Frequently asked questions

TERMS OF INSURANCE CONTRACT

What is the purpose of insurance?

Insurance is a tool to protect against financial loss. In accordance with the principle of insurance and on the basis of mutual assistance, persons seeking to avoid the realization of a certain similar risk collect their funds at the insurer so that some of them receive insurance benefits in the event of a negative consequence. Thus, the principle of insurance is the distribution of the damages (claims) between a large number of persons carrying the same risk.

Why should I join dental insurance?

Dental insurance, like any other insurance, is to prevent and diminish your potential risks. In the case of dental insurance, these risks are the dental costs that you may incur in the future.

Which procedures are reimbursed by dental insurance?

All procedures listed in Annex A of the terms and conditions of your dental health insurance contract are reimbursable by the dental health insurance.

How long is the insurance period?

The insurance period is 1 year. The dental insurance contract is concluded for an indefinite period and is renewed on the date of renewal of the insurance contract for the next 12 months if the insurer or policyholder has not expressed a wish to terminate the contract by notifying 1 month before the end of the current insurance period.

What is qualifying (waiting) period?

Qualifying (waiting) period is a period between the policy commencement date and the point at which insurer will reimburse claims for dental treatment.  Qualifying periods do not apply in case of emergency and accident treatment or upon renewal of the policy.

Do I have to go to a certain dental clinic to get dental insurance cover?

No you dont have to. For dental isurance cover you can receive treatment in your favorite clinic or, if necessary, receive treatment in any dental clinic in Estonia, or in case of an accident, in a dental clinic abroad.

Would dental insurance compensate the filling of my teeth?

If you have joined to insurance and your dentist is doing filling during the waiting period then insurance would not cover this treatment. Insuranceance would cover your fillings made after waiting period.

Are cleaning/polishing/covering with protective varnish covered by the dental insurance?

No, these procedures are so-called beauty or cosmetic procedures which are excluded by dental insurance terms. Dental insurance is covering real dental treatment procedures up to certain benefit level.

Can I change the insurance benefit plan?

The benefit plan cannot be changed during the insurance period. This can only be changed when the insurance contract is renewed for a new insurance period.

Which insurance contract terms and conditions apply to me?

The terms and conditions of the insurance contract that were in force at the moment of joining your dental insurance insurance apply to you. The insurance period is 1 year and the terms and conditions of your insurance contract are also valid for 1 year, even if the insurer issues adjusted or amended insurance terms and conditions during your insurance period. The version of the terms and conditions of the insurance contract valid for you (HRK-2, HRK-3 or HRK-4) is stated in your insurance policy document.

What is the reference price or sum insured per treatment procedure?

This is the maximum amount that can be reimbursed by the insurance per procedure. If it happens that the price of treatment is lower on the dental invoice, the insurance will reimburse you for the price of the dental clinic. If the price of the treatment is higher on the dental invoice, the insurance will only reimburse you for the reference price or sum insured per procedure indicated in Annex A to the insurance contract.

JOINING TO DENTAL INSURANCE

To join to dental insurance do I need to provide status of my teeth?

No, you don’t have to provide it. Dental health insurance can be taken out by anyone between the ages of 21 and 70, regardless of the current condition of the teeth, but the insurance does not apply to the replacement of teeth that were extracted before the date of the insurance period, on that date or removed during the waiting period.

Can I join to dental insurance if tooth/some teeth has been removed?

Yes, you can but dental insurance would not cover the replacement of that tooth or these teeth with the implant, bridge or denture.

Can I join insurance immediately or I need to wait for the offer first?

You can join immediately by selecting the appropriate insurance benefit plan (bronze, silver or gold) and the appropriate payment method (in parts 3, 6 or 12) and confirming your choice by clicking on the link “JOIN AND PAY” on home page.

Can I terminate the policy?

You can terminate the insurance contract only by giving at least 1 month’s notice at the end of the current insurance period, taking into account that the contract expires on the end date of the insurance period.

CLAIMS

How important is the number of the tooth treated on the invoice?

It is very important that the claims handler can follow the indemnity rules established in the terms and conditions of the insurance contract (eg 1 filling per tooth). If the invoice that you submit to the Insurer does not have a tooth number (or a tooth formula), the claims handler will ask you to submit a medical card (Ravikaart) with a tooth number. The dentist can also write the tooth number on the invoice by hand.

Do I have to submit invoices to the claims handler during the waiting period?

Yes, it is recommended. By doing it the claims handler has an overview of the treatments performed on the different teeth, which may be necessary information for reimbursing your invoices after the waiting period.

How long does it take to handle claims?

Handling of claims can take up to 3 weeks. Completion of your claims will be confirmed by a indemnity notification sent to your e – mail address. The insurance indemnity will be paid to your bank account within 5 working days from the receipt of Notice of claim payment.

Why do I need to register on the insurance portal?

Upon joining the dental insurance you submitted your insurance application to the insurer through the website www.hambaravikindlustus.ee. of the insurance broker who is a distributor of the dental insurance. The claim portal is managed by the claims adminsitrator – Denis Europe OÜ – which is a company dealing with insured events authorized by the insurer. When you join the insurance, your data is synchronized with the database of the claims administrator. By registering as a user of the claims portal, you confirm that you are a policyholder and that you have the right to enter this portal to submit the claims and receive compensation.

How insurance indemnity is paid out?

In order to receive the insurance indemnity payment, you must enter your IBAN account number in to the claims portal. Make sure that the IBAN account number belongs to you and that it is entered without errors. Otherwise, the insurance indemnity payment will not reach to you. The insurance indemnity will be paid to your bank account within 5 working days from the receipt of the Notice of claim payment.

Why is a claim submission form necessary?

The claim submission form is necessary for faster processing of your claims.
This form allows the claims handler to understand the information on your dental invoice correctly and faster.

Why is it necessary to pre-authorize certain treatments?

As you are entitled to a deductible from the sum insured per procedure in case of major treatments, in first place it is beneficial for you to get to know which services and to what extent are subject to reimbursement. With this information, you can either 1) negotiate the price of the treatment with your dentist, or b) find an alternative dental clinic that is willing to offer a better price. Both you and the insurer will benefit from one or the other.