No gap dental

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.

Normal dental cover: Most dental policies have your insurer pay a set percentage or dollar figure toward each treatment. For example, a policy might pay 60% of the cost of a policy, or a set $30 for a scale and clean. You'll have to pay the rest, a cost called the 'gap' payment.

No gap dental cover: If your policy boasts no gap dental, you provider pays 100% of the treatment, so there's zero gap to pay. The catch is no gap dental is typically only for basic treatments, and 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 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.

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.

Frequently asked questions

• What is a gap payment?

  Private insurance doesn't cover the entire cost of every treatment, leaving you with a 'gap' to pay out of pocket. These gap payments, or out-of-pocket payments, vary a lot depending on which treatment and health fund you are using. Generally, more comprehensive policies will result in smaller gaps - but not always!

• What does no gap mean?

  If your health fund is advertising a "no gap" treatment, it means you wont' have to pay an out-of-pocket cost for that treatment - the health fund will cover the whole bill. This is generally only available on a few select treatments, and you'll generally need to use a provider within the insurer's network.

• How does no gap dental work?

  If your insurer is offering no gap dental, you'll first need to book an appointment with a dentist that is part of your health fund's network. You fund will then pay the entire cost of the covered treatments. This generally happens in the background, without you having to pay and then claim later. No gap dental typically only applies to basic dental treatment, so if you need anything more complex in your appointment (like a weird filling, for example) you may need to pay a gap for that.

• Is no gap dental worth it?

  No gap dental is generally a great deal, assuming you're happy to use a dentist from your provider's network. It helps you get more back from your extras cover, and makes it more likely that you'll get regular dental appoitments, which is a really key step you can take to improve your overall health.