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    PNB MetLife Dental Care Plan

    Individual, Non-linked, Non-Participating, Pure Risk, Health Insurance plan | App. Ref. No. 395

    Good oral/dental care may lead to overall good health as many critical diseases usually manifest first orally.  Visiting the dentist regularly might help you identify any symptoms early on and take measures to prevent any disease becoming serious.

    PNB MetLife Dental Care Plan pays fixed amounts if you undergo covered procedures at our network of dentists including the cost of oral examination and cleaning.  Now that's something to smile about.

    PNB MetLife Dental Care Plan

    A plan that secures your million dollar smile and provides financial assistance for your overall dental health.

    What you get

    What you don’t get

    Waiting Period:

    Any expenses or claims related to dental treatments during first 24 days of the coverage period shall not be payable, except any claims arising due to Accident, provided the same is covered.

    Please refer to policy terms conditions and exclusions for more details.

    Frequently Asked Questions

    Dental Plan

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    Do I need separate dental plan, if am having Health plan with me?

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    Companies offering Health plans do not necessarily provide dental coverage and mostly have in patient availability which require hospitalization. In case there is OPD offering available it might have sub limits also.

    OPD Dental Care plan is a stand-alone plan which provides fixed cost against listed benefits. For further details, please refer sales brochure

    Why should I buy Dental Insurance?

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    It is generally recognized by healthcare practitioners that oral health plays an important role in overall health.
    However, like general health care, the costs of dental care can be expensive. Dental Care can be as simple as routine clean up or fillings or root canals, tooth extractions which can be quite expensive on your pockets.
    On the other hand, dental insurance plan is low on cost and very affordable with 100% payment by Insurance for consultation and clean-ups.

     

    Plan Details

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    How can I tell if I have gingivitis or periodontitis (gum disease)?

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    Gingivitis is an inflammation of the gums whereas periodontitis refers to more advanced gum disease that involves bone loss. Many people are not aware of it as the disease is painless in the early stages. Hence, it is important to have regular dental check-ups to detect gum disease.

    If you have red and puffy gums and they bleed upon brushing, you could have gingivitis. Other signs & symptoms include bad breath, receding gums and in severe cases, you may have swollen gums filled with pus and loose teeth.

    Are dental radiographs (x-rays) safe & necessary?

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    Dental radiographs are extremely safe as the level of radiation is very low. They are essential diagnostic tools to detect hidden tooth decay & infection in the mouth.With the help of dental radiographs, dentists can visualize the structures beneath the gums.

    How do dental fillings work?

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    Dental fillings are used to restore the tooth back to its original structure before decay. Firstly, dentists will remove the decayed tooth matter. After thorough cleaning, the dentist will then restore the tooth with a dental filling material most suitable for the location of the tooth.

    What is root canal treatment?

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    Root Canal Treatment is a dental procedure to remove infected tissue in the tooth and then sealing it up to prevent re-infection. A Root Canal Treatment can save a natural tooth from being extracted.

    What happens during a surgical extraction?

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    A surgical extraction is required if the tooth is impacted and buried within the gums. In some cases, an extraction may require surgery if a root tip is broken deep inside the gums. The dentist will use a blade to make an incision in the gums to expose the bone. A dental drill is used to remove bone or cut the tooth to allow easy removal. Once the complete tooth has been removed, the dentist will suture the wound.

    What is Amalgam Fillings?

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    Is a dental filling material used to fill cavities caused by tooth decay

    What is Accidental dental treatment?

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    It is defined as medically necessary services to restore accidental damage of sound, healthy and natural tooth to most approximate pre-accident form and function.

    What is Glass Ionometer Fillings?

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    It is a flexible paste, that is used to form a tight seal between the internal tooth and surrounding environment

    What is Resin based fillings?

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    It is a dental material used for treatment of cavity

    What is Bitewing x-rays?

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    It is details of the Upper and lower teeth in one area of the mouth. X-ray shows a tooth from its crown (the exposed surface) to the level of the supporting bone.

    What is complete Series X-ray?

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    Is a survey of whole mouth consisting of 14-22 periapical and posterior bitewing images.

    What is Panoramic X-rays?

