Coverage Of Dental Insurance Scheme And Exclusions Of Claim

Coverage Of Dental Insurance Scheme And Exclusions Of Claim


Dental insurance is a type of health insurance that focuses on providing coverage for dental care and oral health services. Dental insurance aims to help individuals and families manage the costs associated with routine dental check-ups, preventive treatments, and potentially more extensive procedures. Understanding the coverage and exclusions of your dental insurance plan is crucial to maximizing its benefits and avoiding any unexpected out-of-pocket expenses.

Here are some common elements of dental insurance coverage:

Preventive Care: Dental insurance usually covers preventive services, such as regular check-ups, cleanings, and X-rays. These services are aimed at maintaining good oral health and preventing more serious dental issues.

Basic Restorative Services: Basic restorative procedures, such as fillings and simple extractions, are often covered. These treatments are necessary to address dental decay or minor tooth damage.

Major Restorative Services: Some dental insurance plans cover more extensive procedures, like crowns, bridges, and dentures. These are considered major restorative services and are used to repair or replace missing or damaged teeth.

Endodontic Services: Endodontic treatments, such as root canals, may be covered under certain dental insurance plans. These procedures are performed to save a severely damaged or infected tooth.

Orthodontic Coverage: Some dental plans offer orthodontic coverage, which helps offset the cost of braces or other teeth alignment treatments. Orthodontic coverage is often subject to specific waiting periods and age limitations.

Periodontal Services: Periodontal treatments, like gum disease management and gum surgery, might be included in certain dental insurance policies.

Emergency Dental Care: Dental insurance typically covers emergency dental services, such as treatment for dental injuries or severe pain.

Oral Surgery: Certain oral surgical procedures, like tooth extractions beyond basic extractions, might be covered.

Anesthesia: Anesthesia costs for dental procedures may be partially or fully covered under certain insurance plans.

Prosthetic Repairs: Repairs to existing dental prosthetics, such as denture adjustments, may be covered by dental insurance.

Exclusions of Claims

Despite offering valuable coverage, dental insurance plans often have specific exclusions and limitations that policyholders should be aware of. These exclusions can vary between different insurance providers and plans. Common exclusions from dental insurance coverage include:

Cosmetic Procedures: Dental insurance generally does not cover purely cosmetic treatments, such as teeth whitening or veneers, as they are considered elective and not medically necessary.

Orthodontic Limitations: Some dental plans have restrictions on orthodontic coverage, such as age limits or waiting periods.

Pre-existing Conditions: Dental insurance may exclude coverage for dental issues that were present before obtaining the insurance or during a waiting period.

Certain Restorative Services: Some dental plans may have limitations on coverage for certain restorative procedures, like high-end crowns or more expensive materials.

Experimental or Investigational Procedures: Dental insurance typically excludes coverage for experimental or investigational treatments that have not yet been proven effective.

Third-Party Treatments: Treatments performed by non-dental professionals or providers who are not part of the insurance network may not be covered.

Replacement Frequency: Dental insurance may limit how often certain procedures or devices can be replaced, such as dentures or crowns.

Treatment Frequency: Some dental services may have restrictions on how often they can be performed in a given period.

Medical-Dental Cross-Exclusions: Certain dental procedures related to medical conditions may not be covered if they are considered medical services.

It’s essential for individuals to thoroughly review their dental insurance policy and understand its coverage details, exclusions, and limitations to avoid surprises when filing claims. If there are any questions or uncertainties about coverage, policyholders should contact their insurance provider for clarification.

Coverage Of Dental Insurance Scheme And Exclusions Of Claim


Coverage Of Dental Insurance Scheme And Exclusions Of Claim

Eligibility Criteria:

To be eligible for dental insurance coverage, individuals must meet certain age requirements. The minimum entry age is 18 years, and the maximum age allowed for enrollment is 65 years. For children, the eligibility period starts at 90 days old. However, it is essential to note that these age limits may vary depending on the specific insurance company and their policies.

Claim Process for Dental Insurance:

In the event of a dental treatment or procedure covered by the insurance plan, the following steps should be followed to initiate the claim process:

  1. Notify the Insurance Company: As soon as possible after receiving dental services, inform the insurance company about the treatment or procedure that needs to be claimed.
  2. Provide Supporting Documents: Along with the completed and signed claim form, submit any necessary supporting documents, such as dental treatment receipts and invoices. These documents are essential to validate and support the claim.
  3. Verification Process: Once the insurance company receives the claim form and supporting documents, they will begin the verification process to assess the eligibility of the claim and determine the coverage details.
  4. Processing Time: The claim processing time may vary, but typically it takes approximately 10 days for the insurance company to process the claim and release the payment.

