Please Help Me Understand The Math behind Health Insurance Cover (Dental Extras in Particular)

ClioB on 30/04/2022 - 11:43
Last edited 30/04/2022 - 11:44

Hi all, very new to this stuff and could use the help.

Say for instance I have an extra cover of 60% each visit with a yearly limit of $1,000 on major dental, and my dentist quotes me $1,600 for a crown.. what does the math looks like here?
Is it 1600 * 0.4 = $640 out of pocket?
Or
1000 (the yearly limit) * 0.4 + the excess (600) = $1,000 out of pocket?

Trying to weigh if I should get a cover or not. I need some basic + major work done and will also take into account the waive period etc etc. but trying to get my math right first on the actual procedures. Are there any other gotchas I need to consider here?

TIA

Health & Beauty Health Insurance Insurance

Comments

  • Ocker on 30/04/2022 - 11:54
    +6

    Dentist charges $1,600, you can claim 60% = $960. Leaves you with the ability to claim $40 in the future and this will take you to your $1,000 payout limit for the year.

    Just make sure there are no sub-limits in the $1,000 for major dental.

    • wei13 on 30/04/2022 - 11:56
      +1

      This.

      Also usually wait period of 12 months for major dental.

    • ClioB on 30/04/2022 - 12:18

      Thanks!

      • Hugh G Rection on 30/04/2022 - 17:10
        +3

        once you factor in your weekly premiums, its cheaper to just pay out of pocket. I wanted to get dental coverage for my daughter to get braces. after i calculated my premiums and what they cover, it was cheaper to just pay out of pocket for it. not to mention i had to wait 12 months to use the dental coverage, so i am paying 1 year for nothing, and continue to pay that premium for 2 more years for the braces to finish. so 3 years of premiums and only paying a partial amount for the braces = ripoff.
        so instead i just got it financed through the dentist and just pay every month when she gets her braces tightened for the next 2 years.

    • Ozbfan on 30/04/2022 - 14:10

      I think you’d find the sublimits would screw you over Well before you get to the maximum.
      In my opinion hospital insurance is like a proper insurance you pay money so that if you need very expensive surgery you can afford to get it done.
      Extras isn’t really the case, you just pay some money and you get a little bit of money back not exactly anything that’s gonna send you broke. For this reason I have decent hospital cover and very minimalist extras because the benefit on the minimalist extras outweighs the annual premium. If there wasn’t this annual return on investment for me I would ditch extras.

  • RiseAndRuin on 30/04/2022 - 12:17
    +2

    My math is… I do it overseas, price and quality are far better than what you get here.

    • ClioB on 30/04/2022 - 12:18

      Can you recommend a place? I was considering this option

      • RiseAndRuin on 30/04/2022 - 12:20

        I visited my family in Rome at the end of January and had a crown done there, but a lot of people do it in Thailand as it's even cheaper. It depends on where you want to go on holiday ;)

      • Islund on 30/04/2022 - 13:22
        -1

        Fiji. Most private dentists are NZ trained. Some of the NZ dental schools are rated way higher than Australian.

        A crown will set you back about $500 AUD.

        $1,000 AUD will get you there with accomodation and food thrown in for about a week.

        Crowning holiday win-win!

      • DonZarrar on 30/04/2022 - 17:53
        -2

        India, I am from India so I know there are good dentists there .

  • freefall101 on 30/04/2022 - 13:31
    +1

    I haven't seen an insurer waive major dental (they waive dental, but not major dental).

    I also haven't seen an insurance policy that is actually worth getting either when it comes to extras. Far better paying it out of pocket and hunting around for the cheapest dentist (or, as mentioned, going overseas).

    • Ocker on 01/05/2022 - 17:01

      Everyone's situation is different.
      If you are only looking at dental claims that is one thing, but other items such as optical glass, physio, etc etc may well mean the extra cover is worth the premium cost.

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