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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.

FAQs

  • I am young and healthy. Do I really need health insurance?
    Health insurance covers you against unforeseen health expenses. Even if you are healthy and haven't had the need to see a doctor in a while it is essential that you get yourself covered for future emergencies. Also, health insurance policy premiums at the time of subscription may be higher if you subscribe at a later age.While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren’t too costly like routine doctor’s visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury. Please do understand your policy and its inclusions and exclusions and make the right decision.
  • What happens if the primary insured person covered under a family floater policy expires?
    In case the primary insured expires post hospitalization then the claimable health expenses would be reimbursed. If the primary insured is also the eldest member in the family, then for the succeeding years after the death of the primary insured the premium would be calculated on the basis of the age of the next eldest member. For this to happen, the family should fill up the change of request form provided by the insurer. Please note that in case there were only two members covered under the policy then the family floater plan would be converted to an individual plan.
  • What are the things to look for while choosing a health insurance plan?
    When choosing a health insurance policy there are a few things which you should be ready with are: The number of members and relations to be covered- Because this will be the basis of buying a policy. Type of coverage – Individual, Family floater or group. Sum insured or coverage amount – Ensure that you consider future expenses too. Room rent – Check for the capping amount or criteria defined if applicable. Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also, check if the plan has a copay feature. Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital. Policy wording – Most important thing to check before buying a policy. In case you are not sure about the certain term or conditions you can always contact the insurer for clarification. Add-ons: Check for the add-ons that are available and choose the ones that you are definitely likely to use in the following year.
  • Can I cancel my policy and if yes will I get my premium back?
    Yes, you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause you can cancel the policy and get a refund. Stamp duty, expenses on medical check-ups and proportionate risk premium (the number of days that the insurance company was at risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer to the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded. Note: For the refund to happen there should be no claim during the policy period.
  • What are important exclusions under the mediclaim policy?
    There are four important types of exclusions in a Mediclaim policy they are: Time-related exclusions: e.g. Waiting period- general, specific ailments and pre-existing Non-medical expenses: e.g. Registration charges Illegal reasons: e.g. drugs, alcohol abuse, self-inflicted injuries Out-of-scope: e.g. Unproven medical procedures, HIV, adventure sports, etc.
  • Is health insurance policy applicable if hospitalization is for less than 24 hours?
    Yes, your health insurance policy is very much applicable even if the hospitalization is less than 24 hours. This is known as Day Care Treatment. Here, 24 hours hospitalization is not required and you do have a scope of coverage too. Day Care refers to any treatment or surgical procedure that is performed under general or local anaesthesia in a medical clinic/hospital or a day care centre requiring hospitalization for a period of fewer than 24 hours because of technological advancement. However, remember that OPD (out-patient department) are not a part of the Day Care treatments.
  • What will happen if my health insurance lapses when I am hospitalized?
    There can be 2 possible cases: Case 1: You are hospitalized just before the policy expiry date & have intimated the insurance company before the policy lapses (where the policy lapses while you are still in hospital), the company will pay the benefit as per the plan chosen Case 2: If your health insurance lapses and you are hospitalized during the grace period, on intimation during the grace period about the hospitalization, the company will pay the coverage as per the plan, and its terms and conditions.
  • My employer provides me with health insurance coverage. Is it advisable to buy another policy on my own?
    It is strongly advised to take a private policy due to 2 reasons: If you change your job, you might not necessarily get health insurance from your new employer & you will be exposed to health costs in the transition period between jobs. The track record that you have built-in health insurance at your old employer will not transfer to the new company policy. Covering pre-existing diseases might be a problem. In most policies, pre-existing diseases are covered only from the 5th year onwards.
  • Is there any tax benefit that one can avail of while purchasing health insurance?
    Yes, there is a tax benefit available under Section 80D of the Income Tax act 1961. Every taxpayer can avail of an annual deduction of Rs. 15,000 from taxable income for the payment of health insurance premiums for self and dependents. For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show proof for payment of the premium. (Section 80D benefit is different from the Rs 1,00,000 exemption under Section 80 C).
  • Is a medical checkup necessary before buying a policy?
    A medical checkup is necessary for a new health insurance policy for customers above the age of 40 or 45 years depending on the health insurer’s norms. Medical checkups are usually not needed for the renewal of policies.
  • Who is a Third Party Administrator?
    A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely settlement.
  • What do you mean by Cashless Hospitalization?
    In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from the hospital. The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This is for your convenience. However, prior approval is required from the TPA before the patient is admitted into the hospital. In case of emergency hospitalization, approval can be obtained post-admission. Please note that this facility is available only at the network hospitals of the TPA.
  • What is the difference between Health Insurance & Critical Illness policies or Critical Illness Riders in insurance?
    A health insurance policy is reimbursement of medical expenses. Critical illness insurance is a benefit policy. Under a benefit policy upon the occurrence of an event, the insurance company pays the policyholder a lump sum amount. Under a critical illness policy, if the insured is diagnosed with any critical illness as specified in the policy, the insurance company will pay the policyholder a lump sum. Whether the client spends the amount received on the medical treatment or not depends on the client’s own discretion.
  • How does the insurance company decide whether a disease was a pre-existing one or not?
    While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware of whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses. Note: It is important to disclose any disease you might be suffering from before buying the health insurance policy. Insurance is a contract based on good faith and any willful non-disclosure of facts might lead to problems in future.
  • Can I seek treatment at home and be reimbursed for it under health insurance?
    Most policies offer the benefit of treatment at home: a) When the condition of the patient is such that he cannot be moved to the hospital Or b) When there is no bed available in any of the hospitals and only if it is like the treatment given at the hospital/nursing home which is reimbursable under the policy. This is called “domiciliary hospitalization” and is subject to certain restrictions both in terms of the amount which is reimbursable as well as the disease coverage.
