What is included in VHI for dentistry in 2022: pros and cons of the policy

By taking out additional health insurance, the insured person has the opportunity to receive quality medical care in many areas. The list of the most common conditions under a voluntary medical insurance (VHI) policy includes dental services. You will find out below what manipulations and procedures are provided by the VHI dentistry option.

What is included in VHI in dentistry?

There are two ways to purchase voluntary medical insurance with dentistry: become a participant in the corporate insurance program through your employer or take out a policy individually.

The basic VHI program does not include dental services - this is an addition to the list of standard services, which is added at the request of the policyholder. Dentist medical care within the framework of the additional insurance policy includes:

• examination and diagnosis of the oral cavity;
• X-ray and other necessary examinations;
• therapeutic treatment (treatment of acute superficial, medium and deep caries, pulpitis, nerve extraction, canal filling, placement of fillings, pain relief);
• surgery (removal of wisdom teeth, chewing teeth, incisors, benign formations, treatment of inflammation in the mouth, salivary glands, maxillofacial nerves);
• treatment of gums and oral mucosa;
• aesthetic treatment: removal of tartar and plaque, installation of veneers, coating with fluoride varnishes;
• emergency 24-hour free assistance in the clinic.

The above list of standard services does not include implantation and prosthetics. By the way, insurers are very reluctant to agree to add these options to the VHI Dentistry program.

Therefore, if a client hopes to receive this type of treatment, it is necessary to study the contract very carefully. Typically, only maxillofacial trauma is a strong indication for prosthetics.

Good to know! If a tooth is destroyed due to natural reasons - age, caries, etc., the implant is placed at the patient’s expense, which is absolutely unprofitable for the policy owner. Under such circumstances, the insured may never use the dental services provided for by the terms of insurance and regret the money spent.

Even if treatment is included: you need to know this

There is one more important clarification that it is useful for the policyholder to know about. When prosthetics are included in voluntary health insurance programs, this does not guarantee payment for services for installing a prosthesis - dental or orthopedic.

1. The insurance company may specify in its policy that dental prosthetics are included in insurance coverage only if the need for dentures arose as a result of injuries to the maxillofacial area. Tooth destruction due to untreated caries is not included in this risk.
2. Dental programs often stipulate that dental prosthetics are paid for under VHI, but strictly in terms of the cost of dentures and preparatory procedures before their installation. Implants, auxiliary materials, rehabilitation therapy - all this is not included in the coverage area.
3. Only “cheap” prosthetics without the use of expensive materials (precious alloys, imported ceramics) can be included.

Important points for the policyholder

If prosthetics of body parts is taken into account in the VHI, you should carefully study the list of medical facilities of the insurer. It may also happen that there is simply no clinic on this list that provides such treatment. Then overpaying for a more complete set of diseases will be meaningless.

Typically, dentures are part of a comprehensive program offered to a corporate client. It is less often included in contracts for private individuals. But the situation with dentures is still better than with orthopedic or hearing ones.

Dentistry with prosthetics can be insured under VHI - you just need to deduct the terms of the program for the insurance to work. But it is still quite difficult to insure prosthetics of body parts in Russia. And you will have to pay a decent amount for it.

What do you have to pay for out of pocket?

When signing a contract, the policyholder cannot provide for everything - some cases are not covered by the insurance. They are classified as additional medical services of dental care. Among them:

• teeth whitening and inlay (decoration with rhinestones);
• restoration of enamel and coating it with protective agents;
• replacement of fillings at the request of the patient for preventive and aesthetic purposes;
• implantation and prosthetics of lost elements of the dentition;
• orthodontics (correction of bite, alignment of teeth through the installation of braces and other methods, treatment of periodontal tissue, ozone treatment).

The listed services are mostly related to cosmetology, and this type of service is not provided for by the VHI policy.

A little about corporate insurance

It cannot be said that the quality of dental services under the VHI policy is better. In contrast, corporate insurance options are usually quite limited. However, there is a very significant plus - the insured person will not pay for dental treatment under voluntary health insurance in the amount provided for by the policy.

Considering that additional medical insurance is not a cheap pleasure, small organizations cannot always afford to include the “VHI” option in the contract. But huge holdings with thousands of employees receive significant bonuses from the insurer, so adding this service does not affect their financial condition. What you need to know about corporate insurance:

1. Seeing a dentist under a VHI policy is not always “geographically” convenient, because you can get examined and receive treatment in just a couple of medical institutions located at different ends of the city.
2. Typically, corporate insurance has limitations, for example, no more than 2 teeth can be treated per year, and only if it is average caries and the crown is destroyed by no more than 50%. For the rest you will have to pay extra, albeit taking into account the discount.
3. If the collective agreement specifies a certain number of people who can receive treatment during the year, and more employees from this company contact the clinic, this may entail a lengthy showdown with the insurance company. It is possible that some insured persons will have to use paid services.
4. When an employer saves on the “Dentistry” option and chooses clinics with a lower quality of service, one can also expect that cheap materials may be used during treatment. In addition, it is more profitable for a doctor to accept clients who pay for treatment, so VHI holders are “leaked” to inexperienced trainees. Fortunately, this is a rare occurrence.
5. You must make an appointment in advance

Thus, corporate insurance, which provides the opportunity to treat teeth under a VHI policy, is beneficial for the insured, especially if he works in an enterprise with hazardous production, where abrasives, chemicals, etc. are used. Service under such a program is better than under free compulsory medical insurance, and worse than visiting a paid dentist individually at your own expense.

