Good dental and optical care can help you stay healthy. If you pay for private treatment, health insurance or a cash plan can help you save money. In this article, we look at the different types of blankets so you can consider your options.
How does the optical and dental cover work?
You can access the dental and optical cover in two ways. If you have decided to invest in health insurance, you can add optical and dental coverage to your policy as an additional supplement. Alternatively, you can purchase a cash plan. Health cash plans are available as standalone plans or you can add them to your health insurance.
The main difference is that you can file a claim with your health insurance and your insurance pays your dentist or optician for your treatment. With a cash plan, you pay your medical expenses upfront and claim reimbursement. Whichever you choose, you will pay a monthly or annual premium for coverage.
What are the advantages of optical and dental covers?
Optical and dental care will pay for routine dental examinations, eye tests and treatments. This means your day-to-day medical expenses are covered, so you’re more likely to book regular dental appointments and annual eye exams knowing it’s already paid for.
You’ll also be covered for dental emergencies and other procedures, meaning you won’t be hit with a big bill if you need emergency care, a major dental procedure like a crown or root canal, or glasses or contact lenses.
Are there any disadvantages of taking out optical or dental insurance?
With any health insurance, there is always a risk that you will pay more than you have spent.
Health insurance covers private appointments, which you won’t need if you’re entitled to free care because of your age or medical history, or because you’re receiving certain benefits. With a cash plan, you’ll need enough funds to pay for treatment upfront and then claim reimbursement, which can be a problem if you don’t have disposable income.
A broker can help you weigh the pros and cons and decide whether a health insurance or cash plan is right for your circumstances.
What does health insurance include with optical and dental coverage?
Insurance can cover the full range of optical care and dental treatments, from regular check-ups to treatments, glasses and hearing aids. Policies usually include specific procedures and reviews and set financial limits for each type of care. Some providers offer a cash only plan. However, let’s assume that your policy has optical or dental coverage as part of your health insurance. In this case, you will be able to schedule appointments and request care without any upfront costs.
Insurers vary in the coverage they offer, so always check your policy documents before purchasing. Here’s what you can expect in most rules.
Examinations and treatment
Most policies have an annual limit on how much you can claim for dental appointments, eye tests and medical expenses.
Dental care
Dental coverage usually includes routine dental appointments, including hygienist exams and fees, x-rays, fillings, crowns and tooth extractions.
Limits vary but are usually in the region of £250 to £300 a year for routine dental care. Some policies also apply an automatic excess of £50. This is probably enough if you only want to use your insurance for regular checkups, but if you need more significant treatment, your policy may not provide enough coverage. Private dental costs are on the rise, with a root canal costing an average of £403, which varies depending on your postcode. It’s worth checking which dentists your policy covers and what the costs of your treatment are likely to be.
Eye tests
It is essential to check that your policy covers routine eye examinations. Many do, but others only cover prescription glasses and contact lenses after your optician prescribes them.
Dental accidents
There is usually separate coverage for dental accidents and severe pain that cannot be controlled by over-the-counter medications. The limit is usually around £600. Many insurers include overseas cover for emergency treatment abroad.
Other costs
Most policies cover the cost of glasses, contact lenses and hearing aids if your policy includes hearing protection. Some conditions apply; you can only ask for replacement glasses or contact lenses if your prescription has changed since your last visit.
However, they often won’t pay for braces if your dentist prescribes them.
What exemptions apply to health insurance?
All health care has exclusions that the policy does not cover. Some are standard exclusions that the insurer applies to each client, while others depend on your medical history.
Exceptions to the rule
Health insurance is designed to provide treatment for acute conditions. This usually means that insurance does not cover anything that is considered a lifestyle choice rather than a medical necessity. Health insurance will not pay for cosmetic procedures such as teeth straightening, whitening or veneers. Laser eye surgery is also sometimes excluded from optical coverage.
Existing and chronic conditions
All health insurance policies exclude pre-existing conditions for which you have sought care or advice in the five years prior to taking out the policy. Some insurance companies make exceptions for eye tests and dental exams, but they won’t cover you if you need outpatient or inpatient treatment for a pre-existing condition.
Chronic conditions cannot be cured, but they can be managed long-term and are not covered by insurance. If you have long-term or pre-existing glaucoma, cataracts or macular degeneration, this will be excluded from cover.
What do cash plans cover?
A cash plan pays cash back to offset your regular medical expenses. You pay the monthly premium and the costs of examinations, tests and treatments before you claim reimbursement from your plan provider. Some plans also offer a fixed payment if you receive NHS care.
A cash plan usually covers eye tests, dental exams, and follow-up treatments, including glasses, contact lenses, and dentures. Some go further and include laser eye surgery and even prescription glasses and gum guards for sports use. Most plans also include emergency dental treatment.
Each plan provider offers different services, so always check your policy documents to ensure the coverage meets your needs.
Read our reviews of the best health cash plans in 2024 here.
Are there any exceptions?
One of the benefits of a cash plan is that there are often no pre-existing balance exclusions. Some eye conditions qualify you for free eye exams anyway. However, most plans have qualifying periods, which means you can’t take out a plan and immediately claim care in some categories. Qualifying periods vary, and some are based on your medical history. Sovereign Health’s plan applies a 12-month qualifying period to their optical benefits if you’ve had eye surgery.
Do cashback plans offer different levels of coverage?
Most plans offer different levels of coverage so you can tailor your plan to fit your budget. The plan level you choose gives you higher financial limits within each year. For example, if your dentist charges £238 for two routine checks and two hygienist visits a year, but your plan only pays £100 a year, you won’t be able to claim the total cost.
Coverage levels vary between three and five options, depending on your chosen provider. Some companies offer additional services, such as access to private GP appointments, helplines and member reward schemes.
Can I add a cash plan to my health insurance?
Some providers only offer opticians and dental through a cash plan when you take out health insurance. While a stand-alone plan gives you a choice of coverage levels, a plan attached to your insurance often does not. Instead, your plan will include one annual limit within each category. They may also cover 100% of your total costs in some categories, but only 80% in others. Coverage levels may also depend on the provider you choose. Vitality’s plan pays 100% of your optical costs up to £500 a year if you go to their partner, Vision Express. If you choose a different optician, this drops to 80% with a £300 limit. Great news if you’re happy to go to Vision Express, but less so if you’d rather stick with your local provider.
