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Understanding dental insurance in India: Cover, benefits, and claims

Team AckoAug 21, 2022

Rising healthcare costs can drain your savings. That’s where a health insurance policy can come to your rescue. There are different types of health insurance plans in India that cover a wide variety of medical emergencies, diseases, and situations. But where does dental insurance fit in this scenario? Read ahead to know an overview of dental insurance in India.

Dental Insurance

What is the meaning of dental insurance in India?

Dental insurance in India can help you with financial assistance in case of medical procedures for dental problems. It is a part of the health insurance umbrella but is not a standard coverage. Thus, you need to verify if dental insurance is included in your policy or not before buying, renewing, and claiming.

What is the dental insurance process in India?  

In India, dental coverage is usually not a part of a basic health insurance policy. However, it can be covered under an Out-patient Department (OPD) cover (subject to availability) by paying an additional premium. For example, your health insurance policy might cost you Rs. 10,000 annually. By adding an OPD dental insurance coverage, the annual premium might increase to Rs. 11,000.

Even if dental insurance is covered under your OPD cover, it can come with the following conditions.

1. Waiting period

You might be required to serve a waiting period to be eligible to raise a claim against your dental insurance cover. For example, you might have to wait for three years from the beginning of your health insurance policy to claim dental expenses.

Learn more about waiting period for mediclaim policy.

2. Upper limit

The dental cover might settle your claim up to a certain monetary limit. Here’s an example for explanatory purposes. Consider the OPD limit of your health insurance policy for dental insurance is Rs. 5,000. And your dentist’s bill amounts to Rs. 12,000. Your policy will only cover up to Rs. 5,000.   

Once you have the suitable dental insurance coverage and avail of or are about to avail of the necessary dental treatment, you can raise a reimbursement or a cashless claim with your insurer, and it shall be settled as per the applicable terms and conditions.

Benefits of dental health insurance

As dental insurance plans in India are a subset of health insurance, they also offer similar benefits.

1. Financial assistance

In some cases, dental procedures, like other OPD procedures, can be on the expensive side. Especially if the condition is severe, the treatment is complex, and it is availed of in a metro city. Here, dental insurance plans can help in easing the financial burden while settling the medical bill.  

2. Regular check-ups

Frequent dental check-ups are required to ensure optimal dental health. However, not everyone is motivated to visit the dentist regularly. Perhaps, knowing that certain dental care expenses are covered by a Dental Care Insurance Plan might propel people toward regular dental check-ups and better dental health.

Is there any eligibility factor in dental insurance?

The dental insurance eligibility will depend upon the available/chosen insurance cover. If it’s an individual policy, the minimum age eligibility is 18 years and above, and the upper limit is 65 years. To include children in a family policy, their age eligibility is 90 days. Note that this criterion is meant as an overview; actual details might vary from policy to policy and insurer to insurer.

What is covered in dental insurance?

As dental insurance is not a standard cover, the exact inclusions will depend upon your policy. Here’s an overview of what is usually covered in dental insurance. For specific details, it’s suggested to check your health insurance policy wordings.

  • X-rays

  • Oral check-up

  • Dental injury because of an accident

  • Root canal treatment

  • Fillings

  • Extractions

  • Preventive treatment

What is not covered in dental insurance?

Usually, dental insurance excludes cosmetic treatments. Here’s an overview of dental insurance exclusions; for details, do check your policy wordings.

  • Dentures

  • Jaw alignment

  • Implants

  • Prosthesis

  • Orthodontics

How are dental insurance claims handled?

Dental insurance claims are handled the same way as other health insurance claims. There are two options: reimbursement and cashless.

  • In cashless claims, the insurer settles the bill directly with the hospital/dental clinic as they have a tie-up. You just have to pay the amount not covered by your policy.

  • In reimbursement claims, you need to pay the bill first and then get the expenses reimbursed. Your insurer will verify the details and credit the applicable claim amount in your bank account.

What are the documents required for dental claim settlement?

The exact list of documents can differ on a case-by-case basis. Here’s a basic list for your understanding.

  • Active dental insurance policy covering dental insurance.

  • Hospital/clinic bill.

  • Policy card.

  • Identification card, for example, Aadhaar card.

  • Claims form (usually for the offline process).

Why should you get dental insurance coverage?

You should get dental insurance coverage for the following reasons.

  • With timely financial support in case of expenses related to dental care, dental insurance can encourage people to visit their dentist proactively, and not when it becomes inevitable.

  • You can pick such a cover as an add-on (usually part of the OPD cover) and pay a nominal amount (as an additional premium), and get a considerable cover (around Rs. 5,000) in exchange.

  • A dental cover can offer peace of mind as you don’t have to worry about such expenses not being covered by the insurance policy.

Takeaway 

Here are the crucial points that you can take away from this article.

  • Health insurance with dental care is not offered by all health insurance policies. 

  • It is possible to add dental insurance coverage to your base health insurance policy in the form of add-ons.

  • A dental insurance cover usually comes with an upper limit, such as Rs. 5,000.

  • Dental insurance does not cover all dental treatments; it only covers the instances mentioned as policy inclusions.

  • It is beneficial to buy dental insurance in India for financial assistance during treatment. Also, as an incentive for regular dental check-ups knowing that you don’t have to take care of the dental expenses on your own.

Frequently asked questions

Read ahead for some frequently asked questions about dental insurance in India.

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Do all health insurance policies cover dental insurance?

No, all health insurance policies do not cover dental insurance as standard coverage. However, it is possible to include it as an additional coverage as per the availability of such a cover. Note that dental injury due to an accident is covered under health insurance as per applicable terms and conditions. 

Is it possible to buy dental insurance coverage online?

Insurance companies have upgraded their websites and the level of service because of advancements in technology. Individuals can now compare, analyse, and purchase insurance covers online in no time. Thus, buying a dental cover on your own is relatively smooth. However, keep in mind to read insurance-related documents thoroughly and get your doubts cleared before buying the policy.

How to check if my health insurance policy covers dental treatments?

You can check the respective policy wordings to confirm if dental treatments are covered by a particular policy or not. You can also confirm the same with the insurer (such as ACKO) directly via call or email.

Is root canal treatment covered under a dental health insurance policy?

Usually, root canal treatment is covered under a dental insurance cover. However, it’s best to confirm the same by checking respective insurance-related text such as policy wordings and the policy document.

Is the entire cost of dental treatment covered under insurance?

If your health insurance policy offers a dental cover, it’s likely that it comes with its set of limitations. A common restriction is in the form of a Rs. 5,000 upper limit. Even if this limit is on the higher side, it’s unlikely that the entire cost of dental treatment shall be covered under insurance, as there are deductibles (costs not covered by the insurer) to be considered.

Can I buy dental cover for my 70-year-old father?

Usually, the upper age limit for buying dental cover is 65. Therefore, you might not be able to buy a dental cover for your 70-year-old father. Nevertheless, do check the insurance-related documents for confirmation.

Which are the best plans in India offering dental insurance?

The best health insurance plan depends upon your insurance needs. What’s best for one might not get good enough for the other. Thus, it is suggested to read, understand, and compare health insurance plans, Mediclaim coverages, and other covers associated with dental insurance before buying a policy.

Does a dental insurance policy offer a cover for braces?

Some dental insurance policies might cover expenses related to braces, but they might be only for adolescents. 

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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