Using PMI for Dental Treatments Whats Possible
As an FCA-authorised broker that has helped arrange over 900,000 policies of various kinds, WeCovr knows the UK private medical insurance market inside out. A common question we hear is: "Does my health insurance cover my teeth?" The short answer is usually no, but the full story is more nuanced.
Limits on dental care, routine vs emergency cover, and dental policy add-ons
Many people are surprised to learn that standard private medical insurance (PMI) in the UK does not typically cover dental treatment. This often leads to confusion when a hefty dental bill lands on the doormat. The core purpose of PMI is to cover the diagnosis and treatment of unexpected, acute medical conditions. Routine dental care, like check-ups and fillings, is considered predictable maintenance rather than an unforeseen illness.
However, this doesn't mean you're left without options. The world of private health cover provides two main avenues for dental care:
- Limited surgical cover within a standard PMI policy.
- Comprehensive dental add-ons that can be attached to your main policy for an extra premium.
Understanding the difference between these is the key to unlocking the dental care you need and avoiding unexpected costs.
A Critical Note on Pre-existing and Chronic Conditions
Before we delve deeper, it's vital to understand a fundamental rule of UK private medical insurance. Standard PMI policies are designed for acute conditions that arise after your policy begins. They do not cover pre-existing conditions (ailments you already have or have had symptoms of) or chronic conditions (long-term illnesses like diabetes or asthma that require ongoing management). This principle also applies to most dental add-ons.
Understanding the Great Divide: Why Standard PMI Excludes Most Dental Care
Think of your private health cover as a safety net for significant, unforeseen health problems. It’s there for when you need a knee replacement, a cataract operation, or diagnostic tests for a new and worrying symptom.
Insurers view dental care differently for several reasons:
- Predictability: Most dental work is not a surprise. Regular check-ups, hygiene appointments, and even the eventual need for a filling are considered routine maintenance.
- High Frequency: Unlike major surgery, dental treatments are very common. Including them as standard would dramatically increase the price of all PMI policies.
- Distinct Specialism: Dentistry is a highly specialised field, often operating separately from mainstream hospital and specialist care.
By separating dental from core medical cover, insurers keep standard private medical insurance UK policies more affordable and focused on their primary purpose: treating acute medical illness and injury.
What Dental Cover Is Included in Standard PMI? The Exceptions to the Rule
While routine dental work is out, some major dental procedures can be covered by a standard PMI policy, but only under specific circumstances. These are almost always surgical procedures that require the expertise of a consultant maxillofacial surgeon in a hospital setting.
Examples of potentially covered treatments include:
- Surgical Removal of Impacted Wisdom Teeth: If your wisdom teeth are stuck in your jawbone (impacted) and require a complex surgical procedure under general anaesthetic in a hospital, this is often covered. A simple extraction in a dentist's chair is not.
- Jaw Surgery Following an Accident: If you suffer a facial injury in an accident that requires reconstructive surgery on your jaw, your PMI policy would likely cover it as part of your inpatient treatment.
- Treatment for Oral Cancers: Diagnosis and treatment for cancers of the mouth, tongue, or jaw fall under the oncology benefit of a comprehensive PMI policy.
- Abscesses Requiring Hospitalisation: A severe dental abscess that requires drainage in a hospital (not just at the dentist) may be covered.
Real-Life Example:
- Sarah needs a wisdom tooth removed. Her dentist says it's a simple extraction and can be done in the clinic. This is not covered by her standard PMI.
- Tom also needs a wisdom tooth removed. However, his is impacted deep in the jawbone. An oral surgeon needs to perform the procedure in a hospital under general anaesthetic. This is likely to be covered by his standard PMI.
Always check your policy documents and get pre-authorisation from your insurer before proceeding with any hospital-based dental surgery.
Bridging the Gap: Dental Insurance Add-Ons Explained
For everyday dental care, you need to look beyond a standard policy and consider a "dental add-on" or "rider". This is an optional extra that you bolt onto your core private medical insurance policy for an additional monthly premium.
