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.

Is there a program with dental prosthetics?

Dentistry medical insurance in its basic version does not include dental prosthetics. This is due to the high cost of implants. Moreover, they are often made of expensive ceramics or precious metals.

However, in premium and expensive programs, dental prosthetics can be added as an option. But here, too, the client faces restrictions.

For example, it turns out that the contract will stipulate the condition for the need for a prosthesis due to maxillofacial trauma, and not due to untreated caries.

The cost of the program with dental prosthetics included in the package will start from approximately 140,000 rubles / year.

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.

When does it make sense to buy a VHI policy?

Voluntary health insurance is beneficial in several cases:

1. With the help of your employer, you connect your relatives to the insurance program on favorable terms.
2. You get sick a lot and are treated in paid clinics.
3. You have a lot of money and want to receive medical care with maximum comfort.

If this is not your case, then leave VHI for employers who think about their subordinates, want to be attractive to cool specialists and not lose people because they spent the whole day in line at the doctor because of a common runny nose.

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.

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.

How to understand whether it is worth buying a VHI policy

To find out whether it is worth buying a policy, you need to do a little:

1. Calculate how much you spend on treatment.
2. Find out what service packages you need.
3. Check which insurance companies provide the policy and for what amount.

Last year, I didn’t spend much on treatment in commercial clinics and sought help mainly for preventive examinations (the table shows rounded data, prices are relevant for my region):

A calculator from one of the insurance companies calculated that the minimum policy, which would include dental services, would cost me 35,000 rubles per year. At the same time, I will also spend money on treatment, because all prevention, if you believe the insurance rules, will fall entirely on my wallet. That is, massage, teeth cleaning and medicine purchases - the most expensive items on my list - will remain outside of insurance.

You can purchase a policy that will cover these costs. But its price will be sky-high - under a hundred thousand rubles.

Out of curiosity, I called two more insurance companies, where honest employees directly said that for individuals, the VHI policy is unprofitable, and if you are worried about the risk of injury or illness, then it is more logical to conclude an insurance contract against accident or illness: it is several times cheaper .

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.

Is everything possible to include VHI?

But the history of personal insurance in the Russian Federation is not what interests the domestic insurer. It is important for him to understand what is included in the VHI, whether he can take into account prosthetics services in the policy. The answer is yes: prosthetics can be included in the contract with the insurer, but with some reservations:

• as a rule, insurance companies agree to take on such an expensive risk only as part of dental services: coverage includes dental prosthetics with preparation for procedures;
• in 99% of cases, voluntary health insurance with prosthetics is a premium price class program, extended insurance, which not everyone can afford;
• on the Russian market, only large serious insurers take prosthetics into account in their programs.

And the insurers, in a sense, can be understood. The logic of their reasoning is transparent: if a person wants to include such complex treatment in his policy, then he suspects that he will need it. That is, he knows things about his health that he does not tell his insurance partner.

And this already amounts to fraud. You cannot insure yourself to solve an old health problem; VHI insurance is purchased for unforeseen cases of illness.