Worldwide, insuring dental treatment is a complex and somewhat enigmatic issue. The reason for this is that the science of dentistry has blurred the lines between health-related treatments and lifestyle related treatments.
Consequently, determining dental risk is no longer a purely actuarial matter. The clinical element of dentistry is critical in this process in order to distinguish insurable ‘healthcare’ from uninsurable ‘lifestyle needs’ and this makes the insuring of dental treatment – be it private insurance, medical aid or state-sponsored cover – very difficult.
Like medical science, dental science has also grown far more rapidly than the economies of the world. The return on investment on new dental products, new equipment and new treatment techniques has to be sought from the ultimate end user – the patient, the insured. This makes dentistry very expensive and forces actuaries and underwriters to increase premiums at rates significantly above inflation.
However, these factors do not change the reality that the oral cavity is an integral part of the human body. Oral health is directly related to general health and there are many well-documented clinical links between oral conditions and other systemic conditions. These could include periodontitis and sub-bacterial endocarditis (a potentially fatal condition), impacted wisdom teeth left untreated often result in osteomyelitis (an infection of the bone) and untreated gingivitis can result in Vincent’s Angina. There are many such clinical links.
Suffice it to say then, that, health cover without oral health cover is incomplete cover.
A review of medical schemes in South Africa will reveal what is evident around the world: a tendency to cut ‘dental’ cover as a whole because of the inability to distinguish between health needs and lifestyle needs.
Many ingenious benefit mechanisms have been concocted by medical schemes with the sole purpose of transferring risk of oral care back to the insured. The much-promoted medical savings account is one such example, but the reality is that savings accounts offer no insurance benefit to the medical scheme member. Other mechanisms such as thresholds achieve much the same thing.
Dental insurance, a new phenomenon in South Africa, is one solution that goes to the heart of the health/lifestyle issue as it provides clearly stated benefits. The insurance is sustainable and inexpensive because it is not based on treatment, but rather on clinical conditions.
As the affordability of “full cover” medical schemes recedes, many South Africans will be looking to cover their health risk in a more affordable way. Stated benefit health insurance will provide flexible and affordable day-to-day cover and is likely to grow in popularity.
With more than 1 million lives under management and with operations in the United Kingdom, South Africa and Sweden, Denis is one of the world’s leading dental claims administrators. Denis has pioneered dental insurance management and offers a bespoke range of solutions and services to medical schemes and insurance companies
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