Private Health Fund Dental Extras Comparison

Dental care is one of the major health services which is not covered by Medicare. To combat this, all private health funds include dental in their Extras cover. Our team took a closer look at some of Australia’s major private health funds and compared the benefits they offer for dental services.

Dental Covered by Medicare

The Child Dental Benefits Schedule (CBDS) is a scheme organised by the Government through Medicare. It gives eligible children aged between 2 and 17 access to $1,000 worth of basic dental services over a 2-year period. Learn more about the CDBS here.

Private Health Fund Members & Coastal Dental Care

Our Coastal Dental Care practices offer a No Gap check-up and clean for all private health fund members with available dental extras cover. This means, you won’t have any out of pocket costs if you have benefits available. For patients without private health fund, our check-up and clean is $125.

Private Health Funds – Dental Extras Comparison

Health
Fund
Extras
Period
Fortnightly
Cost*
Cover Name
ahm Financial
Year
$58.70 Bronze
bupa Calendar
Year
$50.70 Lite hospital, Your Choice extras 60
CBHS Calendar
Year
$50.94 Basic Plus Hospital with
Intermediate Extras
HCF Calendar
Year
$56.25 Bronze Plus Hospital with
mid extras
medibank Calendar
Year
$48.40 Bronze Everyday &
Healthy Start Extras
nib Calendar
Year
$58.35 Bronze Plus

* All prices based on enquiries for female under 30 in QLD with income below $90,000/year and $750 hospital excess, enquiry date: 29/4/2019

Below we compare the 6 major health funds – ahm, bupa, CBHS, HCF, medibank and nib. In the table below, you can see the prices for each private health cover. All prices are based on enquiries for female under 30 in QLD with income below $90,000/year on 29/04/2019. They all include bronze hospital cover with a $750 hospital excess as well as an intermediate/bronze range of extras cover. 

Each health fund has different annual limits for general dental and major dental. The selected policies for HCF and Medibank have a combined limit for general and major dental of $500 whilst ahm, bupa, CBHS and nib have two separate category annual limits ranging from $500 to $750 per year. Interestingly, in total they all add up to similar amounts. For bupa and nib they have a limit of $1,200 per year, ahm pays a maximum of $1,250 for general and major dental whilst CBHS’s maximum benefit payment for preventative, general and major dental is up to $1,430.

Extras Benefits Claims

Ahm, bupa and HCF pay a fixed or variable dollar amount on the total price of the treatment. If your scale and clean is, for example $80, ahm will pay $74.45 whilst bupa would pay $28.50. This would leave you with a gap payment of $5.55 if you were with ahm or $51.50 with bupa. At Coastal Dental Care, we wave this gap payment for you if you are within your annual spending limits.

Other health funds such as CBHS, medibank and nib offer a payment of a fixed percentage of the treatment price. If you visit a preferred provider, you will receive between 60% to 70% back on the treatment items listed in the Dental Benefits in the table below.

This means if you are with nib, you would receive 60% of the $80 scale and clean costs back from nib which equals $48. The result is a gap payment of $32. Since you are with a private health fund and have available dental extras cover, all Coastal Dental Care practices would wave this gap for you. This means, for this treatment you would have no out of pocket costs.

Coastal Dental Care & Preferred Provider Status

All Coastal Dental Care practices are part of the nib first choice network. Please check the individual practice pages to find out if the location is preferred provider for bupa, CBHS, HCF and medibank.

The major dental category usually covers more extensive treatment items such as crowns, root canal treatment, and dentures.  

Dentures are partly covered by ahm, bupa, HCF and medibank. In contrast to all the other limits, with ahm, bupa and HCF dentures don’t have an annual limit but the limits renew only every three years.

Ahm, bupa, CBHS and nib have also included orthodontic treatment in their Bronze extras cover with annual limits ranging from $350 to $700. However, all funds have a lifetime limit of $1,300 up to $1,800.

Treatment ahm Bupa CBHS HCF Medibank nib
General dental
annual
limit
$500 $700 Preventative:
$230
General: $500
Total
limit:
$650
Total
limit:
$500
$600
Periodic oral
exam
$34.65 $14 70% $32-$73 60% 60%
Scale &
clean
$74.45 $28.50 70% $36-$62 60% 60%
Fluoride treat-ment $25.50 $14.50 70% $27 60% 60%
Surgical tooth
extrac-
tion
$99 $62 70% $
157-250
60% Under
major
dental, 60%
Major
dental
annual
limit
$750 $500 $700
(crowns and
bridges)
Combined
dental
limit
Combined
dental
limit
$600  
Fully
veneered
crowns
$510 $500 70% Placing
crowns+ bridges$238-
$600
60% 60%
Root
Canal
$120.55 (limit: $600) $125
(annual limit: $500)
70%
(annual limit: $400)
$27- $248 60% 60%
(annual limit: $600)
DentureFull set
every 3years
Once
every
3 years
Not incl.$25-600(limits
renew
every 3years)
60% No data
Annual
limit
ortho-
dontics
$600
(lifetime $1,800)
$450
(lifetime $1,300)
$700
(lifetime $1,400)
Not incl.Not incl. $350
(lifetime $1,500)

Restrictions on Dental Extras

In addition to the annual limits, some health funds also have restrictions on services. Ahm, for example, allows patients a maximum of two examinations, three scale and clean appointments and two fluoride treatments per year. HCF has a similar policy allowing a maximum of two check-ups, 2 scale and clean and one fluoride treatment a year.

Please be aware that there are several other policies offered by all private health funds. We recommend undertaking research using your specific details and situation to determine the best private health fund policy for you.

Ask your Health Fund

Before commencing any extensive treatment, we always recommend contacting your private health fund. During your consultation with your Coastal Dental Care dentist, you will receive an itemised treatment plan. The item numbers will help your health fund to exactly determine how much you can claim under your policy.

You can also book your consultation or No Gap check-up and clean appointment at one of our Coastal Dental Care practices online 24/7. If you have any questions, please don’t hesitate to contact our friendly team members at our practice locations.

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