Expert of the day: Gary Rycroft on your dental plan rights

The lockdown has dramatically changed the complaints, issues and queries people contact Resolver for help with. One of the interesting trends we’ve spotted was the rise in people seeking help with dental health insurance policies and credit agreements.

From refunds to rights, often the answers can be found in your contracts. Here’s our regular legal expert from the TV, Gary Rycroft, for his guide to all things dental.

Dental health insurance and capitation plans

There are two main types of standalone dental insurance policy – one which covers the cost of NHS treatment and one which covers a certain level of private treatment. In both cases, usually only routine and emergency treatment is covered.

Cosmetic treatments would usually not be covered. Under these two plans you would still pay your dentist but then claim back from your insurer.

Dental health insurance policies often come in varying forms (the ‘silver, gold’ platinum’ types of cover that pay out more the more you pay). You can also have a policy for you and a partner or have a dental plan as part of your in-work benefits.

A different arrangement is to get cover through your dentist. These plans are called ‘capitation’ plans. Here, the dental insurance plan spreads the cost of treatment over 12 months. The insurance companies say they collect the premiums on behalf of the dentists and for many dentists this regular income is a major part of what they rely on to keep their practices afloat. Around 80% of those with dental insurance have one of these plans.

Like insurance policies, capitation plans tend to be renewed on an annual basis – and what you pay will depend on what work your dentist thinks you will need to be routinely done to your teeth that year.

Refunds and contracts

By far the biggest enquiry we’re hearing from people is about refunds. In particular, as dental surgeries were closed for a considerable period over lockdown – and it’s still hard to get an appointment now with limitations on some treatments too – can people get a partial refund or leave their policies early?

Providers of standalone dental insurance are unlikely to offer you a ‘Covid-19 refund’ as they will say you are still covered, and the policy is not explicitly linked to expected routine treatment. It doesn’t hurt to ask though and I’ve heard of insurers offering smaller refunds to reflect that treatment couldn’t be offered, or even offering partial refunds. However, it’s not a legal obligation.

Capitation plans are different. During Covid-19 and the lockdown, the fact that routine dental treatment was not available from 23 March 2020 to 8 June 2020 (at the earliest – some dentists have still not reopened) means treatment which was budgeted for in the capitation plan may well not have happened. Certainly most people who routinely have two dental check-ups a year are likely to just get one.

Accordingly, some organisations that ‘manage’ the plans or take payments are saying patients should contact their dentists to ask for a part refund, though there is no obligation to give one.

As a patient you should remember even though you have not been able to access routine treatment during the ‘full lockdown’ you have had cover for emergency and urgent care should the need have arisen. At the very least, patients need to speak to their individual dentists, and likewise dentists need to communicate openly and transparently, about whether the treatment for the year intended to be covered by the payment plan will be fulfilled.

There is no absolute legal right to a refund, but it would be poor customer service not to address your concerns. If it becomes clear that for whatever reason you will not be seen by your dentist at all during the 12-month period of the plan, you could argue ‘frustration’ of contract and ask for a full refund.

Frustration of contract is a useful legal argument in many situations like this (check out my caravan park refund guide). Put simply, it means the contract to which you’ve signed up has not been delivered, or ‘frustrated’ – therefore you are seeking recompense.

Can I negotiate?

Many of the people I’ve spoken to tell me they’ve hit a brick wall when it comes to refunds. But remember: you will soon be potentially negotiating the capitation plan for the next year, so maybe asking for a reduction or freeze of the payment plan may be the way forward.

Like everyone else dentists will be worried about an uncertain economic future, so you would like to think they would want to keep you as a patient – which means treating you fairly is in their interest as much as yours. We have heard of some dentists going out of business and certainly the ones who offer the best customer service are likely the ones which have the best chance of survival.

What if I want to cancel my contract mid-term?

If you have a standalone policy by law you can cancel it in full up to 14 days after taking it out and receive a full refund, that is unless you have had treatment in that time frame. Under a ‘capitation’ plan you may stop paying whenever you want (sometimes there may be a 30-day notice period) but clearly once that happens you will not be covered and to get cover again may be expensive.

I’ve been furloughed – am I still covered by the dental or health policy that comes with my benefits from my employer?

If you are fortunate enough to have dental or wider health insurance with your employer, these benefits should continue in full even if you are furloughed. While furloughed you are still fully employed and for instance are also accruing holiday entitlements and other employee benefits which are part of your employment contract.

Do I really need dental health insurance or plans?

Only you can answer this for yourself and your family. However, more challenging times financially mean any ‘discretionary’ spending should be scrutinised. The NHS still offers dental treatment – albeit not free for everyone. If it is big one-off bills you are worried about, then ‘self-insuring’ by putting money aside each month into a designated account for dental and health treatment may work for you just as well, and be more cost effective, than a yearly plan.

Gary Rycroft is a legal expert on a range of primetime TV and radio programmes. For help with dental plans use Resolver – if your insurer or capitation plan isn’t listed on the site, tell us to add them.