Understanding Gap Free Dental

Tori Ingham
Written by Tori Ingham
Tori Ingham
Written by Tori Ingham Digital Marketing Manager

Tori is a digital marketing specialist with experience across health insurance, CRM and member-focused communication. As Digital Marketing Manager at Phoenix Health, she leads digital campaigns, optimises member journeys and develops content that supports clearer, more intuitive experiences. Her work focuses on using thoughtful digital design and CRM-led communication to improve engagement and help members navigate their cover with confidence.

Read More
Published: July 14, 2026
Last checked: July 20, 2026

Regular dental check-ups are one of the simplest ways to maintain good oral health, but concerns about out-of-pocket costs can lead people to delay routine visits. Gap Free Dental is designed to remove that barrier by providing a 100% benefit for preventative dental services.

This guide explains how Gap Free Dental works, what’s included and how to make the most of your Phoenix Health benefits.

Key Points

  • Gap Free Dental provides a 100% benefit for preventative dental services.
  • Gap Free Dental is available with eligible Phoenix Health Extras Covers.
  • You don’t need to visit a preferred provider to receive your benefit.
  • Regular preventative dental care can help identify problems early.
  • Annual limits and waiting periods apply.

What is Gap Free Dental?

Gap Free Dental provides a 100% benefit for selected preventative dental services, meaning you won’t have an out-of-pocket cost for the services listed below.

With eligible Phoenix Health Extras Covers, you can receive a 100% benefit for the following services once per appointment, up to twice per person on your membership, per calendar year:

Treatment Item numbers Gap Free Dental benefit
Oral examination 011, 012 and 013 100% benefit twice per year
Scale and clean 111, 114, 115 and 121 100% benefit twice per year
Fissure or tooth surface sealing 161 100% benefit for one treatment per appointment

Things to know before your appointment: If more than one fissure or tooth surface sealing treatment (item 161) is required during the same appointment, any additional treatment will be paid according to your level of Extras Cover.

2-month waiting period and annual limits apply.

Gap Free Dental focuses on preventative dental care. It doesn’t mean every dental treatment is provided without a gap, but it makes it easier to maintain your oral health through regular check-ups. For example, if you need x-rays taken as part of your appointment, these will be covered at your level of Extras Cover.

Who can claim Gap Free Dental?

Gap Free Dental is available with the following Phoenix Health Extras Covers:

You’ll also need to have served the 2-month dental waiting period before you can claim Gap Free Dental benefits.

Why are regular dental check-ups important?

Regular dental check-ups are one of the best ways to maintain good oral health. They can help identify problems such as tooth decay and gum disease early, often before they become more serious or require more complex treatment.

Preventative dental care also gives your dentist the opportunity to monitor changes in your oral health, provide professional cleaning and offer advice to help keep your teeth and gums healthy.

The Australian Dental Association recommends that most people have a dental check-up every 6-12 months, although how often you should visit depends on your individual oral health needs. Your dentist can recommend a schedule that’s right for you.

Can I visit any dentist?

Yes. Unlike many health insurers, Phoenix Health doesn’t require you to visit a preferred provider to receive your Gap Free Dental benefit.

As long as your dentist is a registered provider, you’re free to choose the dentist you know and trust. You’ll receive your eligible benefits in line with your level of Extras Cover, without needing to change providers.

This means you can continue seeing your regular dentist while still enjoying the benefits of Gap Free Dental.

How do I claim Gap Free Dental?

Claiming Gap Free Dental is easy. Most dentists offer electronic claiming through HICAPS, so they can process your claim while you’re at the reception desk. They’ll use your Phoenix Health membership card to process your claim on the spot.

If your dentist doesn’t offer HICAPS, you can submit your claim through the Phoenix Health Member Services Portal or the Phoenix Health mobile app after your appointment.

If you’re unsure whether your treatment is covered or would like to check your available benefits before your appointment, give our team a call on 1800 028 817. They’ll be happy to help.

Check your available dental benefits

You can check your Extras Cover, available annual limits and claims history anytime through the Phoenix Health Member Services Portal or the Phoenix Health mobile app.

If you’re unsure whether a treatment is covered or have any questions before booking your appointment, our team is always happy to help.

Need help with your dental benefits?

If you’d like to check your cover, waiting periods or available benefits before your next dental appointment, call our team on 1800 028 817. We’re always happy to help.