Written By: Simran saxena

Simran saxena

Health and Term Insurance

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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Reviewed By: Anchita Bhattacharyya

Anchita Bhattacharyya

Health, Term & Life Insurance

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.

To know more about how your dental insurance works, read our article on how does dental insurance works.

List of Dental Health Insurance in India

Common Categories of Dental Coverage

• 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

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:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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:

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:

1. 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).

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. Financial Stability of the Insurer:

   • Choose a reputable and financially stable dental insurance company to ensure they can meet their obligations.

8. 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)

1. 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.

2. 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.

3. 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.

4. 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

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