Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
Anchita has over 6 years of experience in content marketing, insurance, and healthcare sectors. Her motto to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
Updated on May 07, 2025 17 min read
Dental Health Insurance
Are you among the many who postpone or avoid dental visits due to cost concerns? The reality is that quality dental care can be expensive, but neglecting oral health can lead to more significant problems in the future. Dental health insurance plans offer a solution by providing financial assistance for a wide array of dental services.
But what does dental insurance mean, and how does it help you get better teeth health? This article has everything that you want to know about dental health insurance plans in India and expert insights on why having great dental health is so needed.
What is Dental Health Insurance?
A type of health insurance plan which is designed to help you pay for the costs associated with dental care. It works similarly to the other forms of health insurance, where you pay a regular premium in exchange for the coverage. In this case, you will get coverage for dental treatment. The primary purpose of dental insurance is to help protect you from the potentially high costs of dental treatment. It makes oral healthcare more affordable and accessible. Dental plans typically cover a range of services, from preventive care to more complex procedures. The extent of coverage varies depending on the specific plan.
How Dental Insurance Generally Works?
You pay a regular premium (usually monthly) to the insurance company to maintain your coverage.
Many plans have an annual deductible, which is a fixed amount you need to pay out-of-pocket for covered dental services before your insurance starts to pay.
After meeting your deductible, you’ll usually pay a percentage (coinsurance) or a fixed amount (copay) of the cost for covered services, and the insurance company will pay the remaining portion.
Preventive Care: This includes routine check-ups, cleanings, and sometimes X-rays and fluoride treatments. Many plans cover 100% or less of preventive care to encourage regular visits.
Basic Care: This usually covers services like fillings, simple extractions, and treatments for gum disease (periodontics).
Major Care: This category includes more complex and expensive procedures like crowns, bridges, dentures, root canals, and oral surgeries. Coverage for major care is usually at a lower percentage than basic or preventive care.
Orthodontic Care: Some plans offer separate coverage for orthodontics (like braces), which may have its own deductible, coinsurance, and lifetime maximum.
Types of Dental Insurance Plans
Dental Preferred Provider Organisation (DPPO)
Allows you to see any dentist, but youll typically pay less out-of-pocket if you consult with the dentists within the PPO network.
Dental Health Maintenance Organisation (DHMO)
Usually requires you to choose a primary care dentist within the network who coordinates your care and provides referrals to specialists. Out-of-network care is generally not covered. Premiums and out-of-pocket costs (like copays) may be lower.
Indemnity Plans
Also known as traditional or fee-for-service plans, these offer the most flexibility in choosing a dentist. However, you may have higher out-of-pocket costs, and you might need to pay upfront and then get reimbursed.
Dental Exclusive Provider Organisation (DEPO)
Similar to a DHMO, but you don’t need a primary care dentist or referrals to see specialists within the network. Out-of-network care is generally not covered.
Dental Point of Service (DPOS)
A hybrid of HMO and PPO plans, offering some out-of-network coverage but typically with higher costs.
Dental Discount Plans
These are not insurance but rather membership plans that offer reduced fees at participating dentists. You pay an annual fee to join the plan.
In the context of India, dental coverage is often offered as an add-on to comprehensive health insurance plans or as part of specific OPD (Outpatient Department) coverage. Standalone dental insurance plans are less common.
Why Should You Buy Dental Insurance?
There are several reasons why you should consider buying dental insurance:
Managing the High Cost of Dental Care:
Dental procedures, especially restorative and major work like crowns, bridges, root canals, and orthodontics, can be very expensive. Dental insurance helps to reduce these out-of-pocket costs significantly.
Regular premiums are generally more predictable and manageable than facing large, unexpected dental bills.
Encouraging Preventive Care:
Most dental insurance plans cover preventive services like routine check-ups, cleanings, and sometimes X-rays at a very low or even zero cost to you.
This encourages you to visit the dentist regularly, which is crucial for early detection of problems like cavities, gum disease, and even oral cancer, preventing more complex and costly issues down the line.
