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Published : August 05, 2015 | Author : legalbharat
Category : Insurance / Accident Claim | Total Views : 2465 | Unrated

Kumar Bharat

what is Dental Insurance?

A human body is a much complex formation than it seems and taking good care of each and every of its elements seems to be an essential task. It’s a predominant thought that “prevention is better than cure” and it equally applies with one’s teeth’s though they just seem to be that ordinary set of bones that are clearly visible from outside of a human body. A minimal hole in a tooth can cost a greater trouble and hence one must think of a routine checkup at the dentist’s place. The dental diseases are so common these days that being protected by a dental insurance cover does not seems to be a bad option. It is a wise step for any individual or a family. Much similar to ‘life-insurance’, a dental insurance is quite unique. Firstly, it is low cost and hence is affordable and secondly, a dental insurance in general pays for your regular check-ups hence its protection benefits tend to start immediately without any delay. Apart from these, a dental insurance covers a wide range of services including the terms of emergency care and other treatment procedures that might cost you a big hole in the wallet in case not insured. A dental insurance plays the part of a legal agreement between the insurance company and the customer whereby the company lifts the liability of the dental bills falling on its customer. In normal circumstances, a dental insurance company will play its part for as much as 80 percent of the total bill raised. However the terms and conditions with most of the insurance companies vary and there arises the need to double check the dental insurance agreements. It’s a wise step to be fully aware of what your dental insurance covers and what it skips. Traditionally, dental insurance plans were covered under the healthcare packages that were being provided to the employees working at bigger companies, however this practice has been quite abandoned these days.

Preventative dental care

In times where a person successfully secures his dental insurance, one thing he has to make sure and that is a routine checkup at the dentist which can be made once or twice a year. So in case where the individual is fulfilling all the monthly or yearly premiums, it comes within his obligation to routinely visit a doctor so as to make the preventive side done. These initial and effortless steps will help him down in preventing major money clashes in case any future dental accident occurs. By this we presume we have answered this question successfully as to why an individual needs to have a dental insurance because tooth related problems are hard to ignore in case no preventive cover has been maintained as a person relies completely on his teeth and gums for every eatable or drink hence one cannot go dental problem untreated. However in today’s world, people hardly go for insurance and lesser than that opt for dental insurances. One of the major concerns before this is the high cost of insurances covers.

Why it is needed?

The most ordinary answer to this question is that treatment of any dental problem may prove expensive. Hitting on the priority, the most preferred second reason is that dental problems are hard to ignore. Every year, people do visit to the dentists for the purpose of treating their tooth and gum problems and the same may happen for a complete family. Hence one should be prepared for the costs to incur in case their dental insurance plan is missing. Preventive care does involve routine dental checkups and the cleaning processes which can alone do the most of a healthy living. Dental care procedures on the other hand are cheap as compared to the medical care insurances as they need to ascertain the fees of heavy medical tests and treatments. Dental plans are also available online and are easy to use.

The Indian scenario and the International Comparison

There are various countries where the system of oral health care is not defined and articulated in a proper manner which needs to have an efficient system of derived goals and purposes. The dental schools in India normally offer a post graduate program i.e. MDS (Master of Dental Surgery) and the most of minimum qualification for this is a BDS degree (Bachelor of Dental Surgery) which is a five year course and does includes in it a year of internship. The Dental Council of India governs all the above mentioned procedures. In Indian markets, Community dentistry is the other name given to Public Health Dentistry however only a few dental schools in India are aware of this and its meaning is limited to increasing the number of patients admitted in the hospital. Another characteristic of Indian scenario of Public health dentistry are the ‘dental camps’ that are conducted among the poor and the needy in the rural areas and are basically attended by the MDS & BDS people. However these dental camps are organised only to refer the patients to the hospitals where they shall be treated and no treatment is offered to them itself in the rural background. The public health dentistry has till date been treated as a misguided procedure in the Indian dental schools and the same was surely drafted back in 1985 by the ‘oral health policy’but lacking implementation as compared to other countries. In United Kingdom, the health services are one of the most cost efficient procedures in the world where the treatment facilities are being provided under the jurisdiction of safety. In UK, Community dental Service forms an essential part of health promotion scheme. In Sweden, various target groups have been formed where special concern is being shown for the old aged people, the handicapped and the poor. A similar scenario is being presented in the country of Norway. In these countries, special extended services are availed in the areas where there are less practitioners or where a scarcity of dental clinics is an important concern. Again in Netherlands, free and full dental care is being provided to the individuals below 19 yrs of age under its policy of National Dental Insurance. Also the country avails the facility of the treatment to the adults at lower costs under this policy of Insurance. An organised system of health care does exists to some extent in most of the Latin countries where services are rendered collectively by the public and private practitioners. In Latin America, almost seventy percent of the population relies on public services as compared to the private one. However the sector is badly structured and the quality and efficiency of services are not up to mark as compared to the private sector services which are not preferred by the people due to its price difference. Finally, the majority of the government in the region is involved in the process of privatization of the dental sector and hence reliving out the government participation.