How a VHI policy works: pros, cons, features of voluntary insurance

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What could be the pitfalls?

You should familiarize yourself with the disadvantages of dental care before purchasing a policy. Pitfalls that the insured person may encounter:

• inability to change clinics at will. According to the terms of the contract, during the insurance year the client can only be served in the institution that was selected when receiving the policy;
• lack of highly specialized specialists in clinics. According to the rules of VHI insurance, the patient does not have the right to use the services of a prosthetist and orthodontist - he only claims to provide primitive care. The same applies to diagnostic measures - such examinations are limited by agreement;
• drawing up an agreement with a franchise. This will reduce the amount of the insurance premium, but if an insured event occurs, you will have to partially pay for the treatment out of your own pocket. If the franchise is 2000 rubles, then upon initial application you will have to pay this amount;
• chronic diseases. If there are any, VHI registration is usually refused. There is no point in hiding this fact, because if it reveals itself, you will have to pay a huge fine and reimburse the insurance company for all funds spent.

Another significant problem is that not all insurers want to cooperate with individuals and provide dental care. For them, corporate insurance is more profitable. It is difficult to find such companies; not all of them exist on the market.

Good to know! Some individuals join groups of 10-20 people and receive insurance on the same terms as large companies. This allows the insured to save on purchasing a policy.

What insurance doesn't cover

All insurance companies have different conditions. It is possible that your contract for a certain price will contain something that is not in other contracts. But standard policies are the same in most cases. In addition to the already indicated cases of HIV infection and malignant neoplasms, they do not cover the costs of:

1. Medicines. You will have to buy tablets with your own money.
2. Preventative visits to the doctor. Let's say nothing bothers you, but you know that you need to visit the dentist and gynecologist every year or even twice a year. If you take care of yourself, the doctor will confirm that you are healthy. And this appeal will not be considered an insured event. The same can be said about visiting a doctor when you need to get a stamp on a certificate, for example.
3. Pregnancy and childbirth. These events are not considered an insured event, and insurance companies and clinics have separate offers for medical support of pregnancy.
4. Psychiatric help. You will talk about stress, burnout and depression with a psychotherapist at your own expense.

It’s easier to say when a basic policy works: when you got sick, you went to the doctor and were treated on an outpatient basis. Everything else, including hospitalization (in a comfortable room), is additional chips for additional money.

Cost of VHI for dentistry in 2022 in the top 5 insurance companies

Some top insurance companies with high reliability ratings do not provide standard programs for individuals for VHI insurance with the option of dental services. For example, those insured who have dental treatment under the policy of VTB or SOGAZ either have corporate insurance or negotiate the terms of insurance individually. The table shows the prices of those organizations that have standard programs that include dental services.

Advantages of voluntary health insurance

The advantages here are the same as those of paid treatment over free:

1. Service in private clinics with a higher level of comfort and technical equipment.
2. No queues.
3. Quality service. This includes the polite treatment of the staff and such little things as free shoe covers and other disposable consumables.

In addition, the patient pays for the VHI policy once, and then the insurance company reimburses the costs to the medical institution. This approach reduces the number of unnecessary examinations and prescriptions that doctors sometimes do in paid centers: the insurance company simply will not approve manipulations that are not part of the standard of treatment.

How and where to apply

VHI insurance with the “Dentistry” option can be obtained from any of the above companies, or you can first independently monitor the conditions and prices of different insurers and choose a more profitable option. To obtain a policy you will need:

• visit the office of the insurance company, inquire about the provision of such services in the medical institution you like, or leave an application for purchasing a policy on the insurance company website;
• provide a package of documents: passport, SNILS, confirmation of registration, application (filled out on the spot);
• undergo an examination (at the request of the insurer);
• choose a program that provides dental services and sign an agreement;
• pay for the services of the insurance company and obtain a policy.

You can conclude an agreement through an insurance agent, broker or travel agency, but in this case you will have to overpay for mediation. In addition, fraudulent activities are possible, so you need to confirm for yourself the fact of cooperation of a person or organization with the insurer.

Where can I buy VHI

There are few companies that cooperate with individuals. Mostly all top insurers with a high customer trust rating enter into contracts with corporate clients. However, you can find a reliable insurance company. This list includes:

• Rosgosstrakh;
• Renaissance;
• Ingosstrakh;
• VSK.

You can try to conclude an insurance contract with Sogaz. VHI Sogaz provides dental treatment in the best foreign dental clinics. The customer support service is available 24 hours a day and you can contact us with any questions.