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Dental Insurance Plans

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Understanding dental insurance in India

If you need medical treatment for dental issues, dental insurance in India might provide you with financial support. It is a component of health insurance but does not constitute standard coverage. Therefore, before purchasing, renewing, and filing a claim, you must confirm whether dental insurance is covered by your policy or not.

 

Dental insurance is typically excluded from basic health insurance plans in India. However, by paying an extra premium, it may be covered under an Out-patient Department (OPD) policy. For instance, the annual cost of your health insurance plan could be Rs. 20,000. The annual fee could rise to Rs 21,000 by including OPD dental insurance coverage.

Dental insurance may be subject to waiting periods and sub-limits even if it is covered by your OPD coverage. Let us understand dental insurance in the subsequent sections.

Why Do You Need Dental Health Insurance?

Most individuals don't exactly find going to the dentist to be the most thrilling pastime. Sometimes it can be easier to forego dental care entirely given the high degree of uncertainty regarding cavities and unexpected expenses. But visiting the dentist regularly is actually essential for preserving good health, and signing up for a dental insurance plan can help with cost management, increase your sense of security, and increase your awareness of your present health status. 

 

For instance, a root canal treatment can cost you anywhere between Rs 8000 to 12,000 depending on the city tier. Additionally, replacement of missing teeth can go all the way up to Rs 30,000 and implants up to Rs 35,000!

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What is the dental insurance process in India?

Dental insurance may be subject to waiting periods and sub-limits even if it is covered by your OPD coverage.

1. Waiting Period

It's possible that you will have to wait before you can submit a claim under your dental insurance. To claim dental charges, for instance, you might have to wait up to 3 years from the start of your health insurance coverage.

2. Upper Limit

Your claim can be settled by the dental insurance up to a predetermined dollar amount. Here is an illustration to help with the explanation. Take into account that your health insurance policy's OPD limit for dental coverage is Rs. 10,000. The cost of visiting your dentist is Rs. 12,000 as well. Only Rs. 10,000 would be covered by your policy.

Benefits of dental health insurance

1. Financial support

Dental operations can be quite pricey.  Costs of implants and ceramic dentistry are tremendously high, especially if the illness is severe and the patient lives in a big metropolis. Dental insurance plans can assist in reducing the financial strain while paying the medical payment in this situation.

2. Routine examinations

To ensure ideal dental health, regular checkups are necessary. However, not everyone is motivated to visit the dentist regularly. People may be more likely to get regular dental checkups and maintain better dental health if they are aware that some dental care costs are covered by a dental care insurance plan.

Is there any eligibility factor in dental insurance?

The coverage will determine the eligibility for dental insurance. If it is an individual policy, the minimum age requirement is 18 and the maximum age is 65. The age requirement for children to be covered under a family policy is 90 days. The precise facts may differ from one insurer to another; keep in mind that this criterion is only meant to serve as an overview.

What is covered in dental insurance?

Your policy will determine the specific inclusions. Here is a list of the typical dental insurance benefits:

Fillings

Tooth Extraction

Preventive Medicine

Root canal surgery

Dental damage brought on by an incident

Oral examination

X-rays

What is not covered in dental insurance?

Cosmetic dental procedures are typically not covered by insurance. Here is a list of dental insurance exclusions; please refer to your policy wordings for specifics.

Dentures

Implants

Prosthesis

Orthodontics

Jaw Reposition

How are dental insurance claims handled?

If you are about to go for dental treatment, you should contact your insurance provider at once to begin the claim procedure. Both cashless and reimbursement claims are possible. Let's take a look at the procedure:

  1. Submit the correctly filled in claim form after informing the insurance provider via the website or toll-free line.

  2. The hospital will verify and then deliver to the insurance company the required documentation that you have submitted.

  3. If you are admitted to a network hospital, the insurance company will pay the hospital immediately as part of the cashless claim payment after verification.

  4. If you are unable to be admitted to a network hospital or if your claim for cashless payment is denied for whatever reason, you will be entitled to payment under the reimbursement process

  5. For reimbursement, you will pay the hospital upon being discharged. However, you will be reimbursed after submitting the documentation and bill to the insurer.

What are the documents required for dental claim settlement?

Duly filled claims form

Identification Card - Aadhar/Pan/Driver’s License

Policy Card

Hospital Bill

Active dental insurance policy

How to choose the best dental insurance?

