Dental Insurance: Coverage, Claim & Exclusions

Updated: 01-07-2022 09:12:03 AM

The health insurance companies in India do not offer stand alone plans for dental insurance. They are a part of the health plans. To make individual dental insurance a reality in India, the Insurance Regulatory and Development Authority of India (IRDAI) has asked insurance companies to remove dental treatments from the list of non-payable items used by various health insurance companies.

What is Dental Insurance?

It is a form of health insurance designed to pay the escalating treatment costs associated with dental care. Health plans offering dental insurance help individuals get coverage for dental care and hospitalisation expenses and cost of medicines, etc. The IRDAI also said in August 2018 that dental treatment will be a part of the health insurance policy even if it does not require hospitalisation.

What all Dental Insurance Covers?

The huge medical expenses that people have to bear these days are gradually increasing the need for health insurance policies. To provide coverage for dental treatments, some health insurance plans are structured in such a way that they include certain sections of dental care. These cases can be either diagnostic or preventive, and only a part of the expenditure is covered.

Eligibility Criteria

The minimum entry age is 18 years, with maximum being 65 years. For children, it is 90 days, though it may vary with different insurance companies.

Claim Process for Dental Insurance 

• Inform the company about the eventuality as soon as it occurs
• Submit the documents supporting your claim along with the duly filled and signed claim form
• Once this step is done with and the insurance company receives the documents, they’ll start with the verification process of the same
• This will take around 10 days after which your payment shall be released

Documents Required for Claim Process

Mentioned below are the documents required to file claims for this insurance:

• Duly filled in claim form
• Policy documents
• Discharge summary
• KYC documents
• Consultation bill
• Original hospital bill
• Pharmacy bill

Exclusions under Dental Insurance

Mentioned below are some exclusions under this insurance. These cases are not considered for any claims.

• Cosmetic Surgery
• Dentures
• Dental Prosthetics
• Dental Implants
• Orthodontics
• Jaw Alignments
• Upper or Lower jaw bone surgery

Companies Offering Dental Insurance in India

Some of the insurance companies that offer this insurance in India are:

• Bharti AXA
• State Bank of India
• LIC
• Bajaj Allianz
• Chola MS
• ICICI Prudential

Important Aspects

Below mentioned are the important aspects that needs to considered while purchasing this insurance policy:

• Compare plan with different insurance companies
• Read the terms and conditions of the policy carefully
• Know coverage and exclusions offered as per the policy

Advantages of Dental Insurance

• Coverage is provided if damage to teeth is caused by an accident
• Regular checkups to the dentists and the common treatments like scaling of teeth are completely covered
• Other treatments like a root canal, teeth capping and teeth whitening are partially covered
• Assured benefits and discounts for major treatments like implants and bracing in some policies

FAQs

Q1. Is dental coverage provided in case of damage caused due to an accident?

Yes, some of the insurance companies offers dental coverage in case of damage caused due to accident. These insurance companies include- Bharti AXA, Bajaj Allianz, LIC and others.

Q2. What is the entry and exit age for adults to avail Dental Insurance?

For adults to avail dental insurance, minimum entry age is 18 years and maximum entry age is 65 years.

Q3. Can I avail Dental Insurance under Travel Insurance plan?

Yes. Chola MS Travel Insurance offers coverage to the dental health of the policyholder while on any travel route.