When it comes to something as specific as dental insurance in India, it is usually covered under a regular health insurance policy, which may have either in-built OPD cover or has been bought as an add-on policy by the policyholder. Traditionally insurance policies cover dental treatment if any mishap is caused by accident. Meaning, a regular health insurance policy and other general insurance policies like personal accident policies provide coverage for dental treatment, in the scenario where minimum 24 hours hospitalisation is required and the cause is accident. However, according to experts it is quite unlikely that a dental procedure will need a 24-hour hospitalisation.

Dental insurance typically covers treatments carried out by a dental practitioner in OPD including examinations, fillings (where appropriate), crowns, extractions and surgery excluding any form of cosmetic surgery or even implants. Experts opine that , typically most dental treatments are elective in nature, which is not insurable. It is looked as an expense, as it is difficult to ascertain whether the dental issue existed as a pre-existing disease or not and hence it is not insurable. Commenting on the subtleties of dental insurance, Nikhil Apte, Chief Product Officer, Royal Sundaram General Insurance said, “Customer can declare a PED at the time of buying the policy like other health conditions such as arthritis or diabetes it is not possible for a customer to assess and declare his current dental health. Since dental treatment mostly happens in OPD or day care basis at local clinics, which are not on the network and fragmented in nature and hence there is no bargaining power of the insurance companies.”

Today, the standalone insurance policy or exclusive dental insurance products in India are almost non-existent as compared to developed countries, where significant portion of dental treatment is done on OPD basis. “When it comes to India, OPD coverage on dental treatments are not available. Dental insurance if it has to make sense to the customer has to cover cosmetic & OPD procedures. However, these can make the product costly. And we all know that India is a price sensitive market,” said Eswaranatrajan N – COO & Senior Executive Vice President, Kotak General Insurance.

Experts firmly believe that dental insurance is not feasible in India as it needs to be looked as an expense since it is not a probabilistic event unlike a hospitalisation and hence not all expenses can be replaced by an insurance. Commenting on the same Apte said, “Take for example, when a customer pays Rs.10,000 for buying a dental insurance, he will expect to utilise the entire amount where as for the insurance company will have to provide for GST, also towards expense and commission and minimal profit margin, which would be the balance amount left with the insurance company would be not sufficient as the customer will seek to claim the full amount of 10,000 paid by him.”

To top-it up there is also a chance of mis-representation and inflation of bills or fake bills. OPD benefit cost and utilisation plays a crucial role when it comes to pricing strategy of dental insurance. And this is the same reason why due to, which OPD plans have not been successful in India.

“It is expensive because Dental and OPD in general is almost like an expense. Health insurance plans are priced according to the probability of an IPD (in-patient) event happening. In case of OPD coverages, the chances of a customer claiming are very high. Hence price per Sum Insured is on the higher side,” said Amit Chhara, Head of Health Insurance, Policybazaar.com.

Since, there are several new age insurance plans coming up, many insurance companies are widening their scope of coverage, including the dental space. “Companies like Max Bupa Go Active covers dental treatment as a part of OPD which is in-built in the plan. Another example is a rider available by Religare Health Insurance- Everyday Care, which provides OPD coverage,” said Chhara.