Health insurance is used to pay for what services during dental treatment? Currently, the cost of dental examination and treatment at clinics, dentists or hospitals is often very high. Because of the increased demand for dental care as well as investment costs for equipment and machinery, the team of doctors at dentists is increasing day by day.
However, dental insurance today is not really popular and is only applied to certain dental services, making many people hesitant to go to the dentist to treat their dental problems.
So what dental services can the dental and maxillofacial insurance mentioned above be applied to? How much % do we benefit from that insurance? Let’s find out with BeDental through this article!
What dental services will be covered by dental insurance?
Health insurance is a type of health care insurance that helps insured members share part or all of the costs of medical examination and treatment.
Today, as health needs receive more and more attention, social benefits are also promoted by the state to contribute to the development of the country, people and society.
However, in dentistry alone, not all services can be covered by insurance. Some dental services covered by insurance are not covered by BeDental in this section.
Dental examination (covered by insurance)
Accordingly, in Article 21 of the health care insurance law, patients who come for medical examination and treatment using insurance will have the health care insurance fund pay part or all of the medical examination and treatment costs. Therefore, the answer is yes, insurance coverage is available when patients undergo dental examination.
In this case, the patient will receive insurance that covers medical examination and treatment fees when performing medical examination and treatment, and therefore when there is a need for dental examination and treatment, health insurance is used. You will enjoy personal benefits from this type of insurance.
However, you will not receive payment support from insurance if you only perform routine health check-ups.
See more: What should I eat after wisdom tooth extraction? What to abstain from?
Tooth extraction (may be covered by insurance)
Besides dental examination and treatment, many people also wonder if tooth extraction alone can be covered by health insurance? To answer this question, according to Article 21 of the Health Insurance Law, health insurance can only be applied when you have to have teeth extracted in the following cases:
Decayed tooth
Wisdom tooth extraction (tooth number 8), impacted tooth or some other disease
Teeth have dental diseases that require extraction, infection or problems require tooth extraction
As you can see, insurance will cover you if your tooth extraction is due to pathological reasons, the tooth cannot be restored and affects other teeth as well as affecting your oral health. require you to have your tooth extracted.
On the contrary, in some cases insurance will not be covered if you only perform tooth extraction for cosmetic purposes without a doctor’s prescription.
Dental fillings (may be covered by insurance)
Dental fillings are also services considered eligible for health care insurance. You will receive insurance when you have dental fillings in the following cases:
- Teeth must be filled due to disease or in cases where the filling is prescribed by a doctor
- Treatment costs that are not covered by the state budget
Therefore, in cases where your teeth have to be filled due to dental diseases such as tooth decay, chipped teeth or other diseases prescribed by the doctor, you will be completely covered by insurance (if do you use insurance).
On the contrary, in cases where you only perform cosmetic dental fillings, you will not enjoy benefits from health insurance.
Root canal treatment (covered by insurance)
The dental pulp is where blood vessels and nerves connect to the tooth root and enter the tooth. The tooth pulp is responsible for providing nutrients to the tooth and causing sensation to the tooth. When the pulp is damaged or infected, it will not only affect our teeth but also our health if not treated promptly and properly.
Therefore, for this disease, it is possible that root canal treatment is also covered by health insurance according to state regulations.
Accordingly, the insurance coverage will range from 70-100% if root canal treatment is performed at the correct registered route and 40-60% if treatment is performed at the wrong route. Or registering for insurance at private dentists can also reduce the cost of root canal treatment.
Are porcelain crowns covered by insurance? Porcelain crowns (not covered by insurance)
Are porcelain crowns covered by insurance? Accordingly, in Article 23 of the insurance law, although insured people will enjoy insurance benefits in medical examination and treatment.
However, this clause also clearly stipulates the cases that do and do not benefit from insurance. In particular, those who only perform dentistry, medical services upon personal request, cosmetic services, etc. will not receive benefits from health insurance.
Making porcelain teeth is also one of the on-demand cosmetic services and is not on the list of medical examination and treatment. Therefore, the costs are not covered by health insurance. In short, porcelain teeth and crowns are a type of dentistry that is not covered by health insurance.
Braces (not covered by insurance)
Braces are a form of service that helps straighten teeth, improve molars and bite by overcoming oral problems such as overbites, underbites, uneven teeth, misaligned teeth, etc.
This is considered an on-demand cosmetic dental restoration service. Therefore, according to Article 23 of the insurance code, braces are not within the scope of health insurance policies.