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    It is a 2-dimensional dental x-ray examination that captures the entire mouth in a single image, including the teeth, upper and lower jaws, surrounding structures and tissues

    What is Simple Extraction vs Complicated Extraction?

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    Simple Extraction means anesthetic given, after numbness set in, dentist extracts the tooth without any complications.

    Whereas, Complicated Extractions means anesthetic given, after numbness sets in, dentists perform the extraction but has difficulty in removing the tooth.

    Oral Health

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    Why is oral health important?

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    Good oral health can help prevent several serious diseases that can affect your overall health. Maintaining good oral health also improves a person's ability to eat, speak & socialize well.

    How many times a year should I have my teeth professionally cleaned?

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    Professional cleaning involves the removal of dental plaque & tartar. Dentists recommend having your teeth cleaned twice a year to maintain good oral health.

    When do I need to have my tooth extracted?

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    There are many instances in which a tooth needs to be removed. One of the most common reasons is irreparable damage due to extensive decay, severe gum disease or trauma. Another reason to remove teeth is to eliminate overcrowding.

    What are some examples of traumatic dental injuries?

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    • Fractured or chipped tooth
    • Dislodged tooth
    • Fracture of bone & displacement of teeth

    Network Details

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    What is the difference between Network and Non -Network?

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    Within network clinics, customer gets cashless services for benefits listed within Dental plans vs non-network where customer must pay for entire treatment and then claim reimbursement from the Insurance Company.

    Does Dental plan have non-network services available?

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    No, Dental plan offers customer cashless and seamless services only under chain of network providers approved by PNB MetLife.

    In case of emergency or accidents customer can avail treatment outside network and can proceed under reimbursement process.

    How many dental clinics are covered under PNB MetLife Dental Care?

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    We have 300+ clinics across Mumbai, Delhi NCR and Bangalore. Details of clinics and their address can be viewed on our website.

    Appointment Booking

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    Why do I need to book an appointment before seeking dental treatment?

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    PNB MetLife will help coordinate your appointment and will also assist to advise on your available benefits.

    How do I book an appointment?

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    To book an appointment:

    1. Go to Onsite Appointments under Appointments tab of the PNB MetLife eCard (App). 

    2.  You will be asked to provide your preferred provider (location and doctor) and two (2) options for your time availability

    3. Indicate your requested treatments. If unsure, you may request for a consultation first. An PNB MetLife representative may reach you through phonecall upon receipt of your inquiry to clarify requested treatments.

    4.  Status of your appointment request will appear on your app within 45 minutes. A notification will also be sent to your e-mail. 

    Can I book an appointment on weekends of holidays?

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    Appointments may be requested at any time but they will be processed only within the usual operating hours. See back of your eCard (App) to know more of the operating hours of PNB MetLife. 

    Can I cancel my appointment through this app?

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    For appointment cancellation, you may call our dedicated Customer Service hotline. Cancellation of appointment is currently not doable in your eCard (App).

    What happens in case of an emergency and I do not have the time to schedule an appointment?

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    For emergencies, you may opt no to book an appointment and proceed immediately to the clinic of your choice. Corresponding Emergency Dental Services Benefits will apply.

    For Emergency Palliative Treatment obtained either at an In-Network Dentist or an Out-of-Network Dentist, you will have to pay the costs first and submit the necessary claim documents to PNB MetLife for reimbursement of the expenses incurred.

    Claims Submission

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    In case I will go to an out-of-network provider for other treatments, what documents do I need to submit?

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    The required documents for filing a claim are:

    1. Dully accomplished claim form. Please check your eCard (App) My Policy > Documents for a copy of the claim form.

    2. Itemized bill/ invoice indicating the treatments received.

    3. Copy of government issued ID card.

    Once I submitted these claims via the PNB MetLife eCard (App), do I still need to mail the original documents?

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    There is no need to mail the original documents once a copy of those have already been submitted via the PNB MetLife eCard (App). 

    How to fill out the claim form?

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    1. Please fill out Section A with the policy holder’s  information and Section E for bank account details.

