How dental insurance works

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 – these apply to all health funds

Nobody loves waiting. But all health funds have waiting periods to protect their whole membership from ‘hit-and-run’ claims from new members, or people who might join a health fund to claim after the event. Sort of like trying to get car insurance after you’ve already had an accident. (We know you wouldn’t do that, but there are some people out there who do!)

Any waiting periods you have served when transferring from a similar level of cover within 30 days will be recognised. When upgrading your cover, waiting periods still apply if your new level of cover has higher benefits or covers more dental treatments.

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

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 All other services, except for those listed below
2 months Upgrading your cover
2 months Health programs
2 months Hospital substitution programs
2 months Rehabilitation, psychiatric services and palliative care (even for pre-existing conditions)
12 months Pregnancy and birth
12 months Assisted reproductive services
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 straight to a similar level of cover with us)
1 day Ambulance
2 months All other services, except for those listed below
2 months General dental, pharmacy, physio, chiro, podiatry & natural therapies
6 months Optical
6 months Health management programs
12 months High cost dentistry
12 months Pre/post-natal services (including midwifery)
24 months Laser eye surgery & hearing aids

Please note that not all items are listed and other waiting periods may apply. Please contact the fund for more information.

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.

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
per person

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
per person

Mid Extras

60%

$750 per person annual limit

60%

$500 per person annual limit

No

No

Simple Extras

50%

$500 per person annual limit

No

No

No

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!

  • 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. In dental speak, 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 Peoplecare’s combo discount?

Get a 10% discount off any Peoplecare Extras cover when combined with any Peoplecare Hospital cover. Sweet!

Are you near our one-stop dental and optical store in Wollongong?

Get a whole swag of discounts for Peoplecare members and top-quality care. Read more.