It is crucial for policyholders to adhere to the claim submission guidelines and ensure all required documents are provided accurately to facilitate a smooth and timely claims process.

Claim Process Documents:

To initiate the claim process for this insurance, the following documents must be submitted:

  1. Completed claim form
  2. Policy documents
  3. Discharge summary
  4. KYC (Know Your Customer) documents
  5. Consultation bill
  6. Original hospital bill
  7. Pharmacy bill


Coverage Of Dental Insurance Scheme And Exclusions Of Claim


Companies offering Dental Insurance

In India, several insurance providers offer dental insurance coverage. The following companies are among them:

  1. Bharti AXA
  2. State Bank of India
  3. LIC (Life Insurance Corporation of India)
  4. Bajaj Allianz
  5. Chola MS (Cholamandalam MS General Insurance)
  6. ICICI Prudential

Key Considerations

When buying an insurance policy, it is crucial to keep these key aspects in mind:

  1. Compare Plans from Various Insurance Companies: Take the time to compare different insurance plans offered by various companies. This allows you to assess their features, benefits, and pricing to find the most suitable option for your needs.
  2. Thoroughly Review Policy Terms and Conditions: Before finalizing any insurance purchase, carefully read and understand the policy’s terms and conditions. Pay attention to the fine print to grasp the scope of coverage, limitations, and obligations.
  3. Understand Coverage and Exclusions: Familiarize yourself with what the insurance policy covers and what it excludes. Knowing the extent of the coverage ensures you are well-informed about the protection offered by the policy and any potential limitations on claims.
Dental Insurance: Benefits and Coverage

Dental insurance offers a range of advantages that can help individuals maintain their oral health and address dental issues effectively. Here are some key benefits of dental insurance:

Accidental Damage Coverage: Dental insurance provides coverage for accidental damage to your teeth. Whether it’s a chipped tooth from a fall or a dental injury during physical activities, the insurance can help offset the cost of necessary treatments.

Coverage for Common Procedures: Dental insurance typically covers routine preventive procedures like scaling and regular dental checkups. These essential services play a crucial role in preventing more serious dental problems and maintaining overall oral health.

Additional Treatment Coverage: Many dental insurance plans also extend coverage to include additional treatments, such as root canals, teeth capping, and teeth whitening. This ensures that policyholders have access to a broader range of dental services when needed.

Discounts and Benefits for Major Treatments: Some dental insurance policies offer discounts and benefits for major treatments like braces and dental implants. These treatments can be costly, but with insurance support, individuals can receive necessary dental interventions without facing overwhelming financial burdens.

Preventive Care Encouragement: Dental insurance emphasizes preventive care, encouraging policyholders to seek regular checkups and cleanings. This proactive approach helps detect dental issues early, reducing the risk of more complex and expensive treatments in the future.

Financial Security: Dental insurance provides a sense of financial security when it comes to dental care expenses. Knowing that certain treatments and procedures are covered by insurance can alleviate worries about unexpected dental costs.

Wide Network of Dental Providers: Most dental insurance plans have a network of dental providers. This network includes dentists and specialists who have agreed to offer services at negotiated rates. This can make dental care more accessible and affordable for policyholders.

Flexible Plan Options: Dental insurance providers often offer a variety of plan options to cater to different needs and budgets. Individuals can choose plans that align with their specific requirements, ensuring they get the coverage they need without paying for services they may not use.

Improved Oral Health Outcomes: With dental insurance encouraging regular checkups and prompt treatment, individuals are more likely to maintain better oral health habits, leading to improved overall oral health outcomes.

Overall, dental insurance provides peace of mind and practical benefits, enabling individuals to prioritize their dental health and access necessary treatments without undue financial strain.


Dental insurance can be a valuable tool for individuals who are looking to maintain good oral health and manage the costs of dental procedures. While coverage and exclusions vary depending on the specific policy and insurance provider, understanding what is covered and what is excluded can help policyholders make informed decisions about their dental care.

Policyholders should always review their dental insurance policy carefully and ask questions if they are unsure about what is covered. They should also take steps to maintain good oral health, such as brushing and flossing regularly and scheduling routine check-ups with a dental provider. By doing so, they can maximize their dental insurance coverage and maintain good oral health for years to come.


Q1. Is there any dental coverage for damage due to an accident?

Some insurance companies offer dental coverage for accident-related damage. These insurance companies are Bharti AXA and Bajaj Allianz as well as LIC.

Q2. What is the minimum age to be eligible for Dental Insurance?

Adults can only get dental insurance if they are at least 18 years old. The maximum age to apply is 65.

Q3.Can I get Dental Insurance through my Travel Insurance plan?

Yes. Chola MS Travel Insurance provides coverage for the policyholder’s dental health while traveling.

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