We, with limited technical knowledge of insurance, find ourselves in turmoil and often seek the help of our peers, relatives or the broker to invest our hard-earned money in the supposedly best health insurance plan for ourselves and our family. Do we get successful? Health insurance plans, though loaded with attractive features, require some understanding of their fine print especially the part that deals about exclusions since the list of exclusions proves to be the major bone of contention at the time of claim. One such treatment that features in almost 99% plans’ list of exclusions is dental treatments. Dental treatments are usually excluded from the scope of coverage of almost all plans barring two plans and the expenses incurred in the context of such treatments are not paid for by the insurer. So, for those of you looking for dental treatment coverage, only two plans in the market include such expenses subject to certain terms and conditions.
Let us take a look at health insurance plans that cover dental treatment and their features:
Apollo Munich’s Easy Health Plan
It is a comprehensive health insurance plan offered by Apollo Munich which covers dental treatment expenses among other coverage’s. The important features of the plan are as follows:
• Variants – The plan comes in three variants of Standard, Exclusive and Premium. The range of coverage available in Standard Plan is Rs.2 lakhs to Rs.5 lakhs, under the Exclusive variant is Rs.7.5 lakhs to Rs.50 lakhs and the Premium variant provides a coverage range of Rs.4 lakhs to Rs.50 lakhs.
• Age limits – Children aged 90 days and above can be insured provided the parent is also covered under the plan. For individual plans, the minimum age at entry is 18 years and the maximum age is 65 years under all variants with lifelong renewability
• Coverage – The plan provides all the basic covers like hospitalization expenses, pre and post hospitalization expenses, ambulance charges of up to Rs.2000, 144 day care procedures, domiciliary treatments, organ donor expenses, AYUSH Benefit, daily cash benefit for shared accommodation, new born baby coverage, maternity expenses, etc. Free health check-ups covered up to 1% of the Sum Assured can be undertaken after 4 years, 3 years or every year depending on the plan variant.
• Dental coverage – Outpatient dental treatment is covered only after a waiting period of 3 years. The coverage is provided only under the Premium Plan variant and there is a limit on the scope of coverage. Up to 1% of the Sum Assured can be availed as a coverage amount up to a maximum of Rs.5000 if a Sum Assured of Rs.4 lakhs to Rs.10 lakhs is chosen. The maximum limit increases to up to Rs.7500 if a coverage level of Rs.15 lakhs to Rs.50 lakhs is chosen.
• Exclusions for dental coverage – Though dental coverage is provided after 3 years of policy continuation, there are certain exclusions which are completely excluded from the scope of coverage even after 3 years. Such exclusions include any treatments that include cosmetic surgery, dentures, dental prosthetics, dental implants, orthodontics, orthognathic surgery, jaw alignment or treatment for the temporomandibular joint, upper or lower jaw bone surgery and surgery related to the temporomandibular unless necessitated by an acute traumatic injury or cancer.
Bharti AXA Smart Health Insurance Plan
It is a health insurance plan offered by Bharti AXA General Insurance Company which has a provision for coverage of dental treatments if they are necessitated due to an accident. The features of the plan are as follows:
• Variants – The plan is available in two variants of Basic and Optimum. The Basic variant provides coverage of Rs.2 lakhs while the Optimum variant has two coverage options of Rs.3 lakhs and Rs.5 lakhs.
• Age limits – Children aged 90 days and above can be insured provided at least one of the parents is also covered under the plan. For individual plans, the minimum age at entry is 18 years and the maximum age is 65 years under both the variants with lifelong renewability
• Coverage – Coverage under the plan includes hospitalization expenses, pre and post hospitalization expenses, organ transplant costs, home nursing, ambulance charges of up to Rs.2500, in-patient physiotherapy charges, recovery grant, out-patient treatment for accidents, children’s education fund, transportation of mortal remains, day care treatments, etc. These coverage options are provided only in the Optimum variant of the plan while ambulance charges up to Rs.1500 are provided also in the Basic Variant. Health check-up facility is also provided after a block of 4 years.
• Dental coverage – While dental treatment is considered in the exclusions list, out-patient emergency dental treatment due to an accident is covered under the health insurance plan. The coverage is provided under the Optimum variant of the plan up to a maximum of Rs.3000 for Rs.3 lakhs of coverage and Rs.5000 for Rs.5 lakhs of coverage. Along with providing for emergency dental treatment, a follow-up of the treatment by the same dentist is also covered for a maximum of 15 days provided it falls under the maximum allowable limit.
• Dental coverage exclusions – Though dental treatment is covered, only such treatment is covered which is necessary following any accident which has damaged the teeth and gums. Treatments not arising out of accidents are completely excluded from the scope of coverage.
The final word
Yes, only these two plans, among the other hundred plans available in the market, provide for dental treatment. However, the coverage provided is fraught with limitations. Whereas Apollo Munich’s Easy Health Plan covers dental treatments after 3 years, there is a long list of exclusions and Bharti AXA’s Smart Health Plan covers dental treatments only under its Optimum Variant with a maximum limit of Rs.5000. moreover, only treatments due to accidental injury are covered. So, buying a plan because of its dental coverage option is not a prudent choice because dental treatments are not universally sought and even in cases where they are applicable, you can bear the cost out of your own pocket. On the other hand, you can choose a plan which promises other great features like Sum Assured restoration, global coverage, higher no claim bonus rewards coverage to name a few.
So, don’t go looking for a plan with dental coverage because even if you get one, the applicable terms and conditions render the coverage far too limited. Instead choose a plan which offers a long list of coverage options and not a long list of exclusions.