Major Dental Insurance

*Prices are based on a single 30 year old living in Sydney earning less than $101,000 a year.

What is major dental?

Major dental is a category of health insurance you'll find in extras insurance products. The 'major' in opposed to general dental, which covers very basic dental procedures. Major dental covers larger dental procedures, while general dental mostly just covers routine dental care.

What does major dental insurance cover?

• Complex oral surgery. The exact definition of 'complex' can be hard to nail down, but many dental treatments can considered 'complex' after a certain point, especially if surgery is involved. For example, some wisdom tooth extractions are classed as major dental, despite simple extractions generally being considered general dental.
• Root canals. For example, if a tooth has fissured or cracked and the interior pulpy tissue becomes infected and inflamed, you may need root canal.
• Periodontics. This encompasses a variety of non-tooth related treatments such as treatment of gingivitis and other oral tissue problems.
• Dentures. Dentures are removable prosthetic teeth that can be fitted to replace any number of missing teeth.
• Dental crowns and bridges. These are two different but very closely related types of dental implant you may need. They act like partial fake teeth permanently installed on top of damaged existing teeth.
• Veneers. A cover of porcelain or resin that are fixed into the front of the teeth. This procedure is mainly done for changes in shape and colour of the teeth.

General dental vs major dental

Dental health insurance is split into general and major dental. Orthodontic cover and endodontic cover is also available in some higher tier extras policies.

Major dental

Major dental is covered by most mid-range extras policies. You'll have a yearly benefit limit (eg $800 or $1,500) - the more comprehensive the policy, the higher the limit. Major dental generally covers more complex procedures such as root canal therapy (endodontics), root planing, more complex fillings and non-tooth related surgery (periodontics). Major dental usually doesn't include orthodontics – you'll need to pay extra for that. Most treatments come with a 12-month waiting period.

General dental

General dental is available in most extras low and mid-tier policies, including every policy that also includes major dental. This can cover you for the basics like your 6 month exam, scale and clean, fluoride treatments, X-rays, some fillings and simple extractions.

What counts as major dental?

"I recently had a painful infection around a wisdom tooth, which I went to the dentist to fix. I was 10 months into an extras policy so was covered for general dental, but not major dental. Interestingly, while the the general checkup costs were covered, I wasn't covered for the specific infection of the gum. Gum work is classed as periodontics, so covered under major dental. If I had needed to get my wisdom teeth out it would have been really interesting, as one is partially covered by gum so would probably have needed a surgical extraction. That means 3 of my teeth would have been covered under general dental, but the last only with major dental. Luckily that wasn't needed...this time!"

Tim Bennett

Insurance expert

Major dental waiting periods and claim limits

Major dental treatment comes with a 12-month waiting period most of the time. Occasionaly there might be a specific treatment with a longer waiting period - this will vary between funds.

This means you need to hold cover for a year before you can start claiming on treatments like endodontics, root planing and periodontics. Basic dental usually comes with a two-month waiting period.

Major dental benefit limits

A benefit limit is the most the insurer will pay per year, per person. Most mid-range major dental insurance policies come with a $500 to $800 limit, though some more comprehensive policies will give you $1,000 or more. In some cases, sub-limits may apply for specific treatments, such as periodontics.

Here are the benefit limits you'll commonly see with extras insurance:

• 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.

Frequently asked questions

• Can I get major dental with no waiting periods?

  No, all major dental cover policies come with a 12-month waiting period. However, you don't have to serve waiting periods for chiro, general dental and optical with some extras policies, such as ahm Lifestyle Extras.

• Does major dental cover wisdom teeth removal?

  Wisdom teeth removal is typically covered by general dental if it's a simple extraction. However, if the tooth need a surgical extraction, you'll probably need major dental. That might mean some of your wisdom teeth will be covered by different treatment categories. It's also worth noting this varies between fund, so check with your insurer to be sure.

• What is classed as major dental?

  Root canal, periodontics, crowns, bridges, veneers and dentures all generally come under major dental, though this can vary slightly between insurers.

• Does major dental cover periodontics?

  Yes, major dental usually covers periodontics. This can include a wide range of gum-related treatments.

• What does major dental not cover?

  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

• Does Medicare cover dental?

  No, Medicare doesn't cover dental. Honestly it probably should, but it's a whole thing. Anyway that's why many Australians take out extras cover in the first place. That said, some state schemes offer some cover for folks on concession cards, or for children.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Gary Ross Hunter

Journalist

Gary Ross Hunter has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio

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