Extras cover pays benefits towards dental services, and usually has annual limits, waiting periods. Different levels of Extras cover will include different dental treatments. Let’s start with waiting periods.
Waiting periods
All health funds have waiting periods. In short, a waiting period is how long you need to wait after taking out your cover before you can receive benefits for services or items covered. You aren’t able to claim on treatments you receive during this waiting period. Your cover description has a full list of all the waiting periods.
If you’ve switched to us within 30 days of leaving another fund, we’ll recognise any waiting periods you served with them once we’ve got your transfer certificate (as long as you were on a similar or higher level of cover).
Call us on 1800 808 690 (Peoplecare members) or 1800 808 700 (non-members) for details.
Following is an outline of our waiting periods.
| Waiting period | Hospital cover |
|---|---|
| No waiting period | Hospitalisation related to an accident |
| No waiting period | Services covered by your old fund (if you transfer straight to a similar level of cover with us and have already served your waiting periods) |
| 1 day | Ambulance |
| 2 months | Health programs |
| 2 months | Hospital substitution programs |
| 2 months | Rehabilitation, psychiatric services and palliative care (even for pre-existing conditions) |
| 2 months | All other services, except for those listed below |
| 2 months | Assisted reproductive services |
| 12 months | Pregnancy and birth |
| 12 months | Pre-existing conditions (except rehab, psych and palliative) |
Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.
| Waiting period | Extras cover |
|---|---|
| No waiting period | Services covered by your old fund (if you transfer within 30 days to a similar level of cover with us) |
| 1 day | Ambulance |
| 2 months | General dental, pharmacy, physiotherapy, chiropractic, podiatry & complementary therapies |
| 2 months | Pre/post-natal services |
| 2 months | All other services, except for those listed below |
| 6 months | Optical |
| 6 months | Health management programs |
| 12 months | Midwifery |
| 12 months | Major dental |
| 12 months | Orthodontics |
| 24 months | Laser eye surgery & hearing aids |
If you're upgrading your extras cover, waiting periods still apply for the services that you weren't previously covered for.
Transferring from another fund? Switching is easy
We can’t speak for other health funds but switching to Peoplecare is simpler than you think. It takes around five minutes and you can switch online or over the phone.
Don’t worry, if you’re transferring from another health fund we’ll make sure we recognise any waiting periods you’ve already served if you switch within 30 days! Plus, if you’ve only served part of a waiting period, say, 2 months of a 6-month waiting period, you’ll only need to serve the remaining 4 months when you transfer to Peoplecare.
If you’re upgrading your cover, waiting periods still apply for the services that you weren’t previously covered for.
Peoplecare upgrade example: You have Simple Extras cover (which only has general dental coverage) for 12 months and you upgrade to Mid Extras, you’ll still need to wait another 12 months before getting major dental treatment that you can claim on your cover.
| Dental category | Waiting period |
|---|---|
| General dental | 2 months |
| Major dental | 12 months |
| Orthodontics | 12 months |
What's on general dental and major dental?
| Service | Description |
|
Treatment for or relating to your teeth provided by a dentist or a dental surgeon. Typically this includes check-ups, cleans, and simple fillings. |
| Service | Description |
|
Significant dental services, such as complex fillings, tooth extractions, crowns and bridges. |
|
Specialised dental treatment relating to dental pulp. This includes treating tooth pain and root canal treatment. |
|
The branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities. This generally involves the use of braces, removable appliances, functional appliances or headgear. |
Dental inclusions and exclusions: Peoplecare extras covers
| General Dental | Major Dental | Orthodontics | Orthodontic Lifetime Limit | |
|---|---|---|---|---|
| Premium Extras |
80% $1,500 per person annual limit |
80% $1,500 per person annual limit |
80% up to $1,000 per person annual limit |
$3,000 |
| High Extras |
70% $1,000 per person annual limit |
70% $1,000 per person annual limit |
70% up to $800 per person annual limit |
$2,400 |
| Flex Up Extras |
60% |
60% |
No |
No |
| Mid Extras |
60% $750 per person annual limit |
60% $500 per person annual limit |
No |
No |
| Flex Essentials Extras |
60% |
No |
No |
No |
| Simple Extras |
50% $500 per person annual limit |
No |
No |
No |
Dental inclusions and exclusions: Closed Peoplecare extras covers
These covers are no longer available for sale. Existing members can remain on these covers and use their benefits as normal.
