dental care add-on
Start
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condensing dental coverage
Dental coverage is being streamlined by removing routine dental cleanings from the Preventative Plus Care add-on and consolidating all dental-related coverage under the new Dental Care add-on. This add-on will function similiarly to the current Dental Illness add-on but with several key enhancements:
- The Dental Care add-on will have a $1,000 annual limit
- The coinsurance will be applied but claims are not subject to the annual deductible
- Coverage of pre-existing dental-related conditions will be allowed
- Dental cleanings will be eligible for coverage regardless of dental disease grade
- The Dental Care add-on is not subject to any waiting period. That means coverage is effective the day of the policy effective date.
Next
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Dental claim processing guidelines
Since the Dental Care add-on covers all dental-related conditions, including if the pet has a pre-existing dental illness, and there are no waiting periods, dental illness-related claims have been exponentially simplified.
- We do not need to obtain medical records to determine the *disease type or if it's eligible for coverage. There are no coverage restrictions.
- We do not need to ensure that the policyholder followed **timely recommendations to have dental care performed.
In short, dental illness claims with the Dental Care add-on are eligible for coverage as long as they within their policy period.
**Timely Recs - More Information
Important
*Disease Type - More Information
Next
Click the headphones for an audio reading of this page
Rapid fire Q&A
Q: If the pet has pre-existing resorptive lesions, will we really cover their treatment (dental cleaning, extractions, etc.) with the Dental Care add-on? A: Yes! It would be covered up until the add-on limit of $1,000. Q: If the vet recommended a dental cleaning 12 months ago and now the pet has significant dental disease, will that be covered if they have the Dental Care add-on? Or would it be denied due to adequate care/preventable conditions? A: We will not assess whether the policyholder followed their veterinarian’s recommendations. As long as the condition is eligible under the Dental Care add-on, both the dental cleaning and any related treatment for the dental illness would be covered, regardless of how much time has passed since the cleaning was recommended. Q: When do medical records need to be collected for dental-related claims? A: If they have the Dental Care add-on, never. Q: When performing a medical record review (MRR), do we need to list periodontal disease in the medical timeline and pre-existing conditions table? A: Yes. Since we will still be following the historal claim processing guidelines for the Dental Illness and Preventative Plus add-ons, periodontal disease and other dental-related illnesses must still be documented if found during an MRR.
End
Click the headphones for an audio reading of this page
Timely Recommedations
Due to us covering a dental-related illness regardless if it's pre-existing or not, whether or not a policyholder followed timely recommendations to receive treatment becomes a moot point. As such, we will not be checking medical records to ensure the policyholder followed recommendations to have a dental done within a certain amount of time in order for the claim to be eligible for coverage.
Disease Type
Click the headphones for an audio reading of this page
What is classified as a dental illness has not changed. This still includes, but is not limited to:
- Periodontal disease (dental disease)
- Gingivitis, plaque, tartar
- Malocclusion
- Resorptive lesions (FORLs)
- Stomatitis
- CUPs
- Base narrow canines
- Carious lesions (cavities)
Teeth that are fractured due to an accident are still eligible for coverage under the base A&I policy. Confirmed immune-mediated stomatitis is still eligible for coverage under the base A&I policy.
Click the headphones for an audio reading of this page
Important
The claim processing guidelines in this course are ONLY for the new Dental Care add-on. If the pet has the Dental Illness add-on or the Preventative Plus add-on, the historical claim processing guidelines must still be adhered to. These old add-ons will be eventually phased out completely, but it will take some time as the Dental Care add-on is rolled out to each state and the other add-ons sunset. When in doubt, please refer back to Guru.
OB Dental Care Add-On Updates
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Created on March 21, 2026
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Transcript
dental care add-on
Start
Click the headphones for an audio reading of this page
condensing dental coverage
Dental coverage is being streamlined by removing routine dental cleanings from the Preventative Plus Care add-on and consolidating all dental-related coverage under the new Dental Care add-on. This add-on will function similiarly to the current Dental Illness add-on but with several key enhancements:
Next
Click the headphones for an audio reading of this page
Dental claim processing guidelines
Since the Dental Care add-on covers all dental-related conditions, including if the pet has a pre-existing dental illness, and there are no waiting periods, dental illness-related claims have been exponentially simplified.
- We do not need to obtain medical records to determine the *disease type or if it's eligible for coverage. There are no coverage restrictions.
- We do not need to ensure that the policyholder followed **timely recommendations to have dental care performed.
In short, dental illness claims with the Dental Care add-on are eligible for coverage as long as they within their policy period.**Timely Recs - More Information
Important
*Disease Type - More Information
Next
Click the headphones for an audio reading of this page
Rapid fire Q&A
Q: If the pet has pre-existing resorptive lesions, will we really cover their treatment (dental cleaning, extractions, etc.) with the Dental Care add-on? A: Yes! It would be covered up until the add-on limit of $1,000. Q: If the vet recommended a dental cleaning 12 months ago and now the pet has significant dental disease, will that be covered if they have the Dental Care add-on? Or would it be denied due to adequate care/preventable conditions? A: We will not assess whether the policyholder followed their veterinarian’s recommendations. As long as the condition is eligible under the Dental Care add-on, both the dental cleaning and any related treatment for the dental illness would be covered, regardless of how much time has passed since the cleaning was recommended. Q: When do medical records need to be collected for dental-related claims? A: If they have the Dental Care add-on, never. Q: When performing a medical record review (MRR), do we need to list periodontal disease in the medical timeline and pre-existing conditions table? A: Yes. Since we will still be following the historal claim processing guidelines for the Dental Illness and Preventative Plus add-ons, periodontal disease and other dental-related illnesses must still be documented if found during an MRR.
End
Click the headphones for an audio reading of this page
Timely Recommedations
Due to us covering a dental-related illness regardless if it's pre-existing or not, whether or not a policyholder followed timely recommendations to receive treatment becomes a moot point. As such, we will not be checking medical records to ensure the policyholder followed recommendations to have a dental done within a certain amount of time in order for the claim to be eligible for coverage.
Disease Type
Click the headphones for an audio reading of this page
What is classified as a dental illness has not changed. This still includes, but is not limited to:
- Periodontal disease (dental disease)
- Gingivitis, plaque, tartar
- Malocclusion
- Resorptive lesions (FORLs)
- Stomatitis
- CUPs
- Base narrow canines
- Carious lesions (cavities)
Teeth that are fractured due to an accident are still eligible for coverage under the base A&I policy. Confirmed immune-mediated stomatitis is still eligible for coverage under the base A&I policy.Click the headphones for an audio reading of this page
Important
The claim processing guidelines in this course are ONLY for the new Dental Care add-on. If the pet has the Dental Illness add-on or the Preventative Plus add-on, the historical claim processing guidelines must still be adhered to. These old add-ons will be eventually phased out completely, but it will take some time as the Dental Care add-on is rolled out to each state and the other add-ons sunset. When in doubt, please refer back to Guru.