If we talk of Brazil, the government is involved in larger number of initiatives so as to bring more and more population under the grab of the oral health care mission that was included in the Family Health Program nearly in 2000. The Federal government is also employing more and more number of dentists so as to meet their targets of resolving most number of tooth and gums problems.

In United States, a number of dentists professionally carry out their profession at the local, state and the federal level. Research and Oral health promotion in this area goes well hand in hand and the administration seems rigid so as to frame a sound policy management for the efficient working of the sector. The policy framework also deals out with the concern of the lower income generating people and makes sure that most of the dentistry procedures are within the reach of the common man.

Hence it’s clear that the ultimate responsibility of securing the health system of a country falls within the ambit of the government. However at times, there are multiple challenges which are being faced in the path to secure an optimum level of oral dental health of the country. The first among them is the ill understanding of the policy makers who are adopting a wrong concept of ‘public health dentistry’ and this leading to a failed development of the subject matter. Here in the Indian context, all the three phrases- Public, Health & Dentistry are being connoted with a wrong meaning and the reason behind this fact is that most of the dental schools are being run for profits and with no special concern to the awareness of dental knowledge among the masses and the community health. The most obvious reason for the college management of why they require a public health dentist is that the management is involved in charging huge amount of fees for the purpose of the post graduate subject being offered in their college. Further, the government is also missing its steps in procuring the actual status to the public health policies by omitting the inclusion of oral care in it hence forgetting the rural population into their own miseries. This fraction of policy dwindling affects dental camps being organised in rural areas every year and creating new community dental jobs. Even if dental camps are being organised, they are being done for the sake of promotional benefit of the dental schools and that leads to less benefit. Henceforth, the annual population attending these camps gradually decreases as the awareness reaches to its conclusion among the people that the camps only provide referrals and no actual treatment is being offered. The real meaning of ‘public health dentistry’ goes much far than just a paper being taught in the dental schools to clear out the degrees. It involves the whole of the community and the whole of the nation.

What is a dental plan?

Most of the dental plans being offered are not by nomenclature policies of health insurance as some do provide for specific discounts at a certain provider of health care service where at the end of the treatment, the customer has to pay for the services of the doctor and later on, the dental plan company does refunds a certain level of discount on the payment made to the doctor. Hence we can guess a general description that every company does not provide a similar type of dental plan. However, most of the dental plans do have some common features such as discount on the cost of service, reference to a specific doctor or to a number of specific doctors being prescribed by the insurance plan, cost free examination of the problems etc. If we talk about the latest dental insurance plans, they are quite different as compared to the traditional plans. Traditionally, the system of paying monthly premiums was present where the customer was required to submit a monthly premium and then only he was eligible to be covered by the insurance plan. However, the latest dental insurance plans do work much similar to the health insurance plans where a quite categorization is made out on how the bills of the doctor shall be bade and what shall be the benefit of selecting that one doctor over the others who shall be treating the customer under the dental plan. While one has to review the best dental plan available out in the market, some of the major considerations should be-

a) What is the charge of the dental plan if preferred on a monthly basis?
b) Whether getting treated by a dentist outside the dental insurance agreement shall be covered under the insurance?
c) What are the hidden charges involved in the execution of the insurance?
d) Who is the decision maker in the case of our treatment? Whether it’s the Doctor who shall be treating or the dental plan, the customer is covered under or the customer alone can take the minute of the decision.
e) Does the dental insurance plan the customer has selected covers the cases of emergency?
f) Whether the insurance plan covers any ‘major treatment’ or in case it does not cover, does it offers any sort of discount to some extent?
g) Does the insurance plan allows the customer to visit the appointed doctor at any time of the hour or specific time requirements have to be met?
h) Does the insurance plan provides dual benefits or as the case may be, does the dental plan allow the customer to buy another dental insurance plan and hence enjoy dual benefits?

