Dental Insurance in India : All You Need to Know

Posted on: Apr 5, 2023 | 3 mins | Written by: HDFC ERGO Team

Dental Insurance in India : All You Need to Know

Dental insurance helps you take care of your teeth without much financial worry. It covers routine checkups, cleanings, and can significantly reduce the cost of major treatments. This not only supports your overall dental health but also prevents minor issues from turning into costly problems. If you ever need treatment like a cavity filling or a root canal, dental insurance can help reduce the cost. Therefore, having this policy in place can protect both your health and your wallet.

Try to picture yourself waking up in the wee hours of the morning with a throbbing toothache. You try to ignore the pain and go back to sleep, but it only worsens. The next morning, you rush to the dentist and are informed that you need root canal treatment, which can cost a considerable amount of money. This situation can be stressful and overwhelming, especially if you are not financially prepared for unexpected dental expenses. However, your dental insurance can help you manage dental care costs and avoid such situations.

Read on to learn about the types of dental insurance policies, the benefits they offer, and more.

What is Dental Health Insurance?

It is a type of medical insurance policy that provides coverage for various necessary dental procedures and treatments. Dental health insurance in India typically covers procedures such as routine check-ups, cleanings, fillings, extractions, and root canals. Some policies may also cover cosmetic dental procedures, such as teeth whitening and veneers, only if medically necessary and recommended by doctors.

Is Dental Treatment Covered in Health Insurance?

Most health insurance policies do not cover dental treatments because they are considered pre-planned and cosmetic. However, if any dental treatment is required due to an accidental injury or illness and is recommended by doctors as part of the treatment, the medical expenses are covered by insurers.

There is no specific dental insurance plan, but some insurance providers offer dental coverage as part of healthcare plans. Fillings, crowns, extractions and surgery are covered, but not cosmetic surgeries. If you have opted for out-patient (OPD) coverage, the dental expenses are usually covered, but only those related to extractions, fillings, X-rays, root canal treatments, etc. The cost of dentures, cosmetic surgery, dental prosthesis, dental implants, orthodontics, orthognathic surgery, jaw alignment, etc., is not covered unless necessitated by an accidental injury.

Why Do You Need Dental Health Insurance?

Here are a few reasons why you need dental health insurance plans:

1. Manage Dental Treatment Costs:

Dental treatments can be expensive, especially if you require complex procedures, such as root canals, extractions, etc. Dental health insurance can help you manage these costs by providing coverage for various dental treatments and procedures. It also provides coverage for unexpected dental emergencies, including severe toothaches, chipped or broken teeth, and other dental injuries. This coverage can help alleviate the financial burden of unexpected dental expenses.

2. Preventive Care:

Regular dental check-ups and cleanings are essential for good oral health. Dental health insurance typically covers preventive care services, such as routine check-ups, cleanings, and fluoride treatments, which can help prevent costly dental problems in the future.

3. Coverage for Pre-Existing Dental Conditions:

Dental health insurance can provide coverage if you have pre-existing dental conditions requiring ongoing treatment. This coverage can help ensure you receive the necessary care without incurring high out-of-pocket costs.

4. Comprehensive Coverage for the Whole Family:

Dental health insurance typically offers coverage for the whole family, including dependents. This comprehensive coverage can help ensure that everyone in the family has access to necessary dental care and treatments without worrying about the cost.

How Do Dental Insurance Plans Work?

Dental insurance makes it easier to manage the cost of dental care. When you visit the dentist, your plan usually takes care of most of the bill, and you just cover a small portion, called a co- payment. In return for this coverage, you pay a monthly or yearly fee, known as a premium.

The coverage of dental insurance can vary significantly between plans. While some policies cover only basic services, such as cleanings and checkups, others offer protection for a wider range of treatments. That’s why it is important to carefully review the policy details to know exactly what is included and what isn’t.

Types of Health Insurance Plans Offering Dental Insurance Cover in India

Several health insurance plans in India include coverage for dental procedures, either as part of the main policy or as an optional add-on. Common types include:

• Individual health insurance plans:

These may include dental coverage as part of the base plan or offer it as an optional add-on for an extra premium. This enables policyholders to tailor their coverage to meet their specific dental care needs.

