Dentist doing a dental treatment on a female patient

No gap dental

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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Details Features
Active Life Extras
Active Life Extras
Straightforward extras that covers you for vital out of hospital services while keeping premiums low. Treatments include general dental and optical, as well as healthy lifestyle benefits.
  • $500 general and major dental combined limit
  • $400 chiro and osteo annual limit
  • $400 physio annual limit
  • $400 alternate therapies annual limit
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Extras 50
Extras 50
With the Extras 50 policy health.com.au will pay 50% of the provider's fee.
  • From $10.58 weekly
  • 50% back on extras
  • Unlimited emergency ambulance transport cover
  • $500 general dental limit
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Super
Super
Super Extras is the highest level of extras cover available from AHM and provides cover for services ranging from major dental to diet and nutrition to health improvement benefits.
  • No family limits
  • Orthodontics
  • Outpatient care
  • Pre and postnatal
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Premium Options
Premium Options
Premium extras cover for all everyday healthcare services. Save 4% when you pay for 12 months of your cover upfront.
  • Dental and chiropractic cover
  • Osteopathy and optical
  • Occupational therapy
  • Orthoptic
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Platinum 80%
Platinum 80%
Platinum 80% provides you with 80% back on all included extras.
  • Claim up to $8500 on extras
  • General, complex and major dental and orthodontics
  • Pharmacy
  • Travel vaccinations
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Top Extras
Top Extras
Comprehensive extras cover that includes a wide range of non-hospital related treatments and services. Restricted fund: Only current and former employees of the Commonwealth Bank of Australia Group and their eligible families can join.
  • Generous overall limits on services
  • Major dental including orthodontics
  • Unlimited preventative dental
  • Hearing aids
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Gold Extras Set Benefits
Gold Extras Set Benefits
Top level extras cover including cover for a wide range of popular services including orthodontics, physiotherapy and optical.
  • Podiatry
  • Nursing
  • Pressure garments
  • Weight loss program
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Platinum Extras Cover
Platinum Extras Cover
Top level extras cover with highes range of cover for therapies and serivces.
  • 100% back on up to 2 dental visits per year
  • 100% back on initial chiro, physio, osteo
  • General therapies cover
  • Vaccinations and immunisations cover
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Top Extras
Top Extras
NIB's premier extras cover with up to $1,000 in General dental covered annually and cover for a range of therapies including Chiro & Osteo.
  • $1,000 general dental cover annual limit
  • $600 physiotherapy annual limit
  • Unlimited ambulance cover
  • $350 optical annual limit
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Top Extras
Top Extras
Top level extras cover with highest percentage back.
  • 60 - 100% back
  • $800 dental annual limit per person
  • $850 physiotherapy annual limit per person
  • $300 optical annual limit per person
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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
  • X-rays
  • 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.

FundWhat’s covered?More info
Australian Unity health insuranceAustralian 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 health insuranceHCF’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 Logonib 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 insuranceTransport 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
CBHS health insuranceEligible 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

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Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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