These add-ons are designed to help with the costs of both routine and restorative dental work. They function like a separate mini-insurance policy just for your teeth, but are conveniently managed under your main PMI plan.
What do dental add-ons typically cover?
Cover is usually split into levels or tiers, but most will offer benefits for:
- Routine Care: Check-ups, scale and polish, X-rays, and sealant applications.
- Restorative Treatments: Fillings, root canals, crowns, bridges, and dentures.
- Dental Emergencies: Urgent treatment needed to alleviate pain, often outside of normal surgery hours.
- Accidental Injury: Repairing damage to teeth caused by an external blow (e.g., in a sports accident).
- Orthodontics (Less Common): Some higher-tier plans may contribute towards the cost of braces, but this is often limited and may have a waiting period.
These add-ons come with their own set of financial limits, which we'll explore next.
A Closer Look: Routine vs. Restorative vs. Emergency Dental Cover
To make an informed choice, you need to understand the jargon insurers use. Dental cover is almost always categorised into different types of treatment, each with its own annual limit.
| Category | What it Means | Common Examples | Typical Cover Structure |
|---|---|---|---|
| Routine / Preventative | Regular maintenance to keep your teeth and gums healthy and prevent problems. |
| Often 100% of the cost is covered, up to an annual limit (e.g., £200 per year). |
| Restorative / Treatment | Procedures to fix problems that have already occurred. |
| Usually covers a percentage of the cost (e.g., 80%), up to a higher annual limit (e.g., £750 per year). |
| Dental Emergency | Immediate treatment required to relieve severe pain. |
| Often has a separate, smaller limit (e.g., £250 per incident) for immediate care. |
| Accidental Injury | Repairing sound, natural teeth that have been damaged in an accident. |
| Typically has a high annual limit (e.g., £5,000) specifically for accident-related work. |
| Orthodontics | Straightening teeth. |
| The least common benefit. If included, it often has a lifetime limit and a long waiting period (e.g., 24 months). |
Comparing Dental Add-On Policies from Leading UK Providers
When you work with a PMI broker like WeCovr, we can help you compare the intricate details of dental add-ons from the UK's best PMI providers. While specific offerings change, the structure is often similar. Here is an illustrative comparison of what different levels of cover might look like.
| Feature | Level 1 (Basic) | Level 2 (Mid-Range) | Level 3 (Comprehensive) |
|---|---|---|---|
| Estimated Monthly Cost | £10 - £15 | £20 - £30 | £35 - £50+ |
| Overall Annual Limit | £500 | £1,000 | £1,500+ or Unlimited |
| Routine Cover | 100% up to £150 | 100% up to £250 | 100% up to £400 |
| Restorative Cover | 50% up to £350 | 75% up to £750 | 80% up to £1,100 |
| Accidental Injury | Up to £5,000 | Up to £10,000 | Up to £10,000 |
| Orthodontics | Not Covered | Not Covered | 50% up to £1,000 lifetime limit (after 24-month wait) |
| Oral Cancer Cover | Covered by core PMI | Covered by core PMI | Covered by core PMI |
| Waiting Period | 1-3 months for most treatment | 1-3 months for most treatment | Immediate cover for some benefits |
Note: These are illustrative examples. Actual costs and limits vary by provider, age, and location. Your policy excess may also apply.
Is a Standalone Dental Insurance Policy a Better Option?
You don't have to get your dental cover through your PMI provider. You can also buy a standalone dental insurance plan directly from a specialist insurer.
PMI Add-On vs. Standalone Dental Plan
| Aspect | PMI Dental Add-On | Standalone Dental Plan |
|---|---|---|
| Convenience | ✅ One provider, one monthly payment, one point of contact. | ❌ A separate policy to manage with a different provider. |
| Cost | ✅ Can sometimes be cheaper when bundled with PMI. | 🤔 Can be competitive, especially if you don't need PMI. |
| Choice | ❌ Limited to the options offered by your PMI provider. | ✅ Wider market of specialist dental insurers to choose from. |
| Underwriting | ✅ Often benefits from the same underwriting as your main policy. | ❌ Will have its own separate underwriting process and rules. |
| Flexibility | ❌ Tied to your PMI policy. If you cancel your PMI, you lose your dental cover. | ✅ Completely independent. You can keep it even if you change jobs or cancel other insurance. |
The Verdict:
- If you already have or are getting private health cover, a dental add-on is often the most convenient and streamlined option.
