What does pet insurance that covers dental actually pay?

What does “covers dental” actually cover?

Embrace’s terms, its state terms version 6, pay for treating a dental illness, above the deductible you pay yourself, up to a $1,000 sub-limit. Its help centre states the same $1,000 for each policy year, which starts again every twelve months. Embrace calls its overall ceiling the annual maximum, the most it will pay per pet in a year. Its terms say all covered benefits together cannot pass that maximum.

Read those sentences together and the $1,000 sits inside that ceiling, not beside it. That is our reading, not a line Embrace prints.

Embrace’s terms say a dental prophylaxis, meaning a cleaning, is not covered, even when done as treatment for a dental illness. Its help centre lists dental cleaning, with or without anesthesia, under routine care it does not cover. Its dental page says cleanings come back through optional wellness plans instead, which are not insurance.

Root canals have their own line, written for injuries. Embrace’s terms cover root canals and crowns after a dental injury, on the teeth they name: all adult canine teeth, the upper fourth premolars and the first molars.

What counts as a dental illness depends on the page. Embrace’s help centre names gingivitis, stomatitis and periodontal disease. Its terms name a different set, including attrition and gingival hyperplasia. Four Embrace pages carry four lists and no two match, so read any one as an example.

What would that do to a $900 dental bill?

Our tooth extraction guide puts a dental with extractions at about $900 per visit, cleaning under anesthesia and dental X-rays included. The cleaning share, about $500 in our prices, is never eligible, because Embrace excludes a cleaning outright. The plan behind every figure on this site pays back 90 cents on each eligible dollar above a $500 deductible, from the $200 to $1,000 range Embrace publishes.

That leaves the $400 of extractions, which sits under the deductible, so this visit on its own comes back with nothing. Once earlier claims have used the deductible up, the same bill returns $360 and you pay $540, which are that guide’s own figures. A cleaning by itself, about $500 in our prices, returns nothing at any point.

My dog’s mouth already has a problem. Am I too late?

For that mouth, yes. Embrace’s terms say that where dental signs such as gingivitis, meaning inflamed gums, tartar or plaque are already pre-existing, periodontal disease and dental illness stay uncovered. Coverage comes back only after the signs have had the recommended treatment and the exclusion has expired. Both have to happen, and treatment on its own is not enough.

We did not find how long that exclusion runs in Embrace’s terms, so ask.

Embrace counts a condition as pre-existing if, before the policy starts or during a waiting period, a vet gave medical advice, your dog was treated, or verifiable sources show signs or symptoms. The middle one names nobody: it asks whether your dog was treated, not who treated it.

Embrace also waits 14 days from the start date on illness claims. Its terms say conditions that occur during that wait are excluded as pre-existing, which means for the life of the policy. We found no dental wait of its own in Embrace’s terms, its dental help page or its waiting period page.

Embrace’s coverage questions page says a curable pre-existing condition could be eligible going forward if your dog goes 12 months symptom free. Its curable examples are ear infections and undiagnosed vomiting; the incurable ones are diabetes and allergies. It names no dental condition either way, so ask Embrace where your dog’s sits.

What should I ask before I buy?

We have read one insurer’s terms and the pages beside them, so we will not tell you which company to buy. Put these questions to the policy document you are comparing, and ask for the answer in writing.

• Ask whether a dental accident draws on the $1,000 or on the full annual maximum. Embrace’s help centre says dental accidents and trauma are covered up to the annual maximum, while dental illness is capped at $1,000 per policy year. Embrace’s plans page says the same. Its dental page says the opposite twice: accidents and illnesses alike, up to $1,000.
• Ask whether a broken tooth is an illness or an injury. Embrace’s plans page lists fractured teeth under dental illness, capped at $1,000 a year. Its dental page lists tooth fractures under dental injury. The two questions travel together.
• Ask for the list of dental illnesses that belongs to the policy itself. Gingivitis and periodontal disease appear on three of Embrace’s four lists, stomatitis on two, and six more conditions on one list only.

One more, if your dog is old. Embrace’s plans page says dogs up to 14 can enroll in accident and illness coverage, and dogs 15 and over in accident-only coverage. Embrace’s accident-only plan page says that plan does not cover dental illness, naming it in the list of what the plan leaves out.

We read that plan as still paying on a dental injury, and we did not find Embrace saying either way. Its terms define an illness as a change in health not caused by an injury, and its plans page covers dental injuries like any other injury. Ask before you enroll an older dog.

Is the wellness add-on the way to pay for a cleaning?

Embrace sells Wellness Rewards, and it is not insurance. You pick an annual amount, $300, $500 or $700, and Embrace says you can use the funds from day one. Only the smallest has a published price: the $300 plan costs $22.92 each month, adding up to $275 across the year.

Embrace publishes no price for the other two on the two pages we read. Embrace says the allowance has no per-item limits, and that these add-ons pay back for teeth cleanings and annual dental exams. A cleaning costs about $500 in our prices, more than the smallest allowance holds and no more than the middle one.

Two limits are worth knowing. Wellness Rewards is not sold in Rhode Island. Embrace also says using it can leave you owing fees if you end the membership before the 12-month term is up.