  • What is a Critical Illness Insurance?
    Critical Illness Insurance is a policy that pays out a lump sum amount upto the Sum Insured upon diagnosis of a critical illness covered under the policy.
  • Why should I purchase Critical Illness Insurance?
    Critical Illness Insurance provides you and your family, the additional financial security on the diagnosis of a critical illness. The policy provides a lump sum amount which could be used for: Costs of the care and treatment Recuperation aids Debts pay off Any lost income due to a decreasing ability to earn Fund for a change in lifestyle.
  • What is a Fixed Benefit policy?
    Under a benefit policy on the happening of an insured event, the insurance company pays the policyholder a lump sum amount.
  • How does a Critical Illness benefit health insurance policy help you?
    The company will pay the Sum Insured as a lump sum on the first diagnosis of any one of the following Critical Illnesses, provided that the Insured Person survives a period of 30 days from the date of the first diagnosis. The following Critical Illnesses are covered under our plan:- Heart Attack (Myocardial Infarction) Coronary Artery Bypass Surgery Stroke Cancer Kidney Failure Major Organ Transplantation Multiple Sclerosis Paralysis
  • Which documents are required at the time of Claim?
    The Insured shall arrange for submission of the following documents required for processing of the claim within 45 days from the date of Intimation. Duly Completed Claim Form Original Discharge Summary. Consultation Note/ Relevant treatment papers. All relevant medical reports along with supporting invoices and doctors requisition advising the same. Original and Final hospitalization bills with a detailed breakup. Pharmacy Bills along with prescriptions. Any other documents as may be required by the Company. On receipt of claim documents, claims will be processed in accordance with the terms and conditions of the Policy.
  • What is Personal Accident Insurance?
    Personal Accident Insurance protects your finances by providing a lump sum compensation in the unfortunate event of a fatal accident or one that disables you permanently. The compensation shields you and your loved ones from a financial crunch. This insurance also covers accidental hospitalization costs.
  • I am a homemaker who spends the majority of my time at home. Do I also need personal accident insurance?
    Accidents can happen to anyone. Motor accidents, rail accidents, natural calamities, the list is endless. These can sound scary. But, getting intimidated is not the solution, being financially prepared is. Opting for Personal Accident Insurance helps you to meet expenses in case a crisis arises.
  • I travel to different countries often for business and at times for leisure. What if I meet with an accident outside India?
    Accident policies offer worldwide coverage. Your claim will be paid even if you meet with an accident overseas. Contact OneAssure partner to help you understand terms of each policy before buying.
  • I already have health and life insurance coverage. Why should I buy Personal Accident Insurance?
    Life insurance offers a death benefit to your nominee in case you pass away. Health insurance provides compensation and/or reimbursement of hospitalization and other medical expenses. A Personal Accident Insurance policy, on the other hand, insures against the financial risk that could arise due to accidental permanent total disability or accidental death of an earning family member. In short, the policy is essential as it strengthens your financial portfolio securing the future of dependent family members against unforeseen events.
  • What happens if I am hospitalized after an accident? Will the hospitalization expenses be covered by my health insurance?
    Yes. Health insurance policies have optional covers that you get by paying an additional premium. An Accidental Hospitalization Cover provides reimbursement for medical expenses related to hospitalization and a Daily Cash Cover provides you with a cash allowance for each day of hospitalization.
  • Would I need to pay a high premium for availing of Personal Accident Cover?
    No. For example, the premium for a basic policy of Rs. 5 lakh (duration 1 year) is approximately Rs. 610*. It is but a small price for ensuring your family's financial security!
  • I have a family to support. Does Personal Accident Insurance cover death?
    Yes. All you need to do is mention the name of your nominee in the policy document. The sum insured will be paid to your nominee by the insurance company.
  • What is Travel Insurance?
    Travel insurance in India provides coverage for medical expenses incurred overseas for any treatment received as an inpatient or outpatient. All plans also cover trip-related exigencies like trip delays, trip interruptions, trip cancellations and related problems that may arise during your trip. Some plans also provide services such as travel-related advice, Medically required Evacuation to your home in India or a hospital overseas for continued medical treatment. Other assistance services include providing emergency cash or help in the event of the loss or theft of your money, valuables or travel documents.
  • Do I have to get a medical exam done before buying a travel insurance policy?
    No, there is no such requirement to get a medical test for travel insurance. Some companies might ask for medical tests for travellers more than seventy years for higher coverage. Coverage often to fifteen thousand dollars is provided without medical tests.
  • Where should I call for claims assistance while I am abroad?
    You can reach out to us at +91 63643 34343 and we’d be happy to help. You can also contact OneAssure partners for claims assistance. Rest assured that you will be provided with timely support. In addition, your policy document would also have the details to get in touch with you insurer directly.
  • Can I get travel medical insurance for senior citizens who are above 70 years?
    Yes, some insurers are offering travel insurance for travellers aged 71 to 85. Yes, senior citizen travellers who are aged 71 to 85 years are also eligible to buy a Bajaj Allianz travel insurance policy for 6 months with $50,000 coverage.
  • What is Sum Insured Restoration Benefit in Health Insurance?
    It is a benefit that allows an insured to reinstate the entire sum insured in the policy year when it gets exhausted due to incurred claims. Most of the health plans these days offer the ‘restoration benefit'. It is just like a ‘magical backup’ to recharge your exhausted sum insured. In case the entire cover is exhausted, it gets replenished automatically for the next hospitalization that occurs within the policy year. In a situation when the sum insured is completely exhausted, sum insured restoration proves to be of great help not only to family floater policies but individual health insurance policies, equally.
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