- If you only want dental cover and don't need full PMI, a standalone plan is the way to go.
The Financials: Understanding Costs, Limits, and Excess
Getting to grips with the numbers is essential to avoid disappointment at the claims stage.
- Premium: This is the extra monthly fee for the add-on. It's based on the level of cover you choose.
- Annual Benefit Limit: This is the maximum amount the insurer will pay out for a category of treatment (e.g., £750 for restorative) in a single policy year. Once you hit this limit, you pay for any further treatment yourself.
- Percentage of Cost Covered: For restorative treatments, insurers rarely pay 100%. They might pay 50%, 75%, or 80% of the bill. You pay the remaining "co-payment". This encourages you to be mindful of treatment costs.
- Policy Excess: This is a fixed amount you agree to pay towards your first claim(s) each year. Your dental add-on might share the same excess as your main PMI policy, or it might have a separate, smaller excess (e.g., £50).
Putting It All Together: A Financial Example Let's say you have a mid-range dental add-on with these terms:
- Restorative Cover: 75% of costs up to an annual limit of £750.
- Policy Excess: £100 per year.
You need a crown that costs £800.
- Apply the Excess: You pay the first £100 of the cost. This leaves £700.
- Apply the Co-payment: The insurer covers 75% of the remaining £700.
- Insurer pays: 0.75 * £700 = £525
- Your Share: You pay the remaining 25%.
- You pay: 0.25 * £700 = £175
- Total Cost to You: Your excess (£100) + your co-payment (£175) = £275.
- Remaining Benefit: You have used £525 of your £750 annual restorative limit, leaving £225 for any other restorative work that year.
Without the cover, you would have paid the full £800. With the cover, you paid £275, saving you £525.
The NHS and Your Teeth: What's Available for Free (and What's Not)
To decide if private dental cover is worth the cost, it helps to know what the NHS provides. However, NHS dentistry is facing a well-documented crisis. According to a 2023 House of Commons report, the number of dentists performing NHS work has fallen, and many patients struggle to find a practice accepting new NHS patients. Some estimates suggest millions are unable to get the NHS dental appointments they need.
For those who can access an NHS dentist, treatments are not free for most adults in England. Costs fall into three bands (prices are illustrative for 2025, based on projected increases).
| NHS Charge Band | Includes... | Estimated 2025 Cost (England) |
|---|---|---|
| Band 1 | Examination, diagnosis, X-rays, scale and polish (if clinically needed), preventative advice. | £26.80 |
| Band 2 | All Band 1 treatments, plus fillings, root canal work, and extractions. | £73.50 |
| Band 3 | All Band 1 & 2 treatments, plus crowns, dentures, and bridges. | £319.10 |
| Emergency | Urgent care for pain relief or temporary fillings. | £26.80 |
The Private vs. NHS Calculation:
- An NHS Band 3 treatment (e.g., a crown) costs a fixed £319.10.
- A private crown can cost £700 - £1,200.
- Your dental insurance might cost £300 a year.
If you need just one major treatment like a crown, the insurance could pay for itself. The main benefit of private care, however, is speed of access, choice of dentist, and often a wider range of cosmetic options not available on the NHS.
Dental Health and Your Overall Wellbeing
Taking care of your teeth isn't just about avoiding toothache; it's fundamental to your general health. Poor oral health is increasingly linked to serious systemic conditions.
- Heart Disease: Bacteria from gum disease (periodontitis) can enter the bloodstream, potentially causing inflammation in the blood vessels and contributing to atherosclerosis (hardening of the arteries).
