Does Health Insurance include Dental Treatments?

What Does Health Insurance Cover?

Medical treatments have become quite expensive in today's times. Having financial support, such as health insurance, can be a huge benefit. A health insurance policy is that financial aid. It is an agreement signed between a health insurance company and an individual/policyholder.

Under health insurance, the insurance company provides financial coverage for medical treatments in return for annual premiums. The maximum financial coverage for medical treatment and exclusions of the policy are specified in the policy documents.

Typically, a regular health insurance plan may cover the following medical expenses:

• Hospitalisation
  Pre and post-hospitalisation
• Daycare treatments
• Critical illnesses
• Maternity expenses
• Accidental injury treatments
• Room rent and ICU charges
• Ambulance charges
• AYUSH (Ayurveda, Yoga, Unani, Siddha, Homoeopathy) treatments
• Organ donor expenses, etc.

Are Dental Treatments Covered in Health Insurance?

In most cases, dental treatments may not be covered under a regular health insurance policy. However, if the treatment is medically recommended, such as after an accident, the expenses are likely to be covered under the policy.

Also, keep in mind that the scope, waiting period and sub-limits of the dental treatments may vary depending on the type of policy you purchase and your insurance provider.

The type of dental treatments that may be covered in health insurance are:

Medically Required Dental Treatments

Not all dental treatments are cosmetic or voluntary. Some cases are emergency and medically recommended. For instance, in Nisha’s case, it was an accident, and the condition required immediate medical care. It is a medical emergency, not a cosmetic treatment. So, such cases may be covered under a health insurance policy.

Dental Treatment Hospitalisation

While dental treatments are generally daycare procedures, some may require hospitalisation. For instance, oral surgery for jaw realignment may require hospitalisation. So, depending on the type of health plan you have, dental expenses arising from hospitalisation may be covered.

Pre-existing Ailments

Several health insurance plans also cover pre-existing conditions. If someone has dental conditions affecting teeth or gums at the time of purchasing a health insurance policy, related expenses may be covered. Make sure to clarify dental coverage at the time of purchasing the policy.

Mouth Cancer

Critical illness health insurance plans typically cover cancer. Along with other critical illnesses, oral cancer may also be covered under the policy. Upon diagnosis of mouth cancer, the insurance company provides a lump-sum payment to the policyholder for treatment.

Note: Regular screenings and cosmetic dental treatments are typically not covered by health insurance.

What is Dental Health Insurance?

Dental coverage often requires a separate dental insurance plan or an add-on rider. Dental health insurance, as the name suggests, is coverage dedicated to dental care expenses. Many health insurance companies offer separate dental insurance. Under the dental health policy, the policyholder may receive coverage for:

• Dental emergencies
• Surgeries
• Oral cancer
• Accidental injuries
• Regular check-ups
• Annual screenings

Note: Some dental health policies may also cover cosmetic dental treatment expenses.

How to Choose the Right Health or Dental Insurance Policy for Your Needs

Knowing that your dental treatments are covered by health insurance may be good news; however, what truly matters is choosing a policy that provides the right level of protection. Since dental procedures can be expensive and often fall outside the scope of a standard health insurance plan, selecting a well-rounded policy becomes crucial.

Keeping the following points in mind can be helpful.

Know Your Requirements

The first step is to assess your dental history and needs. This will help you determine whether a standard health plan is sufficient or if you need a specialised dental policy. For people who frequently experience dental issues such as cavities, gum disease, or tooth sensitivity, comprehensive dental coverage may be a better option. If your dental needs are minimal and mostly preventive, you may rely on a basic dental add-on rider.

Compare Dental Coverage Options

Health plans offered by different insurers vary in coverage options. Look closely and check the options that you require.

Pay Careful Attention to Exclusions

Knowing what is not covered in your policy is just as important as knowing the inclusions. Keep in mind that most policies will typically exclude:

• Cosmetic procedures
• Dental implants
• Braces and invisible aligners
• Tooth whitening
• Dentures.

Check Sub-Limits and Maximum Coverage Amounts

You should be aware that sub-limits and limits can also restrict the coverage. For example, there may be a cap of ₹5,000 on root canal treatment. This can significantly reduce the claim amount.

Understand How the Coverage Will Affect the Premium

Coverage and premiums are directly linked. More coverage means higher premiums. Thus, plans with extensive dental benefits may cost more. If multiple members in your family require dental care, especially kids, a family floater plan with dental add-ons or OPD benefits may offer more value than buying separate plans for each member.

To Conclude

Health insurance plans are designed to cover expenses arising from medical emergencies and necessary medical treatments. Dental care, like cosmetic treatments, preventive care, regular screenings, check-ups, and voluntary treatments, is generally not a part of standard health insurance. A health insurance plan, however, may cover dental emergencies and surgery expenses. For detailed coverage, you may simply purchase a dental health policy.

At Jio Insurance Broking, you can compare several plans to choose the one that best suits your oral health needs. Whether you prioritise emergency dental care, preventive treatments, or cosmetic procedures, you will find a policy to match your needs at Jio Insurance Broking.