• Critical illness plans:

While critical illness plans are primarily designed to cover serious health conditions, some also include dental treatments if they are

• Family health insurance plans:

Family health insurance plans are comprehensive policies that provide coverage for all family members. In addition to other medical treatments, these plans often include dental care, depending on the policy terms. This allows families to manage dental expenses together under one plan.

• Personal accident plans:

If an accident causes dental injuries, these plans cover the related hospitalisation and treatment costs. They provide financial protection specifically for dental damage resulting from unforeseen accidents.

• OPD health insurance plans:

These plans provide coverage for outpatient dental services, including dental consultations, routine check-ups, and minor procedures such as fillings. They are a great option for individuals who require regular dental care without the need for hospitalisation.

Features of Dental Insurance

1. Dental insurance typically covers root canal treatment, fillings, extractions, diagnostic tests, oral check-ups, X-rays, preventive care, and any injury due to an accident.

2. Dental treatments done in hospitals under anaesthesia due to injuries, illness, or accidents are covered.

3. Cosmetic surgeries, dentures, implants, jaw alignment procedures, prostheses, and orthodontics are out of coverage.

4. You cannot file any claims during a waiting period. The sum insured is also limited.

Benefits of Health Insurance That Covers Dental Treatments

With no standalone dental insurance plans available, you need to compare best health insurance plans based on coverage, benefits, and cost, and choose a good plan that covers dental treatments. The advantages offered are:

1. Expensive dental treatments will be covered:

A single visit to your dentist can be quite expensive due to the high cost of most dental procedures. If you have health insurance with dental coverage, you will be financially protected against in-patient dental procedures as well as OPD dental treatments.

2. Good oral health:

Whether it is for a routine oral check-up or any tooth problems, do you think twice before going to a dentist because it is expensive? A dental insurance plan will take away your financial worries; you can monitor your dental health on a regular basis and keep your teeth healthy. Regular check-ups help avoid and treat issues before they become severe.

3. Cashless hospitalisation:

If you need to be hospitalised for a few days because of a tooth procedure, you can avail of cashless hospitalisation in any of the network hospitals of the insurance provider. The hospital will receive the payment directly from the insurer.

4. Tax benefits:

In addition to the coverage, you can also save money on taxes by availing of tax deductions on your health insurance premium.

Eligibility Criteria in Dental Insurance

Most dental insurance plans are offered to individuals and families aged between 18 and 65, but it can vary. Some family plans also include coverage for children. Basically, your eligibility depends on factors like age and overall health, as well as the insurer’s terms and conditions. Since each plan has its own rules, it is important to check the specific criteria to verify if you are eligible for coverage.

How to Get Dental Insurance in India?

As most health insurance providers do not offer dental coverage, the question is how to get dental insurance in India. Well, you need to check with the insurance provider if dental insurance is included in your medical insurance, because some policies come with built-in dental coverage. The second option is to opt for OPD add-on coverage along with the base healthcare plan. This will cover the procedures that are not considered cosmetic. Once you have shortlisted the plans, compare the policies and purchase the one that suits your needs and pocket.

Things To Remember When Buying Dental Insurance

While getting dental insurance, here are a few factors that you should consider:

1. Sufficient coverage:

Dental treatments and procedures are expensive. So, while buying dental insurance, make sure the plan offers adequate coverage for treatments, such as extractions, fillings, root canals, etc.

2. Compare plans:

Comparing different healthcare plans will help you choose the one that suits your needs. For instance, before you choose a plan, consider whether you need coverage only for in-patient procedures or both in-patient procedures as well as procedures like tooth fillings, extractions, and root canal treatments.

3. Check inclusions and exclusions:

Check if the dental insurance covers routine check-ups, basic oral treatments, preventive care treatments, and if there’s a waiting period. It’s also important to check the policy exclusions, as most dental plans do not cover cosmetic surgeries and treatments.

4. Network hospitals:

One of the important things to consider while buying dental health insurance is checking the network hospitals. Go for an insurance provider with a wide network of hospitals so that you can easily access quality treatment whenever required and also avail of cashless hospitalisation. Some dental procedures, due to accidents, illness, or injury, need hospitalisation.

Conclusion

Certain dental procedures can cost a lot of money, but most health insurance policies do not cover dental procedures by default. Some policies may have inbuilt dental coverage, while others cover the procedures as part of OPD coverage or as an add-on. So, if you are looking to buy a healthcare plan with dental coverage, it is advisable to conduct research, read the policy terms and conditions, and make an informed decision.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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