- Diabetes: People with diabetes are more susceptible to gum disease, which in turn can make it harder to control blood sugar levels.
- Respiratory Infections: Bacteria from the mouth can be inhaled into the lungs, which can cause infections like pneumonia, especially in older adults.
Simple Tips for a Healthier Mouth:
- Brush Smart: Brush for two minutes, twice a day, with a fluoride toothpaste. Use an electric toothbrush for a more effective clean.
- Don't Forget the Gaps: Clean between your teeth daily using interdental brushes or floss. This is where gum disease often starts.
- Watch Your Sugar: Reduce your intake of sugary foods and drinks, especially between meals.
- Stay Hydrated: Drink plenty of water to help wash away food particles and neutralise acid.
- Don't Smoke: Smoking is a major risk factor for gum disease and oral cancer.
A holistic approach to health is key. That's why at WeCovr, we not only help you find the right insurance but also provide complimentary access to our AI-powered calorie and nutrition tracking app, CalorieHero, to all our PMI and life insurance customers. Managing your diet is a cornerstone of both your general and dental health.
How to Choose the Right Dental Cover for You
With so many variables, choosing the right level of cover can feel daunting. Here's a simple, step-by-step approach:
- Assess Your Needs: Think about your dental history. Do you just need check-ups, or are you prone to needing fillings and more complex work? Do you have children who might need orthodontics in the future?
- Check the Limits: Look closely at the annual limits for routine and restorative care. A cheap policy with a very low limit might not be good value if you need significant treatment.
- Understand the Percentages: A policy that covers 80% of costs is significantly better than one that only covers 50%, especially for expensive procedures like crowns or bridges.
- Read the Fine Print: Look for waiting periods. You might have to wait three months before you can claim for a filling, or two years for orthodontic work. Also, check for exclusions, such as cosmetic treatments like teeth whitening.
- Talk to an Expert: Navigating the maze of options from different private medical insurance UK providers is what we do best. An independent and FCA-authorised PMI broker like WeCovr can compare the whole market for you, explain the differences in plain English, and find a policy that matches your needs and budget—all at no cost to you. Our clients often praise our clear, helpful advice, which is reflected in our high customer satisfaction ratings.
Furthermore, when you purchase a PMI or life insurance policy through us, you can often benefit from discounts on other types of cover you might need, adding even more value.
Making a Claim: The Step-by-Step Process
The claims process for dental add-ons is typically straightforward, and often works on a "pay and claim back" basis.
- Visit Your Dentist: Attend your appointment and receive your treatment as normal. You can usually choose any registered UK dentist.
- Pay Your Dentist: Settle the bill for your treatment directly with the dental practice.
- Get an Itemised Receipt: This is crucial. Ensure the receipt clearly lists each treatment you received and the cost for each one.
- Complete a Claim Form: Log in to your insurer's online portal or fill out a paper claim form. You'll need to provide details of your treatment and upload or attach your itemised receipt.
- Receive Reimbursement: The insurer will assess your claim against your policy limits and benefits. They will then pay the covered amount directly into your bank account, minus any excess or co-payment.
For major procedures, it's always wise to contact your insurer for pre-authorisation to confirm the treatment is covered before you proceed.
Does private health insurance cover dental implants?
Is orthodontics (braces) covered by private medical insurance in the UK?
Can I get dental cover if I have pre-existing dental problems?
Your Next Step to a Healthier Smile
While your core private health cover is unlikely to pay for your next check-up, a dental add-on can be a cost-effective way to manage your oral health, providing peace of mind and access to prompt, high-quality private care.
The key is to match the level of cover to your personal needs. Ready to explore your options and see how affordable comprehensive cover can be?
Get a free, no-obligation quote from WeCovr today. Our expert advisors will compare the UK's leading insurers to find the perfect private medical and dental cover for you.
Related guides
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
👉 Do you want faster access to diagnostic tests and scans?
👉 Would you like private hospital accommodation and better food?
👉 Do you want to avoid the stress of NHS waiting lists?
Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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