DeCare's dental insurance policies are comprehensive and each member is covered according to his/her specific plan. Like any insurance policy, members can only be paid for services that are specified on their plan. Therefore, before embarking on any dental treatment, check your policy or call our customer service team on 094 9372277 to ensure that you are fully covered.

Who to contact if you have a query?
For Claims Information contact Vhi DeCare Dental's dedicated claims team in Claremorris on 094 9372277 from Monday to Thursday 8.30am to 5pm and Friday 8.30am to 4pm.

Alternatively write to Vhi DeCare Dental, IDA Business Park, Claremorris, Co.Mayo.

For all other information in relation to the administration of policies, please contact us on 1850 44 44 44 or email info@vhi.ie.

The DeCare claim form
DeCare holds a contract with the patient to pay claims according to the terms and conditions in the benefit rules booklet. Patients are required to provide details of their specific treatments to claim their insurance and we will need details from you to do so.

Each tooth is insured separately - therefore to process claims as quickly as possible to members, specific information on each treatment received is required. For example, for Dentures, Bridges and Implant Crowns the extraction date for the tooth or teeth that are being replaced is required.

Below are the requirements to process a claim

• Completed claim form
• Itemised receipt
• Bank account details for direct payment
• Date of service and fee for the dental services
• Fillings - identify which tooth and surfaces were treated
• Upon receipt of this information, claims will be processed within 10 working days

Will a receipt suffice for patients to make a claim?
All payments to dentists need to be validated with a receipt but additional information is required, such as surfaces and relevant fees in order to pay in line with particular conditions in the policy (such as frequency rules).

If a dentist does not wish to fill out a claim form, patients can be provided with an itemised receipt, as long as this receipt contains all of the information that is required in the claim form.

What is a clinical record and why are they sometimes required?
A clinical record contains the date, diagnosis and treatment notes of every time the patient attends a dental surgery, with full details of the treatment carried out on the tooth in question. It contains clinical findings in relation to each treatment received.

Clinical records may be requested by us in support of dental claims to allow us to process the claim in accordance with the terms and conditions of the policy. There are only some instances in which we require a clinical record, which include:

• High cost claims
• Audit purposes
• Inconsistent information
• Cannot determine why crowns are placed
• Conflicting information given over the phone

Some reasons why claims may not be paid
Although DeCare pays out on over 95% of all claims, claims are sometimes made which are not eligible for payment. They include:

• Wait period - all plans have an initial waiting period from date of subscription to ensure a fair insurance process for all applicants - ask your patient to check that their waiting period has expired before embarking on any major insured treatment
• Frequency / age limitations - each policy is different but frequency restrictions may apply, for example certain cleanings covered 2 times per 12-month period, crowns 1 per tooth per 5-year period etc.
• Age Limitations - again, each policy is different but age limitations may apply in some cases - sealants covered for eligible children up to the age of 16, ortho to the age of 18 etc
• Bridge replacing a denture
• Crowns when they are not placed due to decay/fracture
• Non-covered services, e.g. veneers, mouth guards, tooth whitening
• Eligibility - services performed before coverage started
• Surgical procedures - restrictions apply for oral surgery services, including surgical removal of impacted teeth, or repositioning of teeth
• Temporary procedures