Dental Insurance

Dental treatment costs can add up quickly and become a hefty expense. For instance, as per the Indian Dental Association, a root canal treatment can cost anywhere between ₹5500 and ₹7000 per tooth, depending on the clinic, the tooth involved, and the city where you receive treatment. Since most procedures, such as fillings, cleanings, and root canal treatments, are considered routine dental care, they are usually not covered under standard health insurance policies in India.

This means that, in most cases, people end up paying for dental treatment entirely out of pocket, even if they already have health insurance.

In this article, we break down what dental insurance is, how dental insurance in India works, what dental treatments are typically covered, what is excluded, how OPD riders work, how claims are processed, and whether adding dental coverage to your health insurance actually makes sense.

What is Dental Insurance and How Does it Work?

According to the Insurance Regulatory and Development Authority of India (IRDAI), dental treatment can include procedures such as

• Examinations
• Fillings (where appropriate)
• Crowns and extractions, and 
• Anything related to the teeth, gums, and supporting oral structures. 

However, in most health insurance policies, these treatments are covered only when they're medically necessary for hospitalization for a disease or injury, rather than for routine or cosmetic care or aesthetic needs. 

Is Dental Treatment Covered in Health Insurance?

A common question people ask is whether dental treatment is covered in health insurance or not. The answer depends on the type of treatment and the reason for it. 

Most health insurance policies also list common exclusions such as:

• Cosmetic procedures 
• Non-essential orthodontics
• Self-inflicted injuries / Self Harm
• Adventure sports injuries, if done professionally 

Note: Always check the policy document for the inclusions, exclusions, and any sub-limits related to dental treatment before buying a plan or add-on. This helps you clearly understand what is covered, what is not, and how much of the cost the insurer will actually pay.

Claim Process for Dental Insurance

• Cashless Claims

If you receive treatment at a network hospital, the hospital sends a pre-authorization request to the insurer. Once approved, the insurer pays the eligible bill directly to the hospital. You only pay for non-covered items such as consumables, co-payments, or expenses beyond the policy limits.

• Reimbursement Claims

If treatment happens at a non-network hospital or dental clinic, you must pay the bill first. After that, submit documents like medical bills, prescriptions, and treatment records to the insurer. The insurer reviews them and reimburses the eligible amount as per policy terms.

How Much Does Dental Insurance Cost in India?

A common question our customers ask is how much does dental insurance cost, especially when comparing OPD riders across different health insurance plans. As per IDA, a normal tooth extraction can cost around ₹3000 per tooth, whereas brace therapy can cost around ₹40,000.  This cost varies across locations as well as by the type of treatment taken. 

Now, Dental coverage in health insurance is usually available through OPD benefits, rather than standalone dental insurance plans. For example, some policies, such as Care Health’s Care Plus, offer OPD dental benefits with limits of ₹1,500-₹2,500 per policy year, 

Adding OPD coverage typically increases the overall premium because it extends the policy beyond hospitalization benefits. However, these dental benefits usually come with relatively low annual caps, which means the coverage may only offset a portion of routine dental expenses.

How to Find the Best Dental Insurance Plans?

01

Coverage

Start by reviewing the inclusions and sub-limits. Most health insurance plans cover dental treatment only if it is accident-related or medically necessary. If a policy offers OPD dental benefits, check the annual limit, since these benefits are usually capped.

02

Waiting Periods and Implant Coverage

Many policies apply waiting periods ranging from a few months to years for routine dental treatments. Also, check if dental implants and advanced procedures are excluded, as many insurers cover them only when they result from a serious accident.

03

Claim Process and Insurer Credibility

Check whether the insurer offers cashless treatment, a strong hospital network, and a good claim settlement record. In practice, a smooth claim process often matters more than small extra benefits.

How is Dental Insurance Usually Covered? 

Note: While a few health insurance plans offer dental coverage through OPD riders or add-ons, these options are still limited and vary widely across insurers.

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Abhinav below love us:

• No-Spam & No Salesmen
• Rated 4.9/5 on Google Reviews by 15,000+ happy customers
• Backed by Zerodha
• Dedicated Claim Support Team
• 100% Free Consultation

You can book a FREE consultation with us. Slots are filling up quickly, so be sure to book a call now or chat with us on WhatsApp!

Conclusion

Dental coverage can seem attractive, especially given the rising cost of dental treatments. However, dental insurance in India is usually limited. Hence, it is not a viable option to opt for OPD dental riders, since health insurance premiums keep rising, while your OPD coverage typically remains the same. So, even if it looks like a decent option, you end up paying more in the long run. Hence, it is advisable to cover routine dental care as an out-of-pocket expense.

When choosing health insurance, focus on core features such as adequate sum insured, fewer restrictions, a strong hospital network, and a reliable claims process. Dental coverage can be a good-to-have benefit, but it shouldn’t be the primary factor when selecting a plan.