    2. Seek assistance from the clinic to provide you the treatment done on Section C.

    3. Ask the clinic for a Clinic Stamp, Name and Signature of attending Dentist on Section D of the claim form.

    How do I file for a reimbursement and check for the status?

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    To file a claim for treatments that you initially paid to the providers:

    1. Make sure that you have all your claim documents ready.

    2. Go to Insurance and My Claims

    3. Click Submit claim. 

    4. Attach required documents. These can be photo or files in other format like Word or PDF. 

    5. Click submit. 

    6. The status of your claim is submitted once all required documents are attached. 

    7. Go to Claims List to see the claim that was submitted and the status. Please allow 14 business days for the actual processing of your claim documents and another 14 business days for the actual remittance of claims payment for approved claims. 

    Until when can a claim be submitted?

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    Claim should be submitted at the earliest after your visit to the dentist that is not part of the PNB Metlife panel. Delay in claim submission may lead to delay in claim processing in case required documents are misplaced or are not available.

    What does each claims status mean?

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    Different Claims Status:

    1. Submitted - claim request is successfully submitted for processing.

    2. In process - PNB MetLife Claims team have started evaluating the claims request.

    3. Pending/ Information Required  - PNB MetLife Claims team need further documents or information to process your claim. At this point, "Add supporting documents" is enabled for you to attach the documents/information required by PNB MetLife. Once received, your claim will again have a status of In Process.

    4.a. Denied - Claim has been processed but is Denied. See Explanation of Payment attached on the status to view the reason for the denial.

    4.b. Approved - Claim has been processed and is Approved and is ready for payment. See Explanation of Payment attached on the status to view details of the approval. Not all treatments may be approved for payment for some reason explained din the Explanation of Payment.

    5. Settled - Approved claims will have a subsequent status of Settled to note that claim has been paid.

     

    What is allowed amount per procedure Claim’s Explanation of Payment?

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    Explanation of Payment is the detailed explanation of the result of your claims request. This also shows the explanation of why some treatments may be denied (look for Exception Codes).

    The allowed amount per procedure is the maximum payable price for the treatment. which is based on your policy's benefit schedule. Any amount above the policy benefit schedule will be payable by you, the customer. 

    Disclaimer:

    PNB MetLife Dental Care Plan is an Individual, Non-linked, Non-Participating, Pure Risk, Health Insurance plan. PNB MetLife – Dental Care Plan proposal, Application Ref. no. 395 approved by IRDAI on an experiment basis under the Regulatory Sandbox approach, with validity of six months till Nov 14, 2022, unless otherwise extended with approval of the IRDAI. PNB MetLife reserves right to discontinue offering these services at any time at their own discretion once the experiment is complete or on earlier termination or withdrawal thereof. However, this will not have any bearing on the services opted for during validity period. *Limited Period Benefi­ts T&C Apply.
     
    For more details on risk factors, terms and conditions please read this Sales brochure carefully before concluding any sale. This product brochure is only indicative of terms, conditions, warranties, and exceptions contained in the insurance policy. The detailed Terms and Conditions are contained in the Policy Document. #Tax bene­fits are as per the Income Tax Act, 1961, & are subject to amendments made thereto from time to time. Please consult your tax consultant for more details. Goods and Services Tax (GST) shall be levied as per prevailing tax laws which are subject to change from time to time.

    AD-F/2022-23/062

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    Disclaimer

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    As your trusted life insurance partner, PNB MetLife is with you amidst the current COVID-19 outbreak. Our policies also cover COVID-19 Claims. In case of a Death Claim, kindly submit the signed Claim Intimation Letter mentioning the policy number, brief of the insured event and other claim documents on the email mentioned herewith. Please write-in to us at claimshelpdesk@pnbmetlife.com or indiaservice@pnbmetlife.co.in. You can also call us on 1800-425-6969 for death claims intimations and for any queries on Monday - Saturday between 10:00 am - 7:00 pm.

    PNB MetLife Insurance, amongst the trusted Life Insurance companies in India, aims to provide a wide range of Life Insurance products that suits the needs of an individual at every stage of his life. Life Insurance Plans range from Term Life Insurance PlansTerm PlanProtection PlansLong Term Savings Plans , Retirement Plans & Child Education Plan.

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