Dental and optical cover on international health insurance

Dental and optical are the benefits people use most often and understand least. IPMIBenefits explains the difference between routine, major and emergency dental, where optical fits, and how to read the limits.

Three kinds of dental cover, and why the difference matters

Dental on an international private medical insurance (IPMI) plan is not one benefit. It is usually three, and insurers treat them very differently.

• Emergency or accidental dental pays for treatment after an accident, such as a broken tooth from a fall. It is often included in the core plan, with no waiting period, because it is a medical event rather than routine care.
• Routine dental covers check-ups, hygienist visits, fillings, simple extractions and X-rays. It is almost never in the core plan. You get it on a higher tier or as an optional module.
• Major or restorative dental covers crowns, bridges, root canal work, dentures and sometimes implants. It sits with routine dental but usually at a lower reimbursement rate, a separate sub-limit, or both.

Orthodontics, if covered at all, is a fourth category. It is often restricted to children, paid at a lower rate, and subject to its own limit. Cosmetic dentistry, such as whitening and veneers, is excluded on nearly every plan.

A plan that says "dental included" may mean only the emergency benefit. If you want your six-monthly check-up paid for, look for the words routine or preventive in the table of benefits.

Where optical cover fits

Optical cover pays for eye tests and a contribution towards glasses or contact lenses. It is a small benefit with a modest limit, and insurers rarely sell it alone. It is usually bundled with dental, with a wellness module or with the top tier of a plan. APRIL International, for example, generally packages dental and optical together except on its entry level, and Now Health WorldCare lists optical inside an optional wellness, optical and vaccinations module on its Advance level and above.

Treatment for eye disease, such as cataract surgery or care for glaucoma, is medical treatment, not optical. It falls under the inpatient or outpatient benefit depending on where it happens, and is not restricted by the optical limit. Laser eye surgery to correct short sight is usually excluded as elective.

How insurers package dental and optical

Across the insurers IPMIBenefits compares, dental appears in three structures.

• Optional module. IMG Global offers dental as an optional benefit on all of its plans for an additional premium. Allianz Care sells a dental module that must sit at the same level as the core plan you choose. HCI Nimbl lists dental as an optional module for routine and major treatment. AXA Global Healthcare offers routine dental care as an upgrade.
• Higher tier only. Bupa Global includes routine and major restorative dental on Premier and above. Now Health WorldCare adds routine and complex dental on its Excel and Apex levels. Now Health SimpleCare adds routine and complex dental on its 250 level.
• Emergency only in the core. Expatriate Healthcare includes accidental emergency dental on all of its plans, and HCI Nimbl lists emergency dental in its core.

The module approach lets you add dental without changing anything else. The tier approach ties dental to a bigger decision about outpatient limits and overall cover. Neither is better in the abstract; the question is what else you would get, or pay for, to reach the dental benefit. The cost guide covers the trade-off.

Waiting periods, sub-limits and reimbursement rates

Routine dental nearly always carries a waiting period, because it is easy to buy cover the week before an expensive course of treatment. Among the plans on this site, IMG Global and HCI Nimbl both list a six-month wait for dental, Bupa Global applies six months to routine and major restorative dental, and Now Health WorldCare a nine-month wait. Accidental dental is usually available immediately.

Three mechanics then shape how much you get back.

• The annual dental sub-limit. A fixed maximum per policy year for all dental claims combined, separate from the plan's overall annual maximum. It is often the figure that decides whether a crown is mostly paid for or mostly yours.
• The reimbursement rate. Routine work is often paid in full or at a high rate; major work at a lower rate. The plan pays its share and you pay the rest, on top of any excess.
• Per-treatment or per-item limits. Some tables cap individual items, such as one check-up per year or a limit per crown, inside the annual figure.

Pre-authorisation is uncommon for routine dental but is often required for major work above a stated cost, and some insurers ask for a treatment plan from the dentist first. Network rules matter less than for hospital treatment, because most dental is pay-and-claim, but a few insurers offer direct billing with partner dentists. The limits guide explains how sub-limits sit inside the annual maximum.

What to check in the table of benefits

Dental, underwriting and pre-existing conditions

Dental is underwritten lightly compared with medical cover, but it is not ignored. Under full medical underwriting you may be asked about ongoing dental treatment, and an insurer can exclude a course of work already planned or in progress. Under a moratorium, a dental problem you had treatment or advice for in the look-back period is a pre-existing condition like any other, and is excluded until the symptom-free period has run. The pre-existing conditions guide explains both bases.

The waiting period does most of the underwriting work. Because routine dental cannot be claimed for the first months of the plan, insurers rarely need to ask detailed dental questions; the wait filters out treatment that was already needed on the day you joined. Missing teeth, existing crowns and work recommended before you joined are the items most likely to be excluded by wording, so if you have a known problem, raise it at quote rather than at claim.

Common mistakes with dental and optical cover

• Reading "dental included" and discovering it means emergency dental only.
• Adding dental for a crown you already know you need, then hitting the waiting period.
• Comparing dental limits without comparing the reimbursement rate for major work.
• Paying extra for a dental module whose annual limit is less than the premium it adds.
• Expecting cataract surgery to count against the optical limit, or laser eye correction to be covered at all.
• Assuming direct billing works at the dentist in the same way it does at a hospital.

Dental and optical are easy to compare once you look at the right three numbers: the wait, the annual limit and the rate for major work. Nomi shows those side by side for every plan, together with the outpatient and wellness benefits they are usually packaged with.

Frequently asked questions

This page is general information, not personal or medical advice. Prices are indicative and confirmed by the insurer at underwriting. For advice on your situation, speak to an experienced broker.