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