A complete set of teeth brings upon a better smile. With this in mind, health card holders are wondering whether their HMO will cover dental care. If you are not sure, let’s find out more about your benefits.
List of Covered Services by HMOs
Not all health cards have dental benefits for its members. In most cases, the service is a rider only if you have chosen an individual plan. Of course, we already know that for every benefit you add, the monthly or annual rates of HMO will be higher.
For those with coverage for oral health, here is the list of services that you may avail for free (included in your plan):
- Annual dental check up
- Emergency dental treatment (severe pain)
- Pasta or tooth filling for one (unlimited temporary filling for some health cards)
- Loose dental crown recementation (note that crowns and jacket are not included in the benefit)
- Dentures adjustment
- Oral prophylaxis – teeth cleaning and consultation
- Simple tooth extraction (bunot, excluding wisdom tooth surgery)
Note that the presented list is just some of the common coverage of HMOs. Some companies may have more or less than the list so you better check your policy fine print.
It is alarming that most Filipinos do not care about their oral health. According to a OneNewsPH report, 72% of Filipinos suffer from tooth decay according to DOH. This condition may lead to pain, infections and in rare occasions even death due to sepsis.
Do Health Cards Cover Dental Services?
The answer is Yes. Based on our research, most health cards have at least one type of dental coverage for their members. It can be as simple as teeth cleaning up to permanent pasta. The good news is, you can avail this benefit as part of your health plan.
What is Not Covered
In our country, it is impossible to find an HMO that considers tooth problems as an “illness”. Therefore, many of the highly specialized procedures are not covered. Root canal is not covered by HMOs. This is an expensive dental service that could reach up to Php 52,000 (with crown).
Wisdom tooth extraction and surgery is also not covered by health cards. It does not belong to simple extraction and may cost up to Php 10,000 per tooth.
As expected, no health card will cover these amounts. If there is one, you will have to wait up to the second year of membership which is only available in some companies.
Where to Avail Services?
I find it difficult to locate dental clinics accredited by HMO. It seems that the only sure way to find them is by going to a mall and inquiring with those big name clinics. For those who are not within the serviced areas, it is best to call a clinic nearby and ask whether it is accredited.
What HMO has the Best Dental Benefits?
The “best” may not be an appropriate term since each one of us has a specific preference on service and price. However, we can list some HMO companies that include reasonable benefits when it comes to oral care.
Maxicare – optional care service with unlimited temporary filling
Medicard – one time oral prophylaxis on accredited clinics
Etiqa – wide network of accredited dental clinics
Intellicare – annual prophylaxis, gum related concerns and bleeding
Final Words
Peace of mind may be the most important benefit of having a health card. You know that when it comes to medical bills, you can rely on its benefits. What’s more, additional coverage for dental care may come as a bonus so you become a satisfied member.
Personally, I did not avail of any dental benefit riders when I applied for an individual HMO. I’d rather choose the clinic where I can pay with my own money and save on recurring monthly dues.
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