Dental insurance generally covers treatments performed by a dentist in OPD.
When it comes to something as specific as dental insurance in India, it is usually covered by a regular health insurance policy, which may have integrated OPD coverage or may have been purchased as a supplemental policy by the policyholder. Traditionally, insurance policies cover dental care in the event of an accident caused by an accident. This means that a regular health insurance policy and other general insurance policies such as personal accident insurance policies cover dental treatment, in the event that at least 24 hours of hospitalization is required. and the cause is an accident. However, according to experts, it is unlikely that a dental procedure will require a 24-hour hospital stay.
Dental insurance generally covers treatments performed by a dental practitioner in OPD, including examinations, fillings (if applicable), crowns, extractions and surgery excluding any form of cosmetic surgery or even d ‘implants. Experts believe that most dental treatments are generally elective in nature, which is not insurable. It is considered an expense because it is difficult to determine whether the dental problem existed as a pre-existing condition or not and, therefore, it is not insurable. Commenting on the intricacies of dental insurance, Nikhil Apte, Product Manager, Royal Sundaram General Insurance said: “The customer can report a PED at the time of purchasing the policy, like other health issues such as arthritis or diabetes is not possible for a client. assess and report current dental health. Since dental treatments take place mainly in OPD or day care in local clinics, which are not part of the network and are fragmented in nature and therefore there is no bargaining power of the dental companies. ‘assurance.
Today, stand-alone insurance policy or proprietary dental insurance products in India are almost non-existent compared to developed countries, where a significant portion of dental treatment is performed on the basis of OPD. “As far as India is concerned, OPD coverage on dental treatment is not available. Dental insurance, if it is to be meaningful to the client, should cover cosmetic and OPD procedures. However, these can make the product expensive. And we all know India is a price sensitive market, ”said Eswaranatrajan N – COO & Senior Executive Vice President, Kotak General Insurance.
Experts strongly believe that dental insurance is not an option in India as it should be seen as an expense as it is not a probabilistic event unlike hospitalization and hence not all expenses can be replaced by insurance. Commenting on the same Apte said: “Take for example, when a client pays 10,000 rupees to buy dental insurance, he will expect to use the entire amount while the insurance company will have to provide for GST, also for expenses and a minimum commission and profit margin, which would be the remaining balance at the insurance company, would not be sufficient as the client will be looking to claim the full amount of 10,000 he paid.
To top it off, there is also a risk of misrepresentation and inflation of invoices or fake invoices. The cost and use of OPD benefits play a crucial role in the pricing strategy for dental insurance. And this is the same reason why OPD plans have failed in India.
“It’s expensive because dental care and OPD in general is almost like an expense. Health insurance plans are priced based on the likelihood of an IPD (inpatient) event occurring. In the case of OPD coverages, the chances of a customer making a claim are very high. Therefore, the price per sum insured is higher, ”said Amit Chhara, health insurance manager, Policybazaar.com.
As more new age insurance plans arrive, many insurance companies are expanding their coverage, including dental space. “Companies like Max Bupa Go Active cover dental care under the OPD that is built into the plan. Another example is a rider available through Religare Health Insurance-Everyday Care, which provides OPD coverage, ”said Chhara.