Is Dental Treatment Covered under Health Insurance Policies

Dental pain can be excruciating if you don’t opt for the proper and timely treatment. Unfortunately, though dental problems are still quotidian these days, there is no stand-alone dental insurance in India. Most health insurance policies don’t offer any dental insurance coverage. According to these health insurers, dental treatment falls under the category of cosmetic treatment. In India, dental insurance coverage is available either in case of accidental injuries or under OPD covers.

What are Dental Insurance Plans?

Dental insurance plans are designed meticulously to cover the ever-increasing treatment costs associated with dental care. Health insurance with dental cover plans allows individuals to get coverage for dental care and hospitalization expenses along with the costs of medicines. In August 2018, IRDAI instructed that dental treatment will be a part of the health insurance policy even if it won’t require hospitalization.

Companies Offering Dental Insurance are

• Active Health Platinum Enhanced Plan by Aditya Birla Health Insurance offers dental consultation and examination coverage as additional benefits if you purchased a policy of Rs 15 lakh and above.
• Health-Guard Gold Plan by Bajaj Allianz offers an in-built coverage for dental treatment that includes examinations, fillings (where appropriate), crowns, extractions, and surgery (apart from implants or cosmetic surgery).
• Privilege Healthline Plan by Chola MS embraces policyholders with OPD dental treatment for up to Rs 10,000 at an interval of every two years.
• Smart insurance plan Bharti AXA offers dental treatment coverage for up to Rs. 5000.

Companies like LIC and the State Bank of India also offer dental insurance plans to their customers.

Usually, comprehensive health insurance plans offer dental insurance in the case of an accident and when doctors suggest your treatment as part of the health management and treatment procedure. However, there are no exclusive plans that provide dental insurance. Since most dental treatments are planned and considered as cosmetic surgeries, hence in India, you won’t get any tailor-made insurance plans for dental treatment. At present, only a few insurance companies are offering coverage for dental treatment. So, if you want a dental insurance plan, your options are a constraint.

Covered under OPD benefit

You are eligible for dental insurance benefits if you opted for an out-patient (OPD) benefit as part of your health plan. Out-patient dental treatment generally bears the expenditures related to X-rays, extractions, amalgam or composite fillings, root canal treatments, teeth alignment for youngsters.

OPD treatment Plan Exclusions

The OPD treatment coverage doesn’t sponsor the costs of dental treatments under specific scenarios. Let’s take a look at them.

• Cosmetic surgery
• Dentures
• Dental prosthesis
• Dental implants
• Orthodontics
• Orthogenetic surgery
• Jaw alignment or treatment for temporomandibular (jaw),
• Upper and lower jawbone surgery
• Surgery related to the temporomandibular (jaw) (If not required for cancer treatment or by an acute traumatic injury)

In the case of OPD treatment policies, policyholders may need to pay an additional expensive premium that will burn their pockets. Though dental insurance is buzzing everywhere, still, comprehensive dental coverage is not available in India.

Eligibility Criteria for Dental Insurance

The minimum entry age is 18 years, while the maximum age is 65 years. For children, it is 90 days, but it may vary from company to company.

What is the claim process in Dental Insurance?

Let’s take a look at the claim process for dental insurance.

• Intimate your insurance company about the contingency as soon as it occurs.
• Now, submit your claim documents along with the duly filled and signed claim form.
• After the completion of this step, the insurance company gets the documents. Once the company receives your documents, they initiate the verification process of the same.
• This may take around 10 days to release your payment against the claim.

Documents Required for the Dental Claim

• Duly filled and signed claim form
• Policy documents
• Discharge summary
• KYC documents
• Consultation bill
• Original bills of the hospital
• Pharmacy bill

Some Advantages of Dental Insurance

• You are eligible for coverage only if your teeth damage is caused by an accident.
• Regular checkups to dentists for common dental treatments, including scaling of teeth, are entirely covered.
• Some treatments like a root canal, teeth capping, and teeth whitening are covered partly.
• Some dental policies offer intriguing benefits and discounts for prime treatments like implants and braces.

Things to keep in mind before purchasing dental insurance

• Before purchasing dental insurance, always remember that there is a certain waiting period for a dental treatment facility, and the sum insured amount is also limited
• Compare various insurance plans of different insurance companies before making the final call
• Go through the terms and conditions of the policy thoroughly
• Know all inclusions and exclusions of the policy

These days, many people in India are suffering from various dental problems. Thus, the demand for dental insurance is increasing day by day. To make individual dental insurance available in India, the Insurance Regulatory and Development Authority of India (IRDA) instructed health insurance companies to confiscate dental treatments from their list of non-payable items. Therefore, always handpick a dental insurance coverage that offers a lesser waiting period and a bigger sum insured for your requirements.