includes intensive dental work, specifically endodontics and periodontics, prosthodontics like dentures and restorative dentistry like crowns, bridges and veneers.
These may be available with lower-level extras policies but are more likely to be covered with higher-level extras.
Your major dental insurance policy product disclosure statement (PDS) will specify the exact procedures considered to be complex or major.
Periodontics refers to treatment of the gums, including gingivitis and similar diseases. This is relatively common and important to treat but is not covered by Medicare, so check for periodontics in private health insurance policies.
Endodontics refers to the treatment of inner tooth tissue, such as root canals. These are also relatively common and important to get treated but are also not covered by Medicare. Familiarising yourself with the endodontic cover offered by a policy might be a prudent move.
Benefits payable will generally vary widely, even for the same type of treatments. A single tooth denture, for example, might pay as little as a $20 benefit, while a denture for ten teeth might pay up to $800 or more.
Complex dentistry benefits offered by private health funds will generally also include ongoing treatment, maintenance and repair of devices.
Complex dental treatments are typically more expensive than basic ones, and will generally have higher claim limits.
Orthodontics is covered by comprehensive or major dental plans. Some private health funds may have a separate dental category for orthodontics that is only available with certain dental or extras plans.
The total cost of orthodontics is typically quite high as it involves many sessions over months or even years, as well as costs for radiology, assessments, specialist consultations and more.
Some policies will have limits for orthodontics, such as a particular specialist services limit.
Orthodontic services typically have a 12-month waiting period from when the insurance is taken out.
Are there any limits or waiting periods?
Major dental benefit limits. A benefit limit is the most the insurer will pay per year, per person, per procedure and/or per policy.
For example, you may be able to claim a $50 benefit on a limit of two dental check-ups per person each year. Or you may be able to claim a maximum of $800 every three years for all denture-related costs.
Major dental waiting periods. A waiting period is the amount of time you have to wait after taking out a private health insurance policy before you can make a claim. These times vary depending on the claim and the insurer.
The typical waiting periods for dentistry are 12 months for orthodontics and complex or major dentistry, and a two-month waiting period for basic dental work.
Is there any major dental specific exclusions?
Exclusions may vary between health funds, but some you may encounter include:
No payout for claims made more than one or two years after a procedure
No benefits payable for pre-existing conditions
No cover for treatments or procedures that an independent medical professional deems unreasonable or inappropriate
No benefits for services not provided face to face, such as phone or online consultation, unless stated otherwise
No cover for cosmetic procedures without a specific condition being treated or the presence of symptoms, illness or injury
No cover if you are visiting a dentist or specialist who is not registered with or approved by your private health fund
How do I claim dentistry from my health insurer?
The claims process can vary depending on your fund and practitioner. However, here are some general guidelines to claiming:
If your dentist or specialist is associated with your health fund then they may be able to liaise directly with the insurer and arrange payment.
Most funds will provide you with a membership card, which can be swiped at your treatment facility.
You may be able to download a health insurance app to your phone which lets you claim and pay benefits on the spot.
In some cases you will be required to fill out a claims form and send it to your insurer.
Seeking cover for major dental? Compare health insurance policies with an adviser
Full list of providers who offer cover for major dental
Health fund
Policies that cover major dental services and the annual benefit limits
Find out more
Super Extras. Benefit limit of $1,100 per person.
Family Extras. Benefit limit of $750 per person.
Lifestyle Extras. Benefit limit of $750 per person and $1,500 per family.
Black 60. Shared benefit limit of $650 per person and $1,200 per family.
More info
Platinum 80%. Benefit limit of $2,100 per person.
Gold Extras. Benefit limit of $1,600 per person.
Silver Extras. Benefit limit of $800 per person.
Bronze Extras. Shared benefit limit of $600 per person.
More info
Platinum Extras. Benefit limit of $1,200 per person.
Gold Extras. Benefit limit of $1,100 per person.
Silver Extras. Benefit limit of $1,000 per person.
Your Choice Extras. Initial benefit of $500 after 2 years of retaining cover, increasing by $100 for each additional year until it caps at $1,000 after 7 years.
More info
Gold Extras. Benefit limit of $1,100 per person.
Silver Extras. Benefit limit of $700 per person.
More info
Gold Extras. Shared benefit limit of $2,000 per person.
Silver Extras. Shared benefit limit of $1,000 per person.
More info
GMHBA allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Gold Extras
Silver Extras
More info
Lots Extras Cover. Shared benefit limit of $2,000 per person and $4,000 per couple/family.
Some Extras Cover. Shared benefit limit of $500 per person and $1,000 per couple/family.
More info
GMF allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Complete Extras
Mid Extras
More info
GU Health provides specialised policies to employers to offer to their employees. If you are covered by a GU Health plan through your workplace you should speak to the relevant department to find out if they have included cover for major dental.
More info
Flexi Extras Plus. Benefit limit of $1,051 per person.
Flexi Extras Mid. Benefit limit of $900 per person.
