What´s not covered in my dental insurance policy?
As with all insurance policies, there are certain things that are not covered. Providental specifically excludes the following list which is a summary only.
For a full list of exclusions please see ´What is not covered´ in A Guide to Your Policy.
- Any treatment undertaken or completed prior to joining the plan, or within the qualifying period.
- Any conditions/injuries you had when you took out the plan (pre-existing conditions). This does not apply to check-ups, hygienist, general and restorative treatment.
- Oral cancers diagnosed or for which symptoms or signs develop within the first 90 days of cover (90 day deferment period).
- Cosmetic and aesthetic treatment, implants or treatment that is not clinically necessary.
- Chronic conditions (which are long-term illnesses that lead to long-term monitoring or management) and chronic periodontal disease.
- Restorative treatment associated with material dental neglect under the Dental Injury or Oral Cancer benefits.
- Any claims submitted more than 6 months after the treatment took place.
Where do I find full details of my dental cover?
Does the plan cover cosmetic dental treatment?
No - cosmetic & orthodontic treatment are not covered by the scheme.
What dentists are covered by the dental plan?
Dentists registered with the General Dental Council. The dentist must not be related to you/the patient or recommended by a dentist who is a member of your/the patient´s family. Your dentist will be able to tell you if they are registered or you can check the General Dental Council register via their website http://www.gdc-uk.net/searchregister/
How is the £250 benefit assigned on level two cover?
On level two the maximum amount you can claim is £250 for check-ups, hygienist, fillings, crowns, bridges etc., these must be provided by a UK registered dentist or dental hygienst.
Under what benefit are crowns and bridgework covered?
It covers crowns and bridgework under the restorative treatment benefit. Under level one NHS charges are met in full and on level two WPA pays 75% of costs up to £250 per year. If you require dental treatment as a result of an injury, your claim will be paid in line with WPA´s Dental Insurance Injuries benefit and dental insurance fees schedule, see the dental schedule in A Guide to Your Policy. Providental is not a fully comprehensive dental insurance plan.
How does the 75% cash reimbursement work on level two cover?
This applies to check-ups, hygienist, general or restorative treatment (level two only) and the dental emergencies benefit (level one and two). You visit the dentist for treatment and pay for your treatment in full. Complete a dental insurance claim form with receipts and proof of payment and WPA will reimburse you 75% of this cost up to the maximum annual benefit. e.g. if a dental bill is for £120 you pay the dentist £120, send us the dental bill and we will then pay you £90. Note that eligible oral cancer and dental injuries claims will be reimbursed in full and within the benefit limits.
How do I claim on my dental insurance policy?
Once you have had dental treatment you should pay the dentist in full. Visit www.wpa.org.uk/claim to download a pre-populated dental insurance claim form. Complete this claim form and return by post attaching the original receipt within 6 months of your treatment. Reimbursement of eligible dental plan claims can be made by cheque or direct credit to your bank account.
What is the maximum joining age for dental cover?
For our individual dental insurance plans, the maximum joining age is 65. Upon joining you may continue to renew your plan thereafter.
Can I have my amalgam fillings changed to white if there is nothing wrong with them?
No because Providental does not cover cosmetic treatment and only provides cover for treatment that is clinically necessary.
On level one if my NHS dentist offers treatment outside the NHS costs, will it be covered?
Level one only reimburses NHS treatment costs. Always check with your dentist as even an NHS dentist may offer treatment that is not covered by the NHS (and we would not reimburse it).