You should understand the details of dental coverage in visitors insurance. Most people who have relatives visiting the USA buy visitors insurance but often forget to purchase dental coverage or think that dental coverage is included in the visitors medical insurance itself.
Dental tooth pain is one of the most severe pains people may experience and therefore, it is necessary to seek treatment right away. While some treatment can be delayed until the visitor has returned to their home country, most times though, treatment can't wait that long.
Visitors insurance is primarily focused on medical coverage, where dental coverage is not provided or is very limited.
There are primarily two types of visitors insurance plans: Fixed and Comprehensive.Visitors Insurance Types
Even though the actual coverage varies based on the specific plan you purchase, typical coverage may look like the following:
$100 maximum for necessary treatment of unexpected pain to sound natural teeth. The limit is sometimes $100 maximum, $250 maximum, or $250/tooth or $100/tooth etc.
Up to policy maximum for dental treatment necessary to treat fracture of the bones supporting the teeth and/or to restore or replace sound natural teeth lost or damaged due to an accident.
Comprehensive plans would typically provide coverage in the cases of both Pain as well as an Accident, as described above. However, fixed coverage plans typically provide coverage only in the case of an accident and that will have an upper limit such as $500, instead of the policy maximum.
Sound natural teeth in the above description means the teeth that naturally grew inside your mouth and not artificial ones. That means that it will not cover expenses related to denture, implants, false teeth, bridge, crown, mouth guards, dental braces, retainers and other orthodontic devices etc.
The following expenses are typically not covered in any visitors insurance plan:
- Routine dental care such as cleaning.
- Gum related problems.
- Replacing crowns or bridges.
- Unless due to an accident, replacement of damaged braces.
- Replacement of dentures. Some elderly people lose their dentures or are somehow damaged but there is no coverage for them.
Most visitors insurance plans would require that you complete the treatment before returning to your home country, as there is no coverage in the home country.
Claim and Reimbursement
As there is no PPO network for dentists in any visitors insurance plan, you will have to first pay out of your pocket and file for reimbursement of eligible expenses later. However, in case of any accident with major bills, some providers may be willing to bill the insurance company directly.
Prescription Drug Coverage
In case of a tooth pain, when a person visits a dentist, the dentist will typically prescribe some medicines. As there is no pharmacy network, you will have to first pay out of your pocket. However, in most cases, those expenses will not be eligible for reimbursement as the tooth pain will most likely fall under pre-existing conditions under the medical coverage and therefore any expenses related to it such as prescription drugs will be excluded as well.
As visitors insurance does not provide sufficient dental coverage under most common circumstances, it is advisable to purchase a separate dental plan.