If you hold Extras cover that includes dental with nib, or with a partner brand underwritten by nib, this page explains a change to how nib pays some dental benefits from 1 October 2026.
The amount you get back for eligible dental services may change if you visit a dental provider who isn't part of the nib First Choice network from 1 October 2026. Instead of a percentage of the treatment cost, you'll receive a set benefit amount for eligible services.
Here's what this means for you.
Check your dentist or find a First Choice dental provider
Before your next appointment, check whether your dentist is part of the First Choice network using the Find a Provider tool. If they aren't, the amount you get back for eligible dental services may change from 1 October 2026.
When you visit a First Choice dentist, you'll continue to receive the same benefits you're eligible for today, including 100% back on preventative dental check-ups^ with participating No Gap providers.
From 1 October 2026, we're changing how we pay dental benefits, not what you're covered for. You can still visit any recognised dental provider in Australia. The main difference is what happens when you visit a dentist who isn't part of the First Choice network.
If you visit a First Choice network provider: there's no change to the benefits you receive for eligible dental services. You'll continue to receive the same benefits you're eligible for today, including percentage-based benefits and 100% back on preventative dental check-ups at participating No Gap First Choice network providers.^
If you visit a non-First Choice network provider: your overall dental limit will stay the same, but the amount you get back for each eligible service will be a set benefit, which is a fixed dollar amount. Dentists not participating in the nib First Choice network will set their own private practice fees for treatment. Depending on this charge, you may experience a higher out-of-pocket cost than if you visited a First Choice network dentist.
These changes impact members holding select nib policies that include percentage back dental benefits.
These changes also apply to members holding policies including dental cover for nib underwritten brands including Qantas Health Insurance, AAMI Health Insurance, Apia Health Insurance, Real Health Insurance, Australian Seniors Health Insurance, Suncorp Health Insurance and ING Health Insurance.
From 1 October 2026. Any eligible dental services you receive before 1 October 2026 will be paid the way they are today.
A set benefit is a fixed dollar amount you receive towards an eligible dental service, regardless of what the provider charges. If the provider charges more than the set benefit amount, you’ll have an out-of-pocket cost for the difference, subject to annual limits, waiting periods, nib Fund Rules and Policy Booklet terms.
The First Choice dental network is nib's network of over 2,500 participating dental clinics that charge an agreed rate to nib members for common dental treatments. Not sure whether your dentist is part of the First Choice network? We recommend checking before your next appointment. Use the Find a Provider tool to see whether your current dentist is in the network or to find a First Choice provider near you.
Visiting a First Choice network provider means:
You may get a percentage of your provider's fee back on eligible services
Eligible members may get 100% back on preventative check-ups (No Gap) at participating clinics^
You can access agreed rates* to help your dental Extras limits last longer
You may have more certainty about what you'll pay before you go in.
No, you can still visit any recognised dental provider. However, if you receive dental treatment from a provider outside the First Choice network from 1 October 2026, the amount you get back may change. Depending on your provider’s fees, this could increase your out-of-pocket costs.
Not sure whether your dentist is a First Choice network provider? You can check using the Find a Provider tool.
It depends on the provider, the treatment and your level of cover.
If you choose a non-First Choice network dental provider, you may pay more out-of-pocket costs depending on what the provider charges and the set benefit nib pays.
If you visit a First Choice network dental provider, you may have access to agreed rates, percentage-based benefits and No Gap preventative dental^ at participating clinics.
We recommend you check your cover and provider before each treatment so you understand what you can expect and whether you may have an out-of-pocket cost. You can use the Find a Provider tool to check whether your dentist is part of the First Choice network.
The easiest way is to ask your dentist for a health benefit quote with the item numbers and fees for your planned treatment. That way you'll know roughly what to expect out of pocket before you book.
If you tap your card at a HICAPS terminal with a non-First Choice network dental provider after 1 October 2026, your claim will initially be processed under your new product benefits. If you’re on an existing treatment plan and are eligible for your previous benefits, please submit your claim documents, including your invoice and treatment plan, through the nib App if you’re an nib member, or through your member account if you’re a member of a partner brand underwritten by nib. We’ll manually assess your claim and adjust the benefit to reflect your cover.
If you're partway through a dental treatment plan with a dentist who isn't part of nib's First Choice network, you may be eligible for transitional support until 31 December 2026.
For transitional support purposes, a course of treatment is an agreed and documented treatment plan between you and your dentist that involves more than one visit for the treatment you have been receiving.
Am I eligible? Your course of treatment must meet the criteria below. You must provide an invoice and treatment plan that:
commenced before 1 October 2026, or
was issued after 1 October 2026 but clearly shows that the course of treatment started before 1 October 2026.
You must receive the treatment on or before 31 December 2026.
What do I need to provide? Submit a claim through your member account, including a copy of your treatment plan from your dentist and an invoice showing your treatment started before 1 October 2026.
How will my claims be paid? If you’re eligible for transitional support, your eligible treatment will continue to be paid under your current benefits until 31 December 2026.
A treatment plan is a document prepared by your dentist that sets out the treatment you’re receiving. If you’re applying for transitional support, it should clearly show that your course of treatment started before 1 October 2026.
If you think you may be eligible for transitional support, ask your dentist for a copy of your treatment plan and keep any invoices relating to your treatment to support your claim for transitional support.
Most dental services move to the new benefit model from 1 October 2026, including general services from dentists, oral health therapists and dental hygienists and most specialist services. As specialist treatment can be more expensive and depends on your level of cover, we recommend checking the benefit available in your member account or requesting a quote before treatment. Orthodontics will continue to be paid as a percentage-based benefit.
No, your overall dental limit will stay the same. However, the amount you can claim back per treatment may vary depending on the service you receive.
No, this change doesn't affect your premium. Health insurance premiums are reviewed separately each year and any changes must be approved by the Australian Government as part of the industry's annual premium review process. If your premium changes in the future, we'll let you know in advance.
There's nothing you need to do right now. Before any dental treatment you receive on or after 1 October 2026, it's worth checking whether your dentist is part of the First Choice network so you know what benefits you may be eligible for.
We know getting value from your cover is important. Paying benefits based on a provider network is a common approach in private health insurance, and helps us provide you with greater certainty about benefits, manage rising healthcare costs and keep delivering value through your cover over time.
Members who use a First Choice dental provider will continue to receive percentage-based benefits and access to No Gap preventative dental at participating providers.^
We’re here to help
If you have any questions or would like to discuss your options, we're here to help. nib members can contact us or check what you're covered for in your member account or the nib App.
If you hold a policy with an nib underwritten brand, use the links below to contact us or check your cover:
^Dental benefits are subject to Fund Rules, waiting periods and annual/service limits. A dental check-up includes an examination/consultation (011-015), diagnostics (022, 037), scale and clean (114, 115), plaque removal (111), and fluoride treatment (121) as deemed necessary by the dentist (excludes dentures). The No Gap offer applies only to No Gap First Choice providers, cannot be combined with other offers/government schemes, and is not redeemable for cash.
*nib First Choice providers (i.e. our network) offer competitive fees for many commonly claimed treatments and consultations. These fees are reviewed at least annually and are subject to change. Always check nib.com.au/health-services/find-a-provider before booking to see if your provider participates or simply ask your provider if they are part of nib’s network at the time of booking. Providers occasionally leave the nib First Choice network so it’s important to check before booking to avoid disappointment. Annual limits, waiting periods and T&Cs apply.