What is covered by the Dental Accident, Emergency and Out of Hours Insurance cover?
Damage caused to your teeth by an accident. Dental emergencies outside of normal surgery hours. Dental emergencies when you are away from home.
Can I claim the full cost?
You can claim up to the policy limits set out in the claim form. We don’t have an excess payment like most other dental plan providers.
What is classed as an accident?
A dental injury which is caused by an unforeseen direct impact externally (extra-oral)
What is meant by a dental emergency?
A dental condition requiring urgent treatment for the relief of pain, arrest of haemorrhage, control of acute infection or that which causes a threat to your general health. This includes toothache as well as extra-oral accidents.
What is covered by emergency dental treatment?
Treatment required as a result of a dental emergency as set out in the Fees Schedule and Cover Limits – Section ___. This is treatment that is immediately and necessarily required to stabilise the oral condition.
Do I have to see my own dentist for emergency dental treatment?
Cover applies when: You are at home but the incident occurs outside hours and you are unable to access emergency arrangements at your own surgery. You are in the UK but away from home and cannot visit your own dentist. You are outside the UK.
What is out of hours cover?
You are covered under this section of the policy if a dental emergency occurs outside normal hours, treatment cannot reasonably be given during normal surgery hours, and you are unable to access emergency arrangements at your own surgery. The treatment can be carried out by a rota dentist, subject to the limits in Section 2 of the Fees Schedule and Cover Limits. Out of Hours cover allows the treating dentist to claim the cost of a call out fee if the emergency occurs outside hours and you are in the UK. Call out fees are not paid during normal surgery hours, or when a dentist is on leave as cover arrangements should be made in this circumstance.
What should I do if I am away from home?
If you are in the UK you are covered for emergency dental treatment either during normal surgery hours or after hours. Treatment can be carried out by any dentist. Treatment is subject to the limits set out in Section 2 of the Fees Schedule and Cover Limits. If you are overseas you are covered for emergency dental treatment either during normal surgery hours or after hours. You may claim up to £____ per emergency incident for any necessary temporary treatment to make you comfortable until you are able to visit your regular dentist. Emergency treatment claims must be submitted to Quality Plan NI within 30 days of the accident or emergency. Please keep any receipts provided by the dentist, for any amounts paid for emergency treatment and attach them to your claim form.
Are my teeth covered regardless of their condition?
Only teeth which are in good condition or have been adequately restored are covered under the terms of the policy. This covers your own teeth as well as any restoration of which an integral part is formed by part of the natural tooth. Crowns, bridges or similar false teeth attached to implants are also covered.
Are dentures and orthodontic appliances covered?
Removable dentures are covered for damage in the event of an extra-oral accident. This only applies whilst they are being worn. No cover applies to removable orthodontic appliances or braces or sports mouth guards.
How soon must I see a dentist after an accident?
Any damage must be apparent within 10 days of an accident and a claim form submitted to Quality Plan NI within 30 days of the accident.
How soon must I start my treatment?
Treatment must be started within 45 days of the accident. In any circumstances where this may not be possible, Quality Plan will consider the merits of each case individually.
How do I make a claim?
Request a claim form either from your dentist or from Quality Plan ( either through our website or telephone) and complete this with as much detail as possible. The completed claim form must be accompanied where necessary by, an invoice from the dentist showing the work carried out and a receipt as proof of payment. All these documents should then be sent to Quality plan NI , who will record the claim and forward it to the insurance company, PTIC ltd , whose assessors will deal with the claim. To avoid any delay in your claim being processed please make sure that all parts of the form are completed with as much information as possible.
