Dental Insurance
High-end medical insurance: dental coverage
High-end medical insurance is a type of medical expense coverage that offers high-limit protection, access to premium medical resources, and direct billing services. It goes beyond the restrictions of national health insurance and provides extensive coverage. Depending on the plan or package, high-end medical insurance may include dental benefits. Dental benefits are available in both group high-end medical insurance (group plans) for companies and individual high-end medical insurance sold to private individuals. Group plans are typically paid for by companies and offered as a benefit to employees, helping to enhance the company’s attractiveness.
To clearly explain the claims process, here is a hypothetical example:
In Qingdao, Company A purchased high-end medical insurance with dental benefits for its employees from Cigna & CMB. Li Ming, an employee of Company A, received an insurance card from HR in April 2019. The policy year runs from April 18, 2019, to April 18, 2020. On May 4, 2019, Li Ming suddenly had a toothache and remembered his Cigna & CMB dental insurance. He searched the Cigna & CMB provider directory for the nearest contracted dental clinic and found Paul Dental. He called and made an appointment for 2:00 PM that same day. At 2:00 PM, Li Ming arrived at Paul Dental with his insurance card and ID. The front desk made copies of his documents, called Cigna & CMB’s customer service to confirm his dental benefits, and informed Li Ming before treatment began.
Li Ming’s dental benefits are as follows:
1. Annual dental insurance reimbursement limit: 6,000 RMB – any dental treatment costs exceeding 6,000 RMB must be borne by the patient.
2. Preventive and basic dental treatments (including exams, X-rays, fillings, cleanings, extractions, and wisdom tooth extractions) are covered at 100%.
3. Major treatments (root canals, crowns, inlays, night guards, space maintainers) and orthodontics (for all ages) are covered at 50%.
4. Two cleanings and comprehensive exams per year.
5. Unlimited X-rays.
6. No deductible. (If Li Ming’s total cost for this visit were 700 RMB and he had a 300 RMB deductible, he would need to pay 300 RMB out of pocket before the remaining 400 RMB could be claimed.)
7. Cosmetic dental procedures are not covered.
At the time of the customer service call, Li Ming had not yet used any dental benefits for the policy year, so his remaining balance was 6,000 RMB.
At 3:00 PM, the treatment ended. The front desk calculated his costs based on his benefits, as follows: Exam: 50 RMB; X-rays: 20 RMB; Root canal: 500 RMB. The total came to 570 RMB. The exam and X-rays, totaling 70 RMB, fall under preventive care and are fully covered by the insurer. The root canal treatment, costing 500 RMB, falls under major treatments, with the insurer and Li Ming each paying 50%. Therefore, Li Ming’s out-of-pocket cost is 250 RMB. Li Ming pays Paulo Dental 250 RMB for the visit, and the remaining 320 RMB (570 – 250) is directly billed to Cigna & CMB (well within the 6,000 RMB limit). Thanks to his dental insurance, Li Ming saved 320 RMB on this visit. He signs the claim form and schedules his next cleaning (since cleanings are covered at 100%, Li Ming is happy to take advantage of this benefit to take care of his teeth).
Some high-end medical insurance plans may not include a standalone dental benefit but often include coverage for dental injuries resulting from an accident. If a dental injury occurs, patients can visit Paulo Dental and receive priority treatment for emergencies and direct billing.
Currently, Paul Dental in Qingdao is part of the direct billing network of four international medical insurance providers: Cigna & CMB, MSH China, GBG, and Generali China. If you are considering purchasing high-end medical insurance with dental coverage for your employees or family members, please feel free to contact our front desk. We will connect you with the local Qingdao representative for the relevant insurance provider.