Dental Insurance – Cover, Types, Benefits, Cost and Claim Process
Dental treatments can be a bit expensive due to the expensive set up and lab material involved. To cover your dental treatment expenses, several health insurance providers have come up with policies that cover expenses due to tooth extractions, filling cavities, dentures, root canal treatment, and more. Read to know more about Dental Coverage Insurance.
Types of Dental Insurance in India
Currently, none of the major insurance providers in the country provides exclusive dental insurance policies. The Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for health insurance policies to cover dental care, even if it doesn’t require hospitalisation.
There are several health insurance policies that provide dental care, including:
1. Individual health policies
Individual health insurance policies can cover specific dental procedures. However, it is usually covered under additional benefits or premium covers, and customers may have to pay an additional premium to get this facility.
2. Preventive healthcare insurance
Insurance policies covering preventive care such as health check-ups and doctor consultations often include oral care and consultation.
3. Family floater health insurance policies
Family floater health insurance policies cover dental insurance as a part of the plan for all members of the insured family.
4. Critical illness policies
These are standalone plans covering specific illnesses, which may sometimes include dental surgeries.
5. Personal accident policies
Most personal accident insurance policies cover dental treatment to treat accidental injuries.
6. Travel health insurance
Most travel insurance policies cover dental procedures as a part of accidental injury coverage. However, these will likely have limits on procedures and compensation.
What Coverage is Provided by Dental Mediclaim in India?
There are no exclusive dental insurance plans available in India. This results in different providers offering various types of benefits and coverage. The following is a generalized overview of the various types of treatments covered by dental insurance.
1. Basic restorative care
This includes routine procedures such as extractions, fillings, and check-ups.
2. Orthodontic treatment
It includes using braces, space maintainers, and other devices to properly align your teeth.
3. Preventive dental care
Preventive care includes routine X-rays, regular teeth cleanings, fluoride treatments, and the usage of sealants.
4. Major restorative care
This includes dentures, bridges, and crowns.
The following is a list of treatments and procedures are covered by most teeth insurance policies:
- Tooth filling
- Oral cyst and infections
- Root canal treatment
- Dental implants
- Routine oral check-ups
- Dental surgeries
- Gum diseases
- Dental X-rays
- Follow up care and treatment
What are the Benefits of Having Dental Insurance Coverage?
Following are some of the major benefits of having a dental insurance policy in place:
1. Cost-effective treatment
Dental diseases can pose a significant financial burden as many of the treatments can be quite expensive. Having dental insurance in place is a cost-effective solution to avail of these treatments.
2. Full coverage
Depending on the insurance agency, dental insurance policies can not only cover accidental treatment but also other expenses. Dental insurance policy coverage can include expenses for diagnosis, preventive or curative treatments, regular consultation and other common treatments.
3. Accidental coverage
Many personal accident insurance policies in India cover dental treatment due to accidental damage. This allows the insured to claim benefits for dental treatment when hospitalised without paying any additional premium.
4. OPD treatment
Few insurance companies offer coverage for outpatient department (OPD) treatments and cover dental treatments. This lets the insured person get claims settled without getting hospitalised.
5. Regular check-ups
It can be easy to neglect dental problems when the cost of regular visits is too high. Some dental insurance policies cover the cost of routine check-ups and procedures, making it easy to visit a dentist more often.
What is the Cost of a Full Coverage Dental Insurance Policy?
There are several types of full dental plans with different price models.
1. DPPO model
Also referred to as PPO (preferred provider organisation) plans, these provide cost-effective insurance coverage as they contract a specific dentist for an organisation.
2. DHMO model
Under the ‘Dental Health Managed Institution’ model, the insurance provider contracts a vast number of dental organisations to provide cheap dental treatment.
There are several cost models for the various types of full coverage dental insurance policies:
3. Premium
In this cost model, one pays the full premium for the plan chosen. Generally, DPPOs tend to have a slightly higher premium than DHMO plans.
4. Annual maximum
Here, the insurance policy agrees to pay a certain sum in a year, with additional expenses being paid out of pocket.
5. Deductible
This includes the costs the insured pays before his/her policy covers the rest of the expenses. Some DPPO plans have deductibles, whereas DHMO plans don’t.
6. Coinsurance
Once the deductible is covered, a certain percentage of the expenses is then covered by the insurer.
How to Get Full Coverage Dental Insurance Without Maximum and Waiting Period?
Most dental insurance coverage includes a fixed annual maximum. This is the most that the insurer will pay for dental treatments over a plan year.
Usually, DHMOs don’t have annual maximums, which ensures that the policyholder does not run out of benefits. One can also look for a DHMO plan with higher annual maximums depending on his/her expectations.
Most health insurance policies with dental coverage come with a waiting period when you can’t make claims. Depending on the insurer, this can vary between a few months to years. Hence, policyholders may need to pay out of pocket if their dental issues occur before the end of this period.
It is advisable to get dental insurance coverage as soon as possible to minimise the chances of issues occurring before the end of the waiting period.
Exclusions under Dental Insurance Policies
Depending on the type of policy chosen, there are certain exclusions available.
For example, personal accident policies will exclude all accidental dental treatments. Full coverage dental policies will exclude only the following conditions (which may differ according to policy):
- Cosmetic surgery
- Jaw alignments
- Dental implants
- Dental prosthetics
- Jaw bone surgery
- Orthodontics
Claim Process for Dental Insurance Policies
For dental care involving hospitalization, follow the given procedure to raise a claim:
- Step 1: Contact the insurance company and seek approval for getting cashless claims.
- Step 2: Produce the necessary documents (proof of age, identity, and address) to hospital authorities and TPA (third-party administrators). One may also have to produce a health card for cashless claims.
- Step 3: Once the TPA approves the claims, the hospital will send all relevant documents to the insurer.
- Step 4: If all the terms and conditions are met, the insurance company will settle all dental care bills.
- Step 5: If the insured avails OPD treatments or preventive care, he/she can pay expenses out of pocket and later claim reimbursement.
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Final Word
A dental insurance policy is a requisite owing to the high treatment expenses. You can always sign up for a comprehensive health insurance policy for more extensive coverage.
If you are looking for a health insurance policy that promises fast claim approval with no paperwork involved, look no further than Navi. Download the Navi app and get claims processed in over 10,000 hospitals across India.
FAQs
Ans: Before choosing a dental insurance policy, one should look at the premium, maximum claim benefits and all treatments covered by it. Also, ensure to read through all of the fine print of a particular insurance policy.
Ans: Yes. Most health insurance with dental coverage will have an entry age of 18 years or above and an exit age of around 65 years.
Ans: Mediclaims usually cover dental treatments only if they arise out of accidents or surgeries.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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