Budgeting for Dental Expenses:
Dental insurance allows you to budget for your dental care costs. You pay a fixed premium regularly, making it easier to plan for routine and potential future needs.
Knowing you have dental coverage can make it less likely that youll postpone necessary treatment due to financial concerns.
Access to a Network of Dentists (depending on the plan):
Many dental insurance plans have networks of dentists who have agreed to provide services at discounted rates. This can further lower your out-of-pocket expenses.
While some plans allow you to see any dentist, using in-network providers often maximises your benefits and minimises your expenditures.
Protecting Against Unexpected Dental Emergencies:
Accidents can happen, leading to unexpected dental injuries that require immediate and potentially expensive treatment. Dental insurance can help cover these costs.
Promoting Overall Health:
Oral health is closely linked to overall health. Poor oral hygiene can contribute to various systemic conditions, including heart disease, diabetes, and pregnancy complications.
Having dental insurance encourages regular dental care, which helps maintain good oral health and, consequently, contributes to better overall well-being.
Potential for Long-term Savings:
While you pay premiums, the cost of even one major dental procedure without insurance can easily exceed the total premiums paid over several years.
By facilitating regular preventive care, dental insurance can help you avoid more expensive treatments in the future.
Eligibility Criteria for Dental Insurance Plans
However, specific plans cover dental insurance under a health policy. The eligibility criteria depend on the type of policy and the insurance provider you choose to buy a plan from. Read below some specifications related to the eligibility criteria for buying a dental plan:
Eligibility Criteria
Specifications
Age (min-max)
18-65 years in individual policies and 90 days in case of a child
Waiting Period
1 to 3 years of waiting period
Sum Insured Limit
Rs 25,000 to Rs 1 Lakh
Coverage Comprehensivity
A dental insurance plan with a sum insured of Rs 15 lakhs or more covers the expenses related to dental consultations. It also provides pre-hospitalisation coverage of up to 6 days before hospital admission and 180 days after hospitalisation.
Things to Look Out For When Buying Dental Health Insurance
When buying dental health insurance, it’s crucial to look beyond just the monthly premium. Here are the key things you should consider to make an informed decision:
Coverage Details:
Types of Services Covered: Understand the breakdown of coverage for different categories of dental care:
Preventive Care (Routine Check-ups, Cleanings, X-rays): Many plans cover this at or close to 100% without a deductible to encourage regular visits.
Basic Care (Fillings, Simple Extractions, Gum Disease Treatment): Typically covered at a lower percentage (e.g., 80%) after you meet your deductible.
Major Care (Crowns, Bridges, Dentures, Root Canals, Oral Surgery, Implants): Usually covered at the lowest percentage (e.g., 50%) and may have stricter limitations or waiting periods.
Orthodontic Care (Braces, Aligners): Check if this is included, as it’s often a separate rider with its own limitations (e.g., age limits, lifetime maximums).
Exclusions: Be aware of what the plan doesn’t cover. Common exclusions include cosmetic procedures (teeth whitening, veneers), pre-existing conditions (sometimes), and treatments started before the dental policy’s effective date.
Annual Maximum: Know the maximum amount the insurance will pay within a benefit year. Once you reach this limit, you’re responsible for all remaining costs. This can be a critical factor if you anticipate needing significant work done on your teeth.
Frequency Limitations: Some plans limit how often certain procedures are covered (e.g., cleanings every six months, specific X-rays once a year).
Costs:
Premiums: This is the regular payment you make (usually monthly) to maintain your coverage. Compare premiums across different plans.
Deductible: This is the amount you must pay out-of-pocket for covered services before your insurance starts to pay. Understand the individual and family deductibles, if applicable. Preventive care often doesn’t have a deductible.
Coinsurance/ Copay: After meeting your deductible, you’ll typically pay a percentage (coinsurance) or a fixed amount (copay) of the cost for covered services.
Annual Maximum: As mentioned above, be aware of the annual limit on what the insurance will pay.
