Will a Health Insurance Plan Cover My Dental Expenses

Many of us usually defer our visits to the dentist unless it is very painful. Also, at the same time getting a dental treatment is a far more costly affair too. Dental expenses are rising at a great pace and creates a hole in the pocket for an overall treatment. Dental implants expenses can range from Rs 20,000 to Rs 80,000 to an individual. Orthodontic (braces) treatment may cost somewhere between Rs 40,000 to Rs 3,00,000 and if we talk about the common root canal treatment (RCT) it may cost Rs 3,000 to Rs 8,000 per sitting. The list of expenses aggravating continues for the dental treatments in current scenario. Such unexpected or may be planned expenses, create a big hole in your pocket and you will find ways to cover such expenses.

Many people believe that their dental expenses will be covered under their health insurance policy, but let us have an insight on this aspect.

Will a Health Insurance Plan Actually Cover Your Dental Expenses?

This is a bit tricky question which needs to be substantiated with facts. We all get attracted to only the visible and most talked about features of the health insurance plans or for that matter any other insurance plan by the insurance companies. In the light of those eye-catching benefits, many of us tend to miss out the complete policy details and do not read the policy wordings before buying.

For the majority of the health insurance plans, dental expenses are not covered under the purview of the policy benefits. Dental  expenses are not covered explicitly under the coverage and even if they are covered, it is subject to certain limits and restrictions. The scope of including dental expenses is still far away from the reality. Any dental treatment that comprises cosmetic surgery, dentures, dental prosthesis, dental implants, orthodontics, orthognathic surgery, jaw alignment or treatment for the temporomandibular (jaw) joint, or upper and lower jaw bone surgery and surgery related to the temporomandibular (jaw) unless necessitated by an acute traumatic injury or cancer and also requiring Hospitalization is usually not covered. However, hospitalization expenses pertaining to the dental treatment may be financed from your health insurance policy.

Is There any Specific Dental Insurance Plans?

Most health plans cover dental expenses only when caused due to some kind of accident. Typically, stand alone dental insurance plans  in India is still not a reality. But lately OCARE,  India’s  first,  and  only,  independent Insurance Process as a Service  (PAAS) platform, launched the first ever Dental Insurance Product in the country. A Group Insurance product, it offers a sum assured of Rs 25,000/‐.It  is the maiden Dental insurance, which is being offered as a specific product in India.   It can be clubbed with health insurance and available under the general health insurance plans, where dental expenses are not covered and only the hospitalization and medical costs arising due to a dental emergency are covered.

Ways to cover Dental Expenses under the Health Insurance Plan:

Though outpatient patient department (OPD Teatments):

Many health insurance plans like HDFC ERGO Health Suraksha offers optional benefits like outpatient dental treatment on payment of additional premium over and above the base premium subject to policy conditions.

Under Appolo Munich’s Easy Health Plan, outpatient dental treatment is covered after a waiting period of 3 years. The coverage is provided only under the Premium Plan with a cap on the scope of coverage. Up to 1% of the Sum Assured can be utilized as a benefit amount up to a maximum of Rs.5000 if Sum Assured ranges from  Rs.4 lakhs to Rs.10 lakhs. The maximum limit increases to up to Rs.7500 if a coverage level of Rs.15 lakhs to Rs.50 lakhs is chosen.

Bharti AXA’s  Smart Health Insurance Plan consider dental treatment in the list of exclusions, out-patient emergency dental treatment due to an accident is covered under this plan. The coverage is provided under the optimum plan variant up to a maximum of Rs.3000 and Rs 5,000 for  Sum Insured of Rs 3 lakhs and Rs.5 lakhs respectively. The plan also offers  a follow-up treatment by the same dentist up to a maximum of 15 days considering the maximum allowable limit.

Reasons why Dental Expenses are not Under Main Stream Benefits of a Health Insurance policy:

The common psychology of the insurers may be that claims for procedures that fall under cosmetic dentistry  may be huge and exorbitant and policyholder might opt for high-end  and advanced dental procedures, which will result in increasing claims for the insurers. Secondly, many believe that dental treatment does not come under the purview of the health services as offered by insurers.

Lastly, It is important to read the policy document and wordings carefully before buying. Also one should look at the overall benefits offered under the health plan and make a cost-benefit analysis to opt for a plan offering dental treatment. Even if the plan offers you such provision, I am sure the scope of coverage will be limited or restricted. India is still awaiting for more options and innovation of plans offering a wider scope for dental treatments and covering dental expenses.

Harjot Singh Narula

Harjot Narula is founder and CEO of ComparePolicy.com, an IRDAI approved insurance web aggregator focussed on selling online insurance for companies. Harjot has more than a decade of experience in software development and has also spent 5 years in US working for the mortgage and risk management industry.

Leave a Reply

Your email address will not be published. Required fields are marked *