Flexi Extras. Benefit limit of $750 per person.
Saver Flexi Extras Plus. Benefit limit of $976 per person.
Saver Flexi Extras Mid. Benefit limit of $825 per person.
Saver Flexi Extras. Benefit limit of $675 per person.
More info
HCF Platinum and Gold Extras benefit limits for major dental increase each year you retain your policy. The increase caps at year six.
Platinum Extras. Initially $900 per person, capping at $1,300 per person.
Gold Extras. Initially $600 per person, capping at $1,000 per person.
Silver Plus Extras. Benefit limit of $500 per person.
More info
All health.com.au policies except for Extras 50 must be taken out as hospital + extras cover.
High Extras. Shared benefit limit of $750 per person.
Middle Extras. Shared benefit limit of $700 per person.
Basic Extras. Shared benefit limit of $600 per person.
Simple Extras. Shared benefit limit of $500 per person.
Extras 50. Benefit limit of $750 per person.
More info
Health Care Insurance allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Premier
Active Life
More info
Gold Extras. Benefit limit of $1,000 per person.
Silver Extras. Benefit limit of $500 per person.
More info
The HIF major dental benefit will increase each year you retain your policy. The increase caps at year five.
Premium Options. Initially $1,500 per person, capping at $3,000 per person.
Super Options. Initially $1,300 per person, capping at $2,500 per person.
Special Options. Initially $1,000 per person, capping at $2,000 per person.
Saver Options. Initially $750 per person, capping at $1,250 per person.
More info
All of Latrobe Health Services' extras policies, except for Premier Silver, increase their major dental benefit limits for each year you retain cover.
Premier Gold. Initially $300 per person, caps at $1,500 per person on year six.
Premier Silver. Benefit limit of $1,200 per person after year two.
Premier. Initially $300 per person, caps at $1,000 per person on year four.
Family Care Gold. $300 per person, caps at $1,500 per person on year six.
Family Care. Initially $300 per person, caps at $1,000 per person on year four.
Dental. Initially $300 per person, caps at $1,000 per person on year four.
More info
Top Extras. Benefit limit of $500 per person.
Family Extras. Initially $400 per person, increases by $50 each year until it caps at $600 after four years of continuous cover.
More info
Five Star Extras. Shared benefit limit of $300 per person during the first year of cover, increases to $1,200 per person from year two onwards.
Dental Cover. Shared benefit limit of $300 per person during the first year of cover, increases to $1,000 per person from year two onwards.
More info
onemedifund allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Extras Plus
More info
Top Extras. Benefit limit of $1,300 per person.
Core Extras. Benefit limit of $600 per person.
More info
Premium Extras. Benefit limit of $1,500 per person.
High Extras. Benefit limit of $1,000 per person.
Mid Extras. Benefit limit of $500 per person.
More info
Top Extras. Benefit limit of $2,000 per person.
Mid Extras. Shared* benefit limit of $1,500 per person.
More info
Super Extras. Benefit limit of $1,500 per person.
More info
Top Extras. Initial benefit limit of $800 per person, increasing to $1,000 per person after three years and $1,200 per person after five years.
Healthy Choice Extras. Benefit limit of $500 per person and $1,000 per policy.
More info
Platinum Extras. Benefit limit of $650 per person.
Gold Extras. Benefit limit of $750 per person.
More info
Restricted fund*
CBHS allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Top Extras
Intermediate Extras
More info
Restricted fund*
Premier Extras. Benefit limit of $1,100 per person.
Value Extras. Benefit limit of $900 per person.
More info
Restricted fund*
Premium Extras. Benefit limit of $2,000 per person.
Healthy Living Extras. Benefit limit of $1,500 per person.
Saver Plus. Shared benefit limit of $600 per person.
Basic Extras. Shared benefit limit of $500 per person. Only covers major dental periodontics and extractions/oral surgery services.
More info
Restricted fund*
Total Extras. Benefit limits vary depending on the service. You can find the amounts for each treatment below this table.
Essential Extras. Shared benefit limit of $800 per person.
More info
Restricted fund*
SureCover Extras. Benefit limit of $1,300 per person.
More info
Restricted fund*
rt health fund allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Premium Extras Cover
Smart Extras Cover
More info
Restricted fund*
RBHS allocates varying sub-limits to each service that falls under major dental. You can find the details on each one below this table.
Extras Cover
More info
Restricted fund*
Top Extras. Initial benefit limit of $1,300 per person. Increases for each year you hold cover until it caps at $2,800 on year six.
Essential Extras. Benefit limit of $300 per person.
More info
Restricted fund*
Comprehensive Extras. Initial overall benefit limit of $3,400 per person. Increases every two years until it caps at $4,695 on year seven.
Healthy Options (60%) Extras. Shared benefit limit of $1,000 per person.
Mid Range Extras. Overall benefit limit of $1,000 per person.
More info
*Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.
Breakdown of providers who apply different sub-limits to each major dental service
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