Network Restrictions:
In-Network vs. Out-of-Network:
PPO (Preferred Provider Organisation): You can see any dentist, but you’ll usually pay less if you use dentists within the PPO network.
HMO (Health Maintenance Organisation) / DHMO (Dental Health Maintenance Organisation): You typically need to choose a primary care dentist within the network and may need referrals to see specialists. Out-of-network care is usually not covered.
EPO (Exclusive Provider Organisation): Similar to HMOS, but you don’t need a primary dentist or referrals within the network.
Indemnity Plans: Offer the most flexibility to see any dentist, but you might have higher out-of-pocket costs and may need to file claims for reimbursement.
Check Your Dentist: If you have a dentist you prefer, verify if they are in the network of the dental plans you are considering.
Dental Policy Waiting Periods:
Many dental insurance plans have waiting periods before certain services are covered.
Preventive Care: Often covered immediately or with a very short waiting period.
Basic Care: May have a waiting period of a few months (e.g., 3-6 months).
Major Care: Typically has a longer waiting period (e.g., 6 months to a year or more).
Orthodontics: Can have the longest waiting periods.
Understand the waiting periods for different types of services to avoid unexpected out-of-pocket expenses, especially if you anticipate needing specific treatments soon.
Dental Plan Limitations and Exclusions:
Read the fine print to understand any limitations on specific procedures or exclusions beyond the general categories.
Some plans may have limitations on the number of certain procedures they cover within a specific timeframe.
Claim Process:
Understand how to file claims and whether the insurance company directly pays the dentist (in-network) or reimburses you (out-of-network).
Look for plans with a straightforward and efficient claims process.
Financial Stability of the Insurer:
Choose a reputable and financially stable dental insurance company to ensure they can meet their obligations.
Your Individual and Family Needs:
Consider your current oral health, future needs, and budget when selecting a plan. If you have good oral health and only need preventive care, a basic plan with a lower premium might suffice. If you anticipate needing more extensive work, a plan with better coverage for major services might be worth the higher premium.
By carefully evaluating these factors, you can choose a dental health insurance plan that provides the coverage you need at a cost that fits your budget. Dont hesitate to ask the insurance provider questions to clarify any aspects of the plan before making a decision.
What is Covered in Dental Insurance? (Inclusions)
Preventive Care:
This is usually covered at a high percentage (often 80-100%) because it helps prevent more serious and costly problems in the future.
Routine Check-ups/ Oral Exams: Regular visits to the dentist (usually twice a year) to monitor your oral health.
Teeth Cleaning (Prophylaxis): Professional cleaning to remove plaque and tartar. Some plans may limit the frequency (e.g., two cleanings per year).
Dental X-rays: Used for diagnostic purposes to detect issues not visible during a regular exam. Plans often cover routine X-rays (e.g., bitewings annually, full-mouth series every few years).
Fluoride Treatments: Often covered for children to help prevent cavities. Some adult plans may also include this.
Dental Sealants: Plastic coatings applied to the chewing surfaces of back teeth to prevent decay, typically covered for children.
Basic Care (Sometimes called "Restorative"):
This category usually involves procedures to treat common dental problems and is often covered at a moderate percentage (e.g., 50-80%) after youve met your deductible.
Fillings: To repair cavities caused by tooth decay (amalgam, composite, etc.).
Simple Extractions: Removal of teeth that are badly damaged or decayed.
Root Canal Treatment: To save a tooth with an infected pulp (nerve and blood vessels). This might sometimes fall under "major care" depending on the plan.
Treatment for Gum Disease (Periodontics): Non-surgical treatments like scaling and root planing to address gum infections.
Major Care:
These are more complex and expensive procedures, typically covered at a lower percentage (e.g., 50% or less) and often have waiting periods before coverage kicks in.
Crowns: To cover and protect a damaged tooth.
Bridges: To replace missing teeth by anchoring artificial teeth to adjacent natural teeth.
Dentures: Removable appliances to replace missing teeth.