See more: HOW MUCH DOES IT COST TO REMOVE WISDOM TEETH? 3 REASONS TO REMOVE YOUR WISDOM TEETH
Dental implants (not covered by insurance)
Dental implantation is a form of service that helps restore lost teeth using dental measures that can be applied to restore the eating and chewing functions of teeth and restore the aesthetics of molars.
Most dental implant methods are quite expensive, so many people are also concerned about whether dental implants will be covered by health insurance or not?
The answer is according to clauses 6 and 8, article 23 of the 2014 health insurance law in effect to date. Dental implants are a cosmetic dental service, so they do not receive benefits from health insurance according to the law.
How much % will dental insurance users receive when performing dental examination and treatment?
People who use health care insurance will enjoy benefits to cover costs for medical examination and treatment, regular prenatal care, childbirth, etc. However, in each case the level of cost support from insurance will be different.
In case the subject undergoes medical examination and treatment according to the registered health insurance line, he/she will receive benefits from health insurance with costs covered as follows:
- Receive 100% of support costs from health care insurance when performing medical examination and treatment when belonging to the subjects mentioned in Points a, d, e, g, h and i, Clause 3, Article 12 of the insurance law.
- For the subjects in Point a, Clause 3, Article 12 of this Code, payment is guaranteed if these costs come from health insurance funding or when health insurance funding is not enough to cover, there are cases such as: In the case of this patient, the state budget will compensate.
- Receive 100% of medical treatment costs provided that this cost is lower than the cost prescribed by the government and medical examination and treatment is only performed at the commune level.
- Enjoy 100% when the patient has participated in health insurance for 5 consecutive years or more and has paid his/her medical examination and treatment costs in a year greater than 6 months’ base salary. In case of not receiving benefits when performing medical examination and treatment at the wrong level
Receive 95% of medical examination and treatment costs from insurance for subjects specified in point a clause 2, point k clause 3 and clause a clause 4 of Article 12 of the health insurance code
Enjoy 80% of the costs covered by insurance when performing medical examination and treatment for the remaining subjects.
In case the subject performs medical examination and treatment other than the health insurance registration line
Cases of medical examination and treatment are also entitled to health insurance when different routes are prescribed in Clause 3, Article 22 of the 2014 health insurance law in effect to date. Accordingly, the regulations on payment rates are as follows:
- Enjoy 40% of costs for inpatient treatment at central level hospitals
- Enjoy 100% of costs for inpatient treatment at hospitals nationwide
- Enjoy 100% of inpatient treatment costs at district hospitals
Where can dental insurance be applied to enjoy insurance benefits?
In fact, up to now there is still no form of insurance specifically for the dental field. We enjoy health insurance benefits when performing dental services thanks to the provisions of the Insurance Law.
Therefore, we need to clearly understand the policies and terms before participating in any type of insurance so that we can enjoy many benefits from that insurance when performing medical examination and treatment at dental clinics. like at the hospital.
To determine when health insurance is effective and can be applied to help pay for your medical expenses. In this case, we need to identify places that accept payments with health insurance cards.
Normally, state insurance can be applied at public facilities and hospitals (when performing medical examination and treatment on the right level and with a variable % payment rate when performing on the wrong level).
Health insurance is mostly accepted at hospitals and public facilities, so do private businesses that perform dental examination and treatment receive any benefits from health insurance? People also pay a lot of attention to this issue.
Currently, some private dental clinics can still apply insurance for medical examination and treatment. Some other facilities will accept insurance payments when the insurance has registered medical examination and treatment at these facilities.
See more: Is Wisdom Tooth Extraction Covered by Health Insurance?
What procedures need to be followed to receive health insurance when undergoing dental treatment?
What procedures need to be followed to receive health care insurance when undergoing dental treatment? By participating in health insurance, we can enjoy a number of benefits as well as reduce costs for dental and facial examinations.
However, to be able to receive benefits from insurance, we need to do some procedures when paying that require personal documents to verify information such as ID card/CCCD, insurance card, insurance, driver’s license,…
The ID card or driver’s license are documents that prove identity in case insurance does not have a photo. Therefore, when performing a medical examination using health insurance, you need to bring these documents with you!
Particularly in the case of returning children under 6 years old, many documents are not required, but only need to present the health insurance card for verification.
Health insurance brings us more benefits as well as helps us reduce the burden of costs when performing medical examination and treatment. Especially for dental services, the cost of medical examination and treatment is quite high, so using health care insurance will greatly reduce costs for us.
However, when using health care insurance, we need to clearly understand the policies and terms of insurance as well as the procedures that need to be followed to enjoy benefits from health insurance.
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