Walk into any health insurance office in India and you'll find policies covering everything from your heart to your kidneys. Yet the one body part every Indian uses every day, our mouth, remains largely excluded from mainstream health insurance.
That omission is more than an insurance gap, it is a public health blind spot with significant economic consequences. A research published in Frontiers in Dental Medicine in 2025 revealed that the annual cost of oral diseases in India amounts to around ₹613 billion. And households carry nearly the entire cost out of pocket, one painful bill at a time.
India's health insurance market expanded rapidly after the pandemic. Millions bought retail health policies, while employer-sponsored insurance became a standard workplace benefit. Yet despite this growth, routine dental care remained outside the scope of most policies.
This stark contrast of dental benefit with the rest of the insurance market became evident when a research paper titled ‘Economic burden and economic impact of oral diseases in India: A systematic review and meta-analysis’ revealed that fewer than 15% of patients with oral diseases in India had any insurance coverage, even that offers limited protection. The same study also shed light on the plight of Indian families with nearly one in five households incurring catastrophic health expenditure, spending over 20% of their annual income on dental care. An even more harrowing reality was the finding that up to a third of patients turn to hardship financing, borrowing or selling assets.
The exclusion wasn't accidental. Insurers faced genuine challenges. Dental care is characterised by frequent, low-value claims, making fraud difficult to detect. Unlike hospital procedures, dental treatments lacked standardised coding and consistent documentation, making it hard to verify claims objectively. India's fragmented network of independent dental clinics added another layer of complexity.
{{/usCountry}}The exclusion wasn't accidental. Insurers faced genuine challenges. Dental care is characterised by frequent, low-value claims, making fraud difficult to detect. Unlike hospital procedures, dental treatments lacked standardised coding and consistent documentation, making it hard to verify claims objectively. India's fragmented network of independent dental clinics added another layer of complexity.
{{/usCountry}}The result was a vicious cycle. Without insurance, patients delayed treatment until problems became serious. Costs rose, reinforcing insurers' belief that dental care was too risky to cover.
For years, the insurance industry argued that dental care was simply too difficult to insure. That argument no longer holds. Advances in technology, standardisation and digital health care have fundamentally changed the economics of dental insurance.
Unverifiable claims laid the groundwork for the fear of fraud.
One of the biggest concerns was the inability to verify claims objectively. Today, digital radiographs, intraoral imaging and AI-powered verification allow insurers to assess claims using clinical evidence rather than judgement alone. Treatments can be validated more quickly, fraud can be detected more effectively, and claims processing has become significantly more reliable.
Standardised procedure coding and rules-based claims management are already being used successfully in regulated health care systems. These examples demonstrate that dental insurance is no longer an experimental idea, it is an operational reality.
Digital health platforms have also transformed outpatient care. Employer health programmes and insurtech platforms increasingly support digital OPD benefits, making dental care one of the most frequently accessed and valued preventive health services.
Clinical evidence reinforces the case. A study highlights that people with diabetes face a periodontitis prevalence of 42.3% compared to 31.3% among those without the condition. In a country where diabetes is a prevalent chronic disease, an uninsured mouth puts more than the mouth at risk. The same is true for many other medical conditions as dental health is directly related to our overall systemic health. Studies also show that people without dental insurance are nearly twice as likely to experience dental caries (OR 1.94), while uninsured workers also have a significantly higher prevalence of periodontal disease.
Now, the consequences are predictable: People with coverage seek preventive care early, while those without it often delay treatment until pain forces them into the clinic, when care is more complex and significantly more expensive.
Ninety-five% of a market does not stay uncovered forever. Someone closes the gap. The path forward is clear.
Regulators should establish standard dental procedure codes and encourage minimum outpatient dental coverage norms, much as Arogya Sanjeevani standardised basic health insurance. Insurers can begin with evidence-based dental riders in employer-sponsored plans, where utilisation patterns are easier to monitor, before expanding into retail products.
Employers accelerate it by pulling dental out of the perks afterthought and into the GMC discussion, since no OPD benefit gets used more. India has spent the past decade expanding access to health insurance.
The next step is ensuring that oral health is recognised as an integral part of health care. The question is no longer whether dental is insurable in India. Its which insurer will move first, and which will spend the next decade explaining why it didn't.
(The views expressed are personal)
This article is authored by Dr Manoj Rajan, co-founder & CEO, ToothLens.