Complex Extractions (including surgical extractions and wisdom teeth removal): More involved tooth removal procedures.
Dental Implants: Artificial tooth roots placed in the jawbone to support replacement teeth (coverage varies widely and may not be included in all dental plans).
Inlays and Onlays: Indirect fillings made outside the mouth and then cemented onto the tooth.
Orthodontic Care:
Treatment to correct misaligned teeth and jaws (braces, aligners). Coverage for orthodontics often has its own specific rules.
Separate Rider: It may require purchasing an additional orthodontic rider to your dental plan.
Age Limitations: Coverage might be limited to children and adolescents (under 18 or 19). Some plans, however, are starting to offer adult orthodontic coverage.
Lifetime Maximum: Orthodontic benefits often have a lifetime maximum amount that the plan will pay.
Waiting Periods: It typically has longer waiting periods than other services.
Percentage Coverage: Usually covered at a specific percentage (e.g., 50%) up to the lifetime maximum.
Exclusions of Dental Health Insurance
Cosmetic Procedures:
Teeth Whitening: Generally considered an aesthetic procedure, and is usually not covered.
Veneers (primarily for cosmetic reasons): If veneers are solely for improving appearance rather than for necessary structural repair, they are often excluded.
Cosmetic Bonding: Similar to veneers, excluded if the primary purpose is cosmetic.
Experimental or Investigational Treatments:
Procedures or treatments that are not yet widely accepted or have not been proven effective may be excluded.
Procedures Primarily for Aesthetic Purposes:
Treatments aimed solely at improving the appearance of teeth or gums without a functional medical necessity might not be covered.
Treatments Not Dentally Necessary:
Procedures that the insurance company deems not essential for maintaining or restoring oral health might be excluded.
Services Covered by Other Insurance:
If a dental issue is a result of a medical condition covered by your general health insurance (e.g., jaw surgery for a medical condition), the dental plan might not cover it. Similarly, if a dental injury is covered under accident insurance or workers compensation, the dental plan might exclude it.
Replacement of Lost or Stolen Appliances:
Dentures, bridges, or other appliances that are lost or stolen are typically not covered for replacement under most dental insurance policies.
Oral Hygiene Aids and Supplies:
Items like toothbrushes (including electric ones), toothpaste, mouthwash, and dental floss are generally not covered.
Missed Appointments:
Fees charged by dental offices for missed appointments are the patients responsibility and are not covered by insurance.
Procedures Performed by Someone Other Than a Licensed Dentist (in most cases):
Treatment must typically be performed by a licensed dentist or under their direct supervision to be eligible for coverage.
How to Buy Dental Insurance?
Step 1:Visit the PolicyX.com health insurance page, and enter your details such as name, age, number of members to be covered, and city.
Step 2:Click on Get free quotes and compare dental health insurance plans as per your needs.
Step 3:Select and pay premiums online for the purchased dental health insurance plan of your choice.
Step 4: Our team of insurance experts at PolicyX will provide you with all the assistance required regarding claims and other queries post-purchase of your dental health insurance plan.
How To Add Dental Insurance To Your Existing Plan?
Adding dental insurance to your existing plan depends entirely on the type of existing plan you have and the options offered by your insurance provider. Here are some common scenarios and how you might be able to add dental coverage:
If You Have a Health Insurance Plan:
Check for Add-on Riders: Many health insurance companies in India and other regions offer dental coverage as an optional rider or add-on to their base health insurance policies.
How to add: Contact your insurance providers customer service or your insurance agent. They can inform you if a dental rider is available for your current plan.
When you can add: You can add a rider at the time of policy renewal. Some insurers might allow adding riders mid-term, but this is less common.
Considerations:
Additional Premium: Adding a rider will increase your premium.
Coverage Limits: Dental riders often have specific sub-limits for different treatments and an overall annual limit.
Waiting Periods: There might be a waiting period before the dental coverage becomes effective, even if your base health plan has been active for longer.
