Dental Insurance Coverage Explained: A Comprehensive Guide from Cleanings to Dental Implants
Having a quality dental insurance plan can save you thousands in treatment costs, but coverage varies greatly among plans. This article provides a detailed analysis of the coverage scope of mainstream dental insurance plans in 2024, including preventive care, basic and complex treatments, and orthodontics. It also offers strategy tips, claims guidance, and product recommendations to help you find the best oral health protection plan.
1. Core Coverage Areas of Dental Insurance
1. Preventive Care (100% Covered)
| Service | Annual Coverage Frequency | Market Price (Out‑of‑Pocket) |
|---|---|---|
| Scaling (Cleaning) | 1‑2 times | ¥200–500 |
| Oral Exam | 2‑4 times | ¥50–200 |
| Full‑mouth X‑rays | Once/year | ¥150–300 |
| Fissure Sealants | For children only | ¥80–150/tooth |
Who’s it for: All insured individuals (typically no waiting period)
2. Basic Treatments (50–80% Reimbursement)
| Treatment Type | Typical Reimbursement | Out‑of‑Pocket Cost |
|---|---|---|
| Composite Fillings | 50–70% | ¥200–600/tooth |
| Root Canal | 60–80% | ¥800–3,000/tooth |
| Simple Extraction | 50–70% | ¥100–800/tooth |
| Gum Treatment | 60% | ¥500–2,000/course |
Note: Most plans set annual limits (usually ¥2,000–5,000)
3. Complex Treatments (30–50% Reimbursement)
| Treatment | Coverage Feature | Out‑of‑Pocket Range |
|---|---|---|
| Dental Implants | 30–50% (usually with per‑tooth limit) | ¥8,000–20,000/tooth |
| All‑ceramic Crowns | 40% | ¥2,500–6,000/tooth |
| Removable Dentures | 50% within annual limit | ¥3,000–10,000/set |
| Periodontal Surgery | Pre‑authorization required (50–70% covered) | ¥2,000–8,000/course |
Waiting period: Usually 6–12 months
4. Orthodontic Treatment (Children Only)**
| Covered Item | Typical Terms | Out‑of‑Pocket Cost |
|---|---|---|
| Metal Braces | 50% reimbursement (limit ¥5,000–10,000) | ¥15,000–25,000 |
| Invisible Aligners | Covered by some plans (lower limit) | ¥20,000–50,000 |
Applicable Age: Under 18 (some plans cover adults)
2. 2024 Recommended Dental Insurance Plans
1. Ping An “Haoya Yi” (Best Value Combo)
- Core Benefits:
✅ 100% coverage for cleaning/exams (2/year)
✅ ¥8,000 annual coverage for complex treatments
✅ Covers implants (50%, limit ¥3,000/tooth) - Price: ¥499/year for adults, ¥699/year for children
2. Taikang “Zhongya Bao” (Implant‑Focused Plan)
- Special Coverage:
60% implant reimbursement (any brand)
Includes pre‑op CT scan - Limitation: Treatment must be in specified chain clinics
- Price: ¥999/year (covers 3 implants)
3. Cigna “Ya Wuyou” (Premium Plan)
- Luxury Service:
Coverage in private clinics (e.g., Rui Er, Ma Long)
50% orthodontics (limit ¥20,000)
Global dental emergency support - Price: ¥3,688/year for family plan
4. Alipay “Good Medical – Dental Version” (Digital Pick)
- Features:
Online appointments + direct billing
Zero deductible for basic treatments - Drawback: No orthodontic coverage
- Price: ¥299/year
3. Dental Insurance Buying Strategy
1. Match Plan to Needs
| Need | Recommended Plan Type |
|---|---|
| Only preventive care needed | Digital dental plan (<¥500/year) |
| Need implants/orthodontics | Specialized high‑limit plan |
| Care about clinic experience | Premium plan covering private clinics |
2. Avoid Waiting Period Pitfalls
- Preventive Care: Usually no waiting period
- Basic Treatments: 30–60 days waiting period
- Complex Treatments: 6–12 months (implants usually 12 months)
3. Network Clinic Recommendations
- Prefer: Large dental chains (e.g., Rui Er, Bybo)
- Watch out: Some plans limited to specific regions (e.g., tier‑1 cities only)
4. Claims Best Practices
1. Documentation Checklist
- Required Docs:
Treatment itemized list (with service codes)
Payment receipts (original invoices)
Before/after photos (required for complex treatments)
2. Optimize Reimbursement Process
- Pre‑authorization: Required for implants/orthodontics
- Direct Billing: Premium plans support insurer‑to‑clinic billing
- Fast Track: Online claims (≤¥10,000 reimbursed within 3 business days)
3. Common Claim Denial Reasons
- ❌ Treatment attempted within waiting period
- ❌ Treatment at non‑network clinic
- ❌ Cosmetic procedures (e.g., veneers)
5. 2024 Dental Insurance Trends
- Improved Orthodontic Coverage for Children: More plans extending age limit to 20
- Implant Bulk Purchasing Benefits: Reimbursement rates expected to rise to 60–70%
- AI‑Underwriting Adoption: Gum disease/mild periodontal cases may be accepted
Expert Tip: If you’re planning implants or orthodontics, buy insurance at least one year in advance!