| General Dental | Crowns & Bridges | Dentures | Implants | Orthodontics | Orthodontic Lifetime Limit | |
|---|---|---|---|---|---|---|
| Comprehensive Extras |
Set benefits No annual limit |
Set benefits $1,000 per person
|
Set benefits $650 per person |
Set benefits $1,000 per person |
80% of cost |
$2,100 |
| Loyalty Limits - for Comprehensive Extras* |
No annual limit |
$1,500 per person |
$840 per person |
No |
80% of cost |
$2,600 per person |
| Value Extras |
75% $550 per person annual limit |
No |
No |
No |
No |
No |
| Standard Extras |
60% $500 per person annual limit |
No |
No |
No |
No |
No |
* Loyalty Limits apply after five years of continuous Comprehensive Cover for Crowns & Bridges, Dentures and Orthodontics.
How does Peoplecare’s annual limit work?
Extras annual limits reset 1 July every year at Peoplecare. Many other health funds reset their annual limits 1 January every year.
Are there differences between health funds and their extras covers?
Yes there are, we've summarised a few below:
- Hard to compare
Extras covers, unlike hospital covers, aren’t standardised by the government into different tiers of cover. So, you can get different benefit percentages, annual limits, inclusions and exclusions from fund to fund. That makes comparing covers challenging, so we’re here to help you out.
- General dental
Some health funds may provide very few services with their general dental category. Peoplecare includes benefits for what you’d expect like preventative check-ups and X-rays, as well as things you might not get elsewhere like basic restorations, basic surgery and extractions.
- Your own dentist
Some extras covers only give you top benefits at the health fund’s affiliated dental clinics. At Peoplecare, you get the same benefits no matter where you go, so you can keep your own family dentist who you know and trust.
Does Centrelink pay dental costs?
Youth: There is a federally funded dental scheme called the Child Dental Benefit Schedule for people aged between 2 and 17 years of age. You can read more about it here.
Adults: Australians aged 18 and older on a Centrelink Pension Concession or Healthcare card may be eligible for dental care through the various state government dental schemes, although in places like ACT, dental services may involve out-of-pocket costs. Visit the Department of Health for the full listing.
Can I claim orthodontics?
Yes, orthodontics claims are available on our highest two levels of cover. It’s worth reading about how it works in our detailed orthodontics claiming guide.
How much does dental treatment cost?
We all know that going to the dentist can be pricey. The latest government figures show the median charges by dentists in Australia as:
| Common check-up services | Median charge |
|---|---|
| Comprehensive oral examination: dental item no 011 | $59 |
| Periodic check-up: 012 | $53 |
| Removal of plaque and tartar (the cleaning part): 114 |
$105 |
| Application of fluoride: 121 | $32 |
| X-ray (single – up to 3 teeth): 022 | $41 |
* Australian Institute of Health and Welfare, using figures for 2017-18. Median means that half of the people paid more for these services.
An example of how Peoplecare extras works in a dental check-up
So, you’ve served your waiting periods and go to the dentist for your first preventative dental check-up of the year. This is called a comprehensive oral examination.
Figures in this example use the median figures above for:
- 1x comprehensive oral exam
- 1x clean
- 1x fluoride
- 2x X-ray
Total cost without extras cover = $278
Check-up example with Peoplecare extras covers*
| Premium Extras | High Extras | Mid Extras | Simple Extras | |
|---|---|---|---|---|
|
Peoplecare covers |
$222.40 |
$194.60 |
$166.80 |
$139.00 |
|
Out of pocket |
$55.60 |
$83.40 |
$111.20 |
$139.00 |
*Example is illustrative only.
Did you know about the Peoplecare combined Hospital and Extras cover discount?
Get a 10% discount off any Peoplecare Extras cover when combined with any Peoplecare Hospital cover.
Are you near Peoplecare Optical and Dental in Wollongong?
Peoplecare Optical and Dental is our one stop optical and dental store located in the heart of Wollongong. As a Peoplecare member with Extras cover you'll get no gap preventative dental*. But if you don’t have extras cover, don’t worry, All Peoplecare members have lower out-of-pocket costs^ thanks to our 10% member discount on all dental services.
*‘No gap’ means there are no out-of-pocket costs on a selected range of dental treatments (as long as your annual dental limit hasn’t been used). Preventative dental covers consultation, scale and clean, X-rays and fluoride.
^Lower out-of-pocket costs for dental means that the schedule of dental fees is discounted for Peoplecare members. Pricing structures are reviewed regularly and are subject to change without notice. Not available with any other product discount or special offers.