Most health policies pay for dental treatment only in hospital. What is paid, what is not, and the plans that add outpatient dental cover.
Does health insurance cover dental treatment?
Mostly no, with one important exception. A standard health policy pays for dental treatment only when it needs a hospital stay, usually after an accident or an illness. Routine dental work at a clinic is normally not covered.
What "dental treatment" means in a policy
Policy wordings use a standard definition: treatment related to teeth or the structures supporting teeth, including examinations, fillings, crowns, extractions and surgery. So the exclusion, when it applies, is wide.
What is usually paid
- Dental treatment needing hospitalisation. HDFC ERGO my:Optima Secure covers in-patient dental treatment needed because of disease or injury. Tata AIG MediCare Premier covers hospitalisation for dental treatment under anaesthesia needed because of an accident, injury or illness.
- Injury to the jaw or teeth in an accident, when you are admitted.
Many other wordings say the same thing the other way round: dental treatment or surgery of any kind is excluded unless it is part of an admissible hospitalisation.
What is usually not paid
- Check-ups, cleaning, fillings and root canals at a dental clinic.
- Dentures, implants and bridges.
- Braces and other cosmetic work. Cosmetic treatment is a standard exclusion (Excl08 in current wordings).
Plans that add outpatient dental cover
A few plans include a small dental benefit. Tata AIG MediCare Premier, for example, pays for root canals, extractions and fillings after 2 years of continuous cover, up to ₹10,000 a year on covers up to ₹50 lakh, rising to ₹25,000 on ₹3 crore. Some insurers sell an OPD add-on that includes dental. Compare the yearly limit with the extra premium before buying it.
Jaw surgery
Jaw surgery done for a medical reason, after an accident or for a disease, in hospital, is treated like other surgery. If it is done mainly to change appearance, the cosmetic exclusion applies. Ask your doctor to state the medical reason in writing.
How to check your own policy
Search the wording for "dental". Look for the benefit (often "in-patient dental") and the exclusion together, since they decide each other. Or upload your policy to the policy checker.
Frequently asked questions
Does health insurance cover dental treatment in India?
Usually only when it needs a hospital stay, such as after an accident or for an illness. Routine dental work at a clinic is normally excluded.
Are dental implants or braces covered?
Generally no. Implants and dentures are not covered as routine treatment, and braces fall under the cosmetic exclusion in most wordings.
Which health plans cover outpatient dental treatment?
A few do, with small limits. Tata AIG MediCare Premier pays for root canals, extractions and fillings after 2 years, up to ₹10,000 a year on covers up to ₹50 lakh.
Is dental treatment after an accident covered?
Yes, in most plans, when the treatment needs hospitalisation. Check the in-patient dental benefit in your wording.