What is no gap dental? Find out how you can save on dental with help from your health fund.
Dental work can be expensive, so in order to avoid costly payouts, many funds offer “no gap” dental services to encourage their members to maintain healthy teeth. This guide looks at what no gap dental is, what it covers and which health funds are offering it to their members.
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How does no gap dental work?
If a medical practitioner charges a fee that is higher than the Medicare Benefit Schedule (MBS) fee for that service, “the gap” is the difference between what they charge and the MBS fee. This gap is either paid by your health fund, if applicable, but if not it becomes an out-of-pocket expense for you.
In the case of dental treatment, which is not covered by Medicare and thus not listed on the MBS, the medical gap is the gap between what the dentist charges and what your private health insurance extras policy will pay.
A no gap dental scheme is one where a health fund agrees to cover the medical gap as long as the member goes to a preferred dentist or clinic with which the health fund has an arrangement. In return for increased business, the dental practice charges set fees that have been agreed upon with the health fund.
What types of services are included in no gap dental?
As no gap dental is aimed at reducing the need for expensive dental treatments later in life, the services that health funds pick up the tab for include basic preventative treatments such as:
- Initial check-ups
- Scale and clean
- Basic fillings
- Topical fluoride treatment
- Preventative examinations
- Custom mouth guards for protection during contact sports
These kinds of treatments can prevent bigger dental problems from developing later on and by making them more accessible and affordable for members, health funds are effectively insuring themselves against future losses.
Which health insurers have a no gap dental scheme?
The following table lists the health funds that do and don’t offer no gap dental to their members.
|Fund||What’s covered?||More info|
|Australian Unity No Gap Dental services offer eligible members preventative dental treatments at no out-of-pocket cost up to a set yearly limit from providers chosen by Australian Unity.||More info|
|HCF’s More for Teeth program provides eligible members with a range of fully covered diagnostic and preventative dental services for the whole family. This program is available through over 7,000 participating dental providers across Australia.||More info|
|nib Extras cover provides eligible members with 100% of any cost back for dental check-ups at nib Dental Care Centres. Each check-up includes an examination, scale, clean and fluoride treatment (excludes dentures).||More info|
|Transport Health members are eligible for No Gap Dental at Primary Dental CentresIncluding two check-ups per person per year, two scale and cleans per person per year and one fluoride treatment per person per year.||More info|
|Eligible CBHS members are completely covered for selected preventative dental services including check-ups, scales, cleans and fluoride treatments at any CBHS Dental Choice Network Provider.||More info|