Why are Dental Procedures not Covered by Health Insurance?

Dental hygiene is an essential part of your overall health — yet, dental insurance is not typically a part of health insurance in India. I wasn’t aware of this either, until very recently. To give you a bit of a background, I have diligently renewed my health insurance policy for the last 3 years.

And fortunately, I never had to raise a claim on my plan until last month, when I underwent a root canal treatment. To add to the already painful procedure, I was in for a rude shock when my health insurer informed me that my policy did not cover any dental procedures.

The bottom line — I realised a little too late that I should have purchased dental insurance too.

But why are dental procedures generally not covered under a health insurance policy? Is a dental insurance plan necessary? And what does dental insurance typically cover and exclude? That’s just what I’m going to take you through in the following sections.

Why is dental work not included in health insurance?

To be honest, this is quite a grey area. Most health insurance providers do not cover dental procedures because they are considered cosmetic treatments. And generally, health insurance plans do not cover elective procedures done for aesthetic purposes.

That said, not all dental work is excluded from health insurance. Some health insurance plans cover any dental procedures that may be required if you are injured due to an accident. Then, there are other health insurance plans that may offer dental coverage if you opt for an out-patient department (OPD) benefit. However, OPD benefits do not cover dental procedures that are purely done for cosmetic purposes.

So, it is fairly evident that there is a lot of ambiguity surrounding the inclusion of dental benefits in health insurance. This is why it may often be a good idea to simply buy a separate dental insurance plan and avoid treading the grey area in-between.

What is dental insurance?

Dental insurance, as you may have figured, is a kind of insurance that covers the costs of dental procedures and treatments. It may occasionally form a part of standard health insurance coverage, but you can also buy standalone dental insurance plans if you want more extensive dental insurance coverage.

Why is dental insurance necessary?

Dental procedures can be costly, be it a root canal treatment or a dental reconstruction due to an injury. If you do not have an emergency fund to rely on, an unexpected dental issue could use up a significant part of your savings. Often, when caught in such an unforeseen contingency, people may tend to skimp on the dental care required because of the high costs. But inadequate dental care can do more harm than good.

Here is where dental insurance can help.

Dental insurance is necessary for the following reasons —

1. You can maintain good dental health

Some dental insurance plans may cover routine dental work. If your plan offers this benefit, you can keep dental issues at bay by promptly getting any dental care that you need.

‍ 2. You need not worry about rising dental costs

Among other things, inflation is also contributing to rising dental costs. With a dental insurance plan, however, you need not worry about this financial burden.

‍ 3. You can get the dental care needed without any compromises

You may put off any essential dental work without a dental plan due to the steep price. But a dental cover ensures you get timely dental care without any compromises.

What do dental insurance plans typically cover?

Before you buy any kind of insurance plan, you need to have a clear idea of what’s covered by the policy. This way, if any of the insured expenses crop up, you can raise a claim in a timely manner. So, here’s a preview of what dental insurance coverage (in India) typically includes.

• Dental treatment for tooth fillings
• Root canals
• Dental extractions
• Treatment for dental injuries
• Dental diagnostic procedures
• Oral checkups
• Preventive dental care

What are the common exclusions in dental insurance?

You should also be aware of what’s not covered in your dental insurance plan, so you can have an emergency fund for such contingencies. Typically, the following expenses will not be covered in dental insurance.

• Cosmetic dental procedures
• Dentures
• Jaw alignment procedures
• Prosthesis
• Dental implants

Who should buy a dental insurance plan?

Despite knowing what a particular kind of insurance is all about, you may still have a dilemma about whether it is essential. So, how do you know if you should buy a dental insurance plan? The answer to that lies in your requirements and your financial status.

That said, it always helps to have a benchmark to guide you. So, here’s a set of pointers to help you out. You may need to buy dental insurance if —

• Your health insurance plan does not offer dental insurance coverage
• You are prone to suffering from dental problems
• You work in conditions that are dangerous or likely to cause injuries
• You do not have a sufficient emergency fund saved up for medical contingencies

In conclusion

You now know that health insurance plans do not generally cover dental procedures and the alternative to this. The bottom line is that there is a very thin line between dental and health insurance. And often, that line is blurred.

So, if you are buying a regular health insurance plan, check the terms and conditions of the policy to get a better idea of the extent of dental insurance coverage offered, if any. This will help you make a more informed decision about whether or not you need a dental insurance plan.

Frequently Asked Questions (FAQs)

‍ 1. How much does dental insurance cost?

The exact price of dental insurance is not fixed, per se. It varies based on several factors such as the extent of coverage, the policy term, the dental health and driving history of the person covered, and the benefits offered by the plan. You can get a better idea of the cost of dental insurance in India by requesting a quote online.

‍ 2. What does dental insurance cover?

The precise scope of dental insurance coverage can vary from one plan to another. That said, dental insurance broadly covers procedures like oral checkups, dental X-rays, dental fillings, root canal treatment, dental work following accidental injuries and dental extractions.

3. What is the best dental insurance company?

There are no specific dental insurance companies in India, per se. However, most regular health insurance companies offer dental treatment coverage (usually within the out-patient category) in their premium plans.

4.Why dental treatment is not covered by health insurance?

Most health insurance providers do not cover dental procedures because they are considered cosmetic treatments . And generally, health insurance plans do not cover elective procedures done for aesthetic purposes

5. Is root canal covered in health insurance?

Based on your insurance provider, root canal may or may not be covered in your health insurance package. Usually though, root canal coverages are available in most insurance coverages today.