Scope of Coverage: Understand exactly what dental treatments are covered under the rider. It might be limited to OPD procedures like consultations, cleanings, and minor treatments.
Standalone Dental Insurance:
If your current health insurer doesnt offer a suitable dental rider, you might need to purchase a separate, standalone dental insurance policy from a different provider.
How to Get: Research different insurance companies offering dental plans in your area. You can compare their coverage, premiums, network dentists (if applicable), and terms. You can purchase these plans online or through an agent.
Considerations:
Separate Premiums: Youll have to pay a separate premium for this policy.
Coordination of Benefits: If your health plan also covers some dental issues (e.g., due to accidents), understand how the two policies would coordinate.
If You Have an Employer-sponsored Health Plan:
Check Your Benefits Package: Many employers offer dental insurance as part of their employee benefits package.
Enrolment Process: You can enrol in the dental plan during your initial enrollment period when you join the company or during the annual open enrollment period. Contact your HR department or benefits administrator for enrollment information and deadlines.
Mid-year Enrolment: Generally, you can only enrol outside the open enrollment period if you experience a qualifying life event (e.g., marriage, birth of a child, loss of other coverage).
Optional Voluntary Dental Plans: Some employers offer voluntary dental insurance plans where employees pay the full premium. These are still convenient as they are often offered at a group rate, which might be lower than individual plans.
Check with your HR department if this is an option.
Average Cost of Dental Procedures in India
Procedure
Cost in INR (approx.)
Consultation
200-800
Routine check-up and cleaning
1,000-4,500
Dental Filling (composite)
1,200-4,000
Tooth extraction (simple)
600-3,000
Root canal treatment (RCT)
3,500-10,000
Dental crown (PFM)
4,000-12,000
Dental crown (zirconia)
9,000-17,000
Dental Implant (per implant)
20,000-60,000
Teeth whitening
5,000-20,000
Braces (metal, full mouth)
30,000-50,000
Wisdom tooth removal (surgical)
5,000-10,000
POV- Now you see why you need a health insurance plan for your dental care.
Conclusion
Maintaining our dental health is a little tricky task, as we are not so aware of any problems going on with our teeth. In such situations, a health plan accommodating dental care coverage can work wonders for you. You can improve your dental health and cut off extra charges on your hard-earned money. If not now, then when?
Schedule a call with India’s number 1 trusted advisor with a 4.5+ rating on Google. We are not your average insurance agents. Our advisors are experts in their insurance knowledge and will give you the right information at the right time. The service is free of cost! Don’t worry, we won’t spam as we value your time.
1. Why should I consider buying dental insurance in India?
Dental insurance helps manage the high costs of dental procedures, encourages preventive care, aids in budgeting for dental expenses, can provide access to a network of dentists, offers financial protection against emergencies, promotes overall health, and can lead to long-term savings.
2. What is preventive dental care, and what are its insurance benefits in India?
Preventive dental care focuses on maintaining oral health and preventing disease through regular check-ups, cleanings, X-rays, fluoride, sealants, and oral hygiene education. Insurance plans in India often cover preventive services at a high percentage (80-100%) with little or no out-of-pocket cost to encourage these essential visits.
3. Does dental coverage count under medical insurance?
No, health insurance policies don& 039;t consider dental insurance as standard coverage. But, companies include dental treatment as an additional coverage to their policy.
4. Are dental injuries caused by accidents covered by all dental insurance plans?
Yes, dental injuries caused due to accidents are covered by all dental insurance plans.
5. Do insurance companies in India cover canal treatment in dental insurance plans?
Yes, insurance companies in India cover canal treatment in dental insurance plans.
6. Are tooth extraction costs covered under dental insurance?
Yes, tooth extraction costs are covered under dental insurance
7. Do the insurance companies in India cover dental implants?
No, the insurance companies in India don& 039;t cover dental implants.
Simran has over 3 years of experience in content marketing, insurance, and healthcare sectors. Her motto is to make health and term insurance simple for our readers has proven to make insurance lingos simple and easy to understand by our readers.
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