This is an important question you need to ask yourself before deciding to take out private health insurance in Australia or before travelling and taking cover for your trip.
Does Health Insurance Cover Emergency Appointments?
Government-provided dental insurance does not exist in Australia. The best way to be insured for dental services is to get a private health insurance cover. Private health insurance providers can cover general dental services such as oral exams, fillings and scale and cleans. General services are available if you get an extras policy, which basically insures you for out-of-hospital care. Extras policy is also called ancillary cover or general treatment. An extras policy also shoulders major dental procedures or surgery, which include gum disease treatment and veneer placement. And, with the same extras policy, you can also be insured for orthodontic and endodontic services. Orthodontic services include treatment for jaw and facial irregularities, while endodontic services include treatment of tooth decay and damage.
Cover for dental services through a private health insurance policy is helpful. However, it is important to note that the number of benefits you are eligible depend on the level of cover you will avail. Also, there may be out-of-pocket expenses for dental treatments, but you can expect that your policy can cover the expenses partially or fully. Below you can find common treatments and their respective prices as of 2014.
|Treatment||Cost (Natural Average)|
|Periodical oral examination||$53.11|
|Radiograph (per exposure)||$41.57|
|Removal of plaque and/or stains||$56.96|
|Removal of calculus (first visit)||$104.22|
|Fissure sealing per tooth (i.e. fillings)||$51.51|
|Oral surgery (e.g. tooth removal)||$158.99|
|Full crown – veneered – indirect||$1,441.01|
The prices are not exact, but they can give you an idea on how much you should pay, whether partially or fully, or how much will be deducted from your dental policy fund. According to comparemarket.com.au, 77% of Australians that had dental cover still paid for some of their treatment. The reason behind it is that there are expenses that go beyond the limit set by the health insurance provider. Make sure to know the amount of dental cover per procedure which your provider offers to give back.
What Is Annual Limit?
Annual limit is a set amount of fund that a health insurance provider allocates for each dental treatment. It is called annual limit because the fund allocated for each treatment replenishes every year. There are treatments, especially expensive treatments such as orthodontics that have lifetime limits. It is important to note that there is a waiting time before the claiming of dental benefits begins, and the length of waiting time is set by the health insurance provider. To give you an idea, here are examples of usual waiting periods for general dental service that has been published by the Private Health Insurance Ombudsman:
- General dental services – 2 months
- Major dental procedures (crowns, bridges, etc.) – 12 months
- High cost procedures – 2 to 3 years
Overseas Insurance for Dental Emergencies
Make sure to read the fine print before taking out any travel insurance to be sure that dental is included. To be clear, you’re not going to pop into the dentist for a routine checkup while on vacation, the only reason you’ll be there is an emergency or if you’re in pain. This could be expensive so it pays to ensure you’re covered for unexpected dental mishaps or plain bad luck. Most health insurance plans should cover dental, but if you’re buying the cheapest be sure to read the fine print.
How to Get the Right Health Insurance Provider
The first thing you need to do is to compare the extras policy offered by different health insurance providers. Check whether you are amenable to the amount each provider is willing to reimburse for each dental treatment in comparison to the typical price of the treatment. Also, check other benefits that you can use.
Contracted Provider Agreements
Contracted provider agreements allow you to know the cost of a treatment prior to coming to the health fund dentist. Check whether a health insurance provider offers the agreements. With contracted provider agreements, you have the benefit of transparent pricing before seeing the dentist, as well as pay lower charges because of better negotiation and get quality dental services by having access to patient reviews.