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You can buy insurance for dental treatment but do read the caveats

Priya Nair / Mumbai 13 Dec 16 | 09:22 AM

If you are member of a housing society or a club, you can buy insurance for dental treatment. Ocare, an independent Insurance Process as a Service (IPAAS) platform, has launched a group dental insurance scheme, assuring a sum of Rs 25,000 per annum per person at Rs 1,699 annual premium. Since there is no family floater policy, if a housing society were to purchase it, every family member of the registered members will have to purchase a separate policy.  To claim insurance, treatment must be availed of at dentists who are part of the IPAAS platform. If you prefer a certain dentist, then she/he can be included in the platform, after providing details such as qualifications, number of years of practice etc, says Neeraj Sheth, CEO of Ocare. “Registering with the platform ensures a certain standardisation in the services offered. It is also essential for the claims process." Currently, the service is available in 22 cities and there are plans to extend it to 100 by the end of this year.

The patient first registers on the IPAAS platform and chooses a dentist. When he visits the dentist, the dentist captures a picture of the problem tooth with an intra-oral camera. This is uploaded on the platform before the treatment starts. Then the treatment is selected from the list of options. Once the Ocare review committee approves the case, the dentist carries out the procedure. Following this, the dentist has to upload a post-treatment picture, which is captured using the intra-oral camera. The patient pays the dentist’s charges and gets the money reimbursed after the review committee approves the treatment.  The policy covers pre-existing diseases. There is no waiting period. There are sub-limits for different procedures. For instance, the limit for a root canal treatment is Rs 4,000, dentures Rs 8,000, metal crowns Rs 2,000, ceramic crown Rs 4,000, surgeries Rs 6,000, orthodontist Rs 8,000, braces Rs 8,000 and so on. If you choose a dentist whose rates are higher than the limits, you have to pay the remaining amount from your pocket. Exclusions include cosmetic treatment like teeth whitening and braces for adults. Braces for children are covered. Arvind Laddha, deputy CEO of JLT Independent Insurance Brokers, says: “Misrepresentation of claims is very high in case of dental care. For instance, for a root canal treatment, customers have to submit just an X-Ray and a bill. There is no hospitalisation. So, it is open to abuse and fraud." 

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Alok Bhatnagar, CEO and co-founder of Easypolicy.com says: “You don’t have to get orthodontist treatment but many of us choose to. If this were to be insured, the number of people who want to opt for dental treatment will shoot up. This will, in turn, drive insurance costs up. Second, the cost involved in dental treatment for the same procedure is not uniform and it varies widely. Thus, the coverage cannot be standardised for the cover."

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