Dental treatment is costly. Here’s how you can finance it

Karan Khona, a resident of Mumbai, says he had to spend more than ₹3 lakh recently for his mother Preeti Khona’s dental treatment. That sum covered the costs of five dental implants and three dental bridges and crowns, all done in a span of two months and several sittings.

Delhi-based Ganesh Jha says he paid ₹75,000 for dental implants at a clinic in his hometown, Chandigarh. “The same procedure would have cost me nearly ₹1 lakh in Delhi,” he says.

Khona and Jha are among the millions of people who seek dental treatment in the country every year. According to the Indian Dental Association, the dental industry in India is estimated to be worth over $5 billion, with an estimated compound annual growth rate, or CAGR, of 20%.

Both Khona, a chartered accountant, and Jha paid for the treatments from their savings. They did so because their insurance policies did not cover the treatment costs. To be sure, most insurance policies in India do not cover dentistry, which is designated as outpatient department (OPD) treatment that does not require hospitalization. Very few insurers allow such claims as part of OPD cover in retail and corporate health policies. Separately, some non-banking financial companies (NBFCs) such as Bajaj Finserve, Fibe, Tata Capital have started offering zero-cost EMI option on loans for dental treatment.

Dental insurance

A majority of insurance policies issued in India cover dental treatment only if a policyholder meets with an accident and suffers a dental injury. Insurers generally avoid OPD cover for dental treatment and the coverage amount in the few policies that do is very low and the waiting period long, some lasting up to four years. For example, Care Health Insurance’s Care Plus policy offers out-patient dental cover of up to ₹2,500 when the sum insured is in the range of ₹10-25 lakh. The coverage is a mere ₹1,500 if the sum insured is ₹7 lakh. ICICI Lombard General Insurance’s Health Advantage policy offers ₹5,000 cover in case of ₹10 lakh sum insured and it goes up to ₹50,000 if the policy cover is ₹1 crore.

Even where you have limited coverage, some treatments are kept out of the purview of the policy. These include cosmetic procedures such as dentures, implants, prosthesis, smile makeover and orthodontics. Insurers cover the costs of X-rays, Oral check-up, root canal treatment, fillings, extractions and preventive treatment.

Akshay Golechha, vice president at Plum,an insurance tech firm, says corporates have started covering dental treatment in the group insurance policies given to employees. “It is easier to underwrite dental cover in the group construct, but it is seldom exhaustive and almost always excludes cosmetic treatment,” says Golechha.

There is, however, no standard definition in insurance as to what entails a cosmetic dental treatment. “An insurer may cover root canal but a premium cap might be deemed cosmetic. Some insurers even consider regular cleaning and scaling to be a cosmetic procedure,” says Golechha.

HDFC Ergo recently launched a group dental insurance plan—CHOMP —wherein a policyholder can pick and choose between treatments like fillings, extraction, root canal, gum inflammation, minor surgeries, bridges, consultations, and cleaning, etc. and design a customized plan. Premium ranges between ₹150 and ₹15,000 depending on the coverage and is age agnostic. “These plans can only be sold on B2B2C basis, meaning only corporates can opt for this product for their customers or employees. It cannot be sold to a customer directly. Currently, it is available for corporate customers of HDFC Bank through branch banking and net banking channel,” says a spokesperson of HDFC Ergo.

Some companies adopt a reimbursement model in which they reimburse employees from their own funds. “This pay-as-you-go flexible benefit model helps them avoid upfront payment of premiums for the OPD cover that is too high. Corporates usually set aside a fund or wallet through which they can not just reimburse employees but also custom-design the coverage. We help them with the tech for such a model,” says Golechha of Plum.

Why is dental cover not exhaustive in India? The answer lies in the high probability of fake bill generation. Ankur Gigras, CEO and co-founder, HexaHealth, suggests a co-payment model for dental OPD coverage to address this issue. A co-payment model envisages the policyholder and the insurer sharing the treatment costs in a pre-defined proportion. “Not only will it reduce the premium amount on dental insurance but also prevent fraud. Insurers can also restrict coverage only within network hospitals where chances of fraud are fewer,” says Gigras.

HDFC Ergo, for example, is considering a cashless claim option, wherein the policy premium will be lower.

Loans

When Delhi-based Abhishek Chopra’s mother needed a dental implant that involved tooth extraction and bone grafting, he got it done from a leading dental chain in New Delhi for ₹47,000 on which he got a 25% discount. “My credit card allowed me to make the payment with 3 equated monthly instalments (EMIs) that came at an interest of 14%,” says Chopra.

Experts say that a lot of people opt for a loan to meet their health expenditure since the treatment is mostly expensive and they can repay the loan at their convenience in easy instalments. While personal and credit card loans are now widely available for meeting treatment costs, a few dental chains have also started offering zero-cost EMI option on dental loans. For example, Fibe (earlier Early Salary) offers this facility for loans above ₹10,000, spread across 24 EMIs. There could be a one-time processing charge and late payment fee in case people miss a payment. “It is essentially a buy now, pay later (BNPL) loan in which we disburse money to the merchant directly. A customer deals with the merchant (dental chains in this case) and not with NBFCs,” says Parvaiz Hussain, business head, Fibe Healthtech, which works with dental chains such as Sabka Dentist, Clove Dental, Toothsi, Partha Dental, Orthosquare, Enliven and Invisalign, among others.

The easy availability of zero-cost loans helps dental chains manage their business better. “About 60-65% of our revenues come from zero-cost EMIs. A small percentage comes from in-clinic EMIs and the rest is upfront payment by patients,” says Dhairyasheel, chief operating officer at Sabka Dentist. Under in-clinic, no=cost EMI option, the dental clinic chain allows customers to split payments in multiple instalments without extra payment or the involvement of lenders.

Full mouth rehabilitation, orthodontic procedures such as aligners and braces and dental implants are the top three processes for which people opt for zero-cost EMIs at Sabka Dentist. The company has a tie-up with Fibe, Bajaj Finserv, Save In, and Shop Se, among others. The average ticket size for the loan amount is ₹21,000. Hussain says it is ₹70,000 at Fibe. “Braces, implants, oral regeneration, facial correction surgeries and root canal are the most popular procedures for which Fibe disburses loans,” says Hussain.

Ideally, one should not borrow to fund treatment , even when zero-cost EMI offers are available, say financial experts. Opt for it only if you have a cash crunch and are in dire need of the treatment.

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Updated: 30 Nov 2023, 05:50 PM IST