No gap dental

Compare health funds with no gap dental cover

Finder Score - Health Insurance Extras

Each month we analyse over 10,000 extras insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare extras cover a bit faster.

We want to compare apples to apples, not apples to apple pie. It doesn't make sense to compare a top extras policy with coverage for hearing aids and braces against a policy designed only for dental. So we've separated all the extras policies on the market into pools and categories. Once in their pools and categories, each product gets a price score and a features score, which are then combined to give the Final Score.

Read the full Finder Score methodology

What is no gap dental?

No gap dental is a type of dental health cover where your insurer agrees to pay 100% of the cost for certain dental treatments if you use a dentist in their network.

The way most dental policies work is that your insurer will agree to pay a specific percentage of the cost toward treatments covered by your policy. For example, your policy might pay 60% toward dental work whether it's something simple like a cleaning or something more complex like a root canal.

You're responsible for the additional 40%, and this out-of-pocket expense is called your gap.

If your policy includes no gap dental, your 40% contribution will be waived - leaving you with nothing left to pay. But again, it's only for certain treatments and it's only available if you use a dentist in your insurer's network.

Which funds offer no gap dental schemes?

Most of Ausrtalia's big health funds offer 1 or 2 free dental checkups a year if you see a dentist in the fund's network. This includes funds such as Bupa, HCF, ahm, Medibank, HBF, nib and AIA.

Many smaller funds also offer no gap dental checkups, including Peoplecare, Teachers, Australian Unity, Defence, RT Health, TUH and more. Check the details of any policy you're considering to be sure what you can get.

What types of services are included in no gap dental?

No gap dental schemes focus on preventative procedures so that insurers don't have to shell out the big bucks for expensive procedures down the track.

No gap policies commonly cover the following preventative treatments:

Even if your overall dental policy covers more complex treatments like root canals, crowns and implants, they won't be part of the no gap scheme and you'll have to pay the gap on those treatments.

How does no gap dental work?

To take advantage of your insurer's no gap dental benefit, you'll need mid-tier or comprehensive extras cover. You may also need to see a dentist within your health fund's partner network. Each insurer will have a similar set of guidelines, but they can differ in the details.

Generally speaking, here's how to avoid your dental gap:

• You must use a dentist in your insurer's network. Your insurer can only offer this deal because they've negotiated a special rate with specific dentists. That means you have to see one of the dentists in this network or else you'll have to pay your gap.
• The treatments must be covered by the no gap policy. Most insurers with no gap dental include a similar set of covered treatments, but there may be some minor differences. For example, not every insurer will cover mouthguards, x-rays and fillings as part of a no gap policy.
• You can only claim a certain number of times per year. Most insurers will limit the number of times you can claim for certain treatments. For example, you might be limited to only 1 or 2 no gap check-ups and cleans per year.

What types of services are included in no gap dental?

No two no gap policies are the same, so you'll want to keep the following in mind:

• Does it cover the services you need? Not every insurer will pay for all the same services. For example, some will cover mouth guards and others won't. Make sure it has the benefits you need.
• Is there a participating dentist near you? To take advantage of your no gap policy, you need to visit a dentist who already has an arrangement with your insurer. A no gap policy won't do you any good if the nearest participating dentist is 200km away.
• Is the benefit limit high enough? Your no gap dental cover will come with a benefit limit. The insurer will continue to pay the dentist for your covered treatments until you hit this limit, and you’re responsible for everything after that. So make sure your limits are high enough to cover what you’ll need throughout the year.

What if you need additional treatment?

If you need treatment above and beyond what's covered by your no gap policy, you'll still get the no gap treatments covered at 100%. However, you will have to pay the gap for the additional treatments or pay for the entire cost of those treatments if your policy doesn't cover them.

Let's say you visit an in-network dentist for a check-up and a clean, but during the visit, the dentist notices a cavity that can only be filled with a complex filling. Most no gap policies will cover the check-up and clean at 100%, but will not cover the complex filling.

You'll walk out of the dentist's office paying nothing for the check-up and clean, but you will have to pay something for the filling. If your policy covers complex fillings, you'll pay the gap after the insurer pays its share (often around 60%). If it doesn't cover complex fillings, you'll pay 100% for that treatment and that treatment alone.

How to get the most out of your no gap dental policy

No gap dental benefits can certainly make a dental policy more attractive, but it won't automatically make it the best health insurance policy for you. Before you choose a policy based on this feature alone, it pays to make sure it is right for you. Here's what to look out for:

• Make sure there is a no gap dentist near you. You can usually search insurers' websites for a list of dentists in your insurer's network.
• Look at what's covered. Not all no gap policies are created equal. If you have cavities, you might want to find one that covers fillings.
• Understand how it affects your benefit limits. Some policies deduct no gap treatments from your benefit limits, while others don't.