With OneAssure, you may evaluate plans from several insurers online based on coverage, premium etc. to determine which dental insurance plan is best for you. For example:

 

With Aditya Birla Activ Health Platinum Enhanced Plan you get coverage for dental investigation and consultations. The coverage is available for listed dental services as mentioned in the policy wording. However, this cover is available only to people opting for a sum insured of Rs 15 lakh and above.

 

As another example, ManipalCigna ProHealth Insurance Plan covers the cost of dental treatments. The coverage limit, however, varies from up to Rs 500 to Rs 20,000 depending on the opted variant.

 

Such clauses vary from plan to plan. Hence it is of utmost importance that you consult a OneAssure partner before opting for any plan who will help you understand the policy wording and features before you make a final decision

Recommended Dental Insurance Plans

Dental Health Insurance Plan
Sum Insured (Rs.)
Dental Insurance Cover
Aditya Birla Activ Health Platinum Enhanced Platinum Plan
Rs 15 Lakh and above- Rs 2 Crore
Dental Consultation and Investigations
Bajaj Allianz Health Care Supreme Plan
Rs 35 Lakh - Rs 50 Lakh
Dental Consultation, Investigations and Procedures
Bharti AXA Health Advant EDGE Plan
Rs 5 lakh - Rs 3 crore 0.5% of SI or Rs 1 Lakh
OPD dental treatments
Care Plus Health Insurance Plan
Rs 5 lakh – Rs 25 lakh
OPD dental treatments
Chola MS Privilege Healthline Plan
Rs 5 Lakh - Rs 25 Lakh
Outpatient dental expenses 10,000 every 2 yrs.
Digit Health Care Plus Plan
N/A-
Outpatient Dental treatments Cover
Edelweiss HealthPlus Plan
Rs 5 lakh – Rs 1 crore
Outpatient dental expenses
Future Generali Health Total Plan
Rs 15 lakh – Rs 1 crore
Outpatient dental consultations and diagnostics
IFFCO Tokio Individual Medishield Insurance Plan
Rs 50,000 – Rs 50 lakh
Dental services
Kotak Mahindra Health Premier Plan
N/A-
Outpatient dental expenses
Liberty HealthPrime Connect Plan
Rs 10 lakh – Rs 1 crore
Dental expenses
Magma HDI OneHealth Insurance Plan
Rs 10 lakh - Rs 1 crore
Outpatient dental treatment
ManipalCigna ProHealth Insurance Plan
Rs 2 lakh – Rs 1 crore
Dental treatments
National Parivar Mediclaim Policy
Rs 1 lakh – Rs 10 lakh
Outpatient dental treatment
New India Premier Mediclaim Policy
Rs 15 lakh – Rs 1 crore
OPD dental treatment
Niva Bupa Health Premia Insurance Plan
Rs 5 lakh – Rs 3 crore
OPD dental treatment and diagnostic services
Oriental Mediclaim Insurance Policy
Rs 1 lakh – Rs 10 lakh
Accidental dental surgery
Raheja Health QuBE Insurance Plan
Rs 1 lakh – Rs 50 lakh
Accidental dental expenses
Reliance Digital Care Management Policy
Rs 1000 - Rs 5000
OPD dental consultations
Royal Sundaram Lifeline Health Insurance Plan
Rs 25 lakh – Rs 1.5 crore
Dental OPD treatments
SBI Arogya Plus Plan
Rs 1 lakh – Rs 3 lakh
OPD dental treatments
Star Comprehensive Insurance Plan
Rs 5 lakh -– 1 crore 25 Lakh
Outpatient Dental treatment Cover ( Rs 5,000- Rs 10,000)
Tata AIG Medicare Premier Plan
Rs 5 lakh – Rs 50 lakh
Dental treatment
United India Individual Health Insurance Policy
Rs 2 lakh – Rs 20 lakh
Dental treatment
Universal Sompo Complete Healthcare Insurance Plan
Rs 1 lakh – Rs 10 lakh
Dental treatment

Takeaway

Here are the key ideas from this post that you should remember.

 

  1. Not all health insurance policies include coverage for dental care.

  2. You can get dental insurance add-ons to supplement your primary health insurance plan.

  3. Typically, a dental insurance policy has a cap, which varies from plan to plan

  4. Dental insurance only covers the situations listed as policy inclusions; it does not cover all dental treatments.

 

To get financial support during treatment, it is advantageous to purchase dental insurance in India. Additionally, the knowledge that you won't be responsible for paying for your own dental treatment might serve as an incentive for getting frequent dental exams.

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