What Does Dental Insurance Actually Cover in Australia?
General vs major dental, annual limits, benefit percentages — everything decoded.
Australian dental insurance divides cover into two buckets: General Dental (the everyday stuff) and Major Dental (the expensive stuff). Understanding what's in each — and how benefits are calculated — is essential before you buy.
General (basic) dental
- •Examinations and check-ups: Usually 2 per year
- •Scale and clean: Typically 2 per year
- •Fluoride treatments: Most policies
- •X-rays: Periodic x-rays included; annual limits apply
- •Fillings: Usually covered at 60–80% of benefit
- •Simple extractions: Covered; surgical extractions may be major dental
- •Mouthguards: Often included at low benefit
Major dental
- •Root canals: 12-month waiting period common
- •Crowns and bridges: 12-month waiting period; $1,500–$2,500 limit typical
- •Dentures: 12-month waiting period
- •Orthodontics: 12–24 month waiting period; lifetime limit up to $3,000
- •Implants: Often excluded or very limited
- •Periodontal treatment: Gum disease treatment — check your PDS
How benefits are calculated
Most insurers pay a percentage of their own benefit schedule (not the dentist's actual fee). If your dentist charges $350 for a filling but the insurer's schedule says $220, you'll be paid 70% of $220 = $154 — leaving a gap of $196.
Tip: use a dentist in your insurer's preferred network (like Bupa's Members First or HCF's More for Teeth) to minimise or eliminate the gap.
Key term
The 'gap' is the difference between what your insurer pays and what the dentist charges. Always ask your dentist for an itemised quote before treatment.
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