On the basis of this categorization, the following dental insurance plans can be classified:
a) Indemnity Dental Insurance: where the customer is allowed to see any dentist who accepts the terms of the insurance.

b) PPO: these are the dental plans being offered by the ‘Preferred Provider Organizations’, where a specific dentist being consulted by the insurance company agrees to provide his services at a discounted cost.

c) DHMO: the ‘Dental Health Managed Organizations ‘provide a wider option to the customer where he can consult a wide network of doctors for his dental insurance to get recovered.

Coverage’s that a dental plan can offer:

a) Most of the dental plans are ‘preventive’ in nature where the insurance covers routine examinations and cleaning of the teeth and gums. Other basic services may also be offered depending upon the type of dental insurance selected.

b) The other category is of ‘restorative dental plans’ which basically covers all procedures where a deteriorating tooth is restored for example as in ‘root canals’.

c) The third category covers some of the complex procedures such as major crowns, dental implants, all surgery related procedures etc.

Prevention is considered better over cure.

While trying to chalk down some of the major differences between a ‘Dental Plan’ and a ‘Dental Insurance’, one landmark differentiation can be surely made and that is, a ‘dental plan’ works majorly on the prevention of the tooth and gums related diseases while a ‘dental insurance’ deals with the cost cutting of the future illnesses. However, one of the major proportions being advised in the favor of health science is that ‘prevention is better than cure’ and this statement fits equally for the dental related diseases. This is because, dental diseases are much easier to prevent and a routine appointment with the dentist will do the need. Another argument favoring the dental insurance is that they are quite cheaper as compared to the health insurances as the procedures involved in a dentist clinic are not that complex as compared to an ICU of a hospital. Hence the patients must be encouraged to go on with a dental insurance which fulfills most of their needs. The IDA (Indian Dental Association) from a long synapse of time is striving hard to complement an oral dental policy which can work throughout the regime of India. However, nothing substantial has been attained since years of attempt. Dental health insurance is the only policy present till date that is cost effective and has been preferred in the favor of the individuals. It also fulfills a good source of motivation to the next generation of people where they keep attending the dentist’s clinic in order to prevent future concerns.

The issue of dental insurance is a wider issue of debate in the present times. While a lot number of individuals do go for hefty family health insurances, no special care is shown in terms of oral problems and is handled in a loose manner. Dental insurance is in its flourishing stage all over the world and is best served in the western countries however the concept was much lately introduced in India. It’s widely in the hands of the nation’s government to introduce policies in relation to the subject matter but the Indian conception in relation to the issue has been misunderstood. In the present era, where the medical expenses are touching the sky, preferring the edge of insurances should be the priority decision. Also oral problems once reaching a stage of infinity go intolerable and cannot be further ignored. A dental insurance also supports the need of the individual where one can select an insurance of his own liking. To improve the picture in the present canvas, the misconception is in need to be cleared at the grass root level i.e. the dental schools. ‘Public Health Dentistry’ should not be taught merely as a subject and the students must not study it just for the sake of grades. A clear understanding is the need of the hour and must be coupled with the government involvement and initiatives.

1. Available from: www.dentalinsurance.com, last accessed on 12/07/15
2. Available from: http://www.dentalinsurance.com, last accessed on 12/07/15
3. The Core Committee, National oral health policy- Ministry of Health and Family Welfare, 1985
4. D. Holst and I. Rossow, Legislation and Reality in public dental services in Norway: Dental health services for children and adolescents in 1975 and 1985, Journal of Public Health Dentistry (1991)
5. Available from: http://www.tribuneindia.com/2008/20081101/biz.htm, last accessed on 12/07/15
6. B. Daly, Essential dental public health, Oxford University Press, 1st Edition, New Delhi, India (2002)
7. Available from: http://www.economywatch.com, last accessed on 12/07/15
8. Available from: http://www.ehealthinsurance.com/dental-insurance, last accessed on 12/07/15
9. Available from: www.dentalcare-indiatour.com, last accessed on 12/07/15
10. Available from: http://www.123-dental-medical-insurance.com, last accessed on 12/07/15


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