Most health insurance companies in India do not provide any coverage for dental procedures as they fall under the cosmetic treatment category. However, procedures arising out of accidental injuries are often covered by insurers.
Thinking of buying a health insurance plan and spoilt for choice with all the options available? With the rising awareness of the need for health insurance among the population nowadays, there is an increase in the number of health insurance policies being sold. With the options and add-ons that insurers offer, individuals can opt to increase their cover as they grow older or based on their health requirements.
And while there are a lot of comprehensive health insurance policies that provide coverage for an array of medical conditions and treatments, very few offer dental insurance. Most health insurance packages offered in India do not offer coverage for dental procedures for both private as well as group (in most cases, company-paid) insurance policies.
So why is dental treatment receiving the proverbial cold shoulder from insurance companies in india? While there is no consensus as to the exclusion of dental cover from traditional health coverage, many believe that dental treatment does not come under the umbrella of health services as classified by insurers.
Another possible reason is a few policyholders could file claims for procedures that fall under cosmetic dentistry or opt for high-end dental procedures, resulting in insurers having to pay out large sums toward claim settlement.
What is Dental Insurance?
Dental insurance refers to the cover provided for dental procedures (not including cosmetic dentistry) that are deemed necessary by a medical professional. Procedures would be classified under either preventive or diagnostic. A few of the procedures that are covered under dental insurance include filling of caries, tooth extractions, dentures, root canal procedures, etc.
Dental Insurance Coverage in India:
In India, there are very few insurance providers who cover dental procedures, with none of the major insurance companies offering dental insurance as an exclusive cover. More often than not, dental treatments are covered in the event of an accident and would be limited to repairing the damage caused by such. An example of such coverage is the Bharti AXA Smart Health Insurance Plan, which covers dental treatment up to a maximum of Rs.5,000.
OCare, an insurance Process as a Service (PAAS) platform has recently launched India’s first dental insurance plan. The plan provides insurance up to Rs.25,000 a year per person and covers pre-existing dental conditions as well. Additionally, the plan provides two dental check-ups a year as well as a loyalty card that is redeemable on dental services. With a view to making dental treatment accessible and affordable for all, OCare’s dental insurance plan is being launched in villages through the respective Gram Panchayats. In this way, it is hoped that individuals across India will have access to quality dental care with having to worry about the cost.
Another way insurers cover dental treatment is through out-patient department (OPD) treatments. Insurance companies that offer dental insurance for dental procedures up to a maximum limit as specified in the policy document only, irrespective of the dental procedure opted for. Additional terms govern this kind of coverage, however, further limiting their scope. This includes claims pay-outs for dental procedures after the second policy year only, among others.
In the case of OPD treatment policies, policyholders will have to pay an additional premium, which is often very high. Thus, while some inroads are being made in providing dental insurance, comprehensive dental coverage is still not a reality in India.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.