Dental Insurance Plans: What’s Covered, What’s Not

Dental care treatments are extremely expensive. With the rising healthcare inflation, the cost is going up year on year. Specifically, when it comes to dental care, highly expensive surgical tools, sterilisation machinery, materials used, and equipment that requires high maintenance contribute to the extravagant cost of treatment. Dental health issues like tooth decay, total tooth loss, and gum diseases are quite common. These oral health issues call for expensive dental care procedures like tooth extraction, root canal treatment, gum surgery, dental implants, etc. Having dental insurance plans is the only solution for financial protection against such dental health issues.

What is dental insurance?

Dental insurance is health insurance coverage or a rider offered under a health insurance plan that gives coverage for dental care treatments. The coverage typically includes the cost of outpatient consultation, in-patient treatment expenses and the cost of surgical procedures, and more.

In India, dental insurance is offered as a base cover in a regular health insurance policy. Many insurers also offer dental insurance riders under a standalone health insurance plan to give exclusive coverage for dental care treatments. However, there are few insurance companies that offer standalone dental insurance as a part of your comprehensive health insurance plan. 

What is covered under dental insurance?

The coverage offered under dental insurance in India may vary widely from one insurance company to another. Also, the cost of dental insurance may also vary depending on various factors such as type of plan, coverage limit, etc. Generally, the following are the coverages offered under dental insurance:

1. Preventive care: Dental insurance plans offer coverage for preventive services like routine cleanings, examinations, and X-rays. These are essential for maintaining good oral health and catching issues early.
2. Dental care procedures: Health insurance with dental cover generally offers coverage for most of the basic dental care procedures. This includes minor surgeries, tooth extraction, etc. However, some policies may not provide full coverage and restrict their coverage to a certain percentage varying from 70% to 90%. Most dental insurance plans also provide coverage for major procedures such as root canals, crowns, bridges, dentures, and orthodontics with coverage limitations and waiting period restrictions.

What is not covered under dental insurance?

There are some limitations in every dental insurance plan. Let us take a look at general exclusions in the policy:

1. Cosmetic procedures: Pure cosmetic procedures like veneers or teeth whitening are not covered as they are elective treatments.
2. Pre-existing conditions: Some plans might have limitations or waiting periods for pre-existing conditions. This means that if you already have a dental issue when you sign up for the insurance, there might be a waiting period before the insurance covers treatment for that specific issue. For example, orthodontic treatment for adults can have a waiting period or be completely excluded from certain dental insurance plans.
3. Specific treatments: Specific treatments like certain types of oral surgeries, implants, or experimental procedures might not be covered. Moreover, few dental insurances that cover implants and other specific treatments can come with many limitations.

Important points to consider 

Here are some of the key points to consider while buying a dental insurance coverage:

1. Check on the dental care services that are covered under the plan. This includes fillings, x-rays, tooth extractions, surgeries, and more. It is also important to know the coverage limit for each dental care service that is covered under the plan.
2. Check on the network of dentists with your insurance provider to ensure your preferred dentists are on the list to avail of the quality treatment.
3. Check thoroughly on the co-payment clause wherein you have to share a certain percentage of treatment cost along with the insurance provider. Be aware of the co-payment and deductibles clause.
4. Check on the waiting period to kick-start the coverage for specific treatments, if any.

Conclusion

Dental insurance is extremely important to have as it covers expensive dental care treatment services. Though dental insurance helps you manage dental care treatment costs, it is also essential to choose the right dental insurance plan that suits your needs and affordability. Further, ensure to read the fine print, and understand the scope of coverage and limitations of the policy. It’s vital to review plans available, and compare them on basis of coverage features and cost to get best.