Employees nowadays are very much particular about the kind of benefits that they are offered. Dental insurance is one employee benefit that is considered to be very important in an employee’s overall health plan. Employers are aware that dental problems can mean financial loss.
Dental problems and their treatments are low risk compared to almost all other health conditions. This is the reason why offering a dental plan to your employees is a sound decision. Dental health concerns can often be prevented through prophylaxis and only involve minimal costs. Once a dental problem is diagnosed in its early stage, treatment can immediately be administered. Early treatment is considerably less expensive than treatment during advanced stages. Financial factors are important considerations when deciding on which health benefits are to be included in your employees health plans. Dental insurance plans are the most cost effective of all the health benefits plan.
How to Choose the Right Dental Insurance Plan
There are a lot of factors to be considered when choosing a dental insurance. But before we go through these factors let us first discuss in detail what a dental insurance plan is. A dental insurance plan is an agreement between a company and an insurance provider. This agreement is comprised of several details pertaining to the benefits that a company’s employees will receive.
There are dental insurance companies that give partial reimbursements for dental expenses and exclude certain types of treatments in their plans. A company looking a dental insurance company should carefully sift through all the offers that they receive from various companies to find one that will best benefit their employees. Choosing a dental insurance provider is similar to finding the right dentist for you and your family. You have to consider several options before deciding on one that best suits your needs and provides the best services.
A lot of plans do not cover dental conditions that have been existent before insurance coverage was purchased. There are also plans that do not cover implants and other procedures. These conditions may mean that dental treatment may only be paid partially or an insurance parlance may be availed for the Lease Expensive Alternative Treatment (LEAT).
Dental insurance companies have their own way of determining the UCR level (usual, customary, and reasonable) for each geographical area. Companies operating within the same geographical area may not necessarily have the same UCR level. This means that the UCR level defines a patient’s liability because in some plans a patient may receive more benefits while in another plan he may have to pay more. This all depends on the type of dental plan that is offered by the employer.
Some Important Questions to Ask Yourself Before Choosing a Dental Benefits Plan
Ask yourself these questions as you evaluate your dental plan options:
Will you have the freedom to choose your own dentist?
Will you have a say in the type of treatment that will be administered?
Will routine and preventive dental care be covered? Will it cover orthodontic treatment, oral surgery, placement of dental caps and crowns, root canals, treatment of periodontitis and other dental conditions?
Will it cover services that are diagnostic and preventive in nature such as sealants and fluoride treatments, and x-rays?
Will major dental care such as implants, dentures and treatment of temporomandibular joint disorder (TMJD) be covered?
Will specialist referrals be allowed? Will you be allowed to choose your own specialist or will your choice be limited to a list?
Will emergency services be covered? Will you be provided emergency provisions when on tour?
Will a large percentage of monthly premiums go into actual care and not into administrative expenses?
Every employee should carefully consider these factors before deciding on a dental plan. Additionally, when deciding on getting treatment, patients should consider their dental plan but not solely base their decision on it.
What are the Various Dental Insurance Plan Models?
There are two dental insurance plan models:
a. Managed Care
This type of dental plan is a restricted form of dental insurance which aims to reduce costs and reimbursements. Coverage in this type of model is restricted, and access to care if limited as a list of preselected dentists, specialists, treatments and hospitals is provided. Types of treatments and their frequency are also limited and usually indicated in the coverage policy.
b. Fee-for-service
This type of dental plan gives patients the freedom to choose their dentist, specialists and treatments. Fees are paid in full as determined by the service provider.
Types of Dental Insurance Plans
1. Managed Care Dental Plans
There are two kinds of plans under this type:
a. Preferred Provider Organization (PPO)
This is a plan wherein a patient can only go to a dentist that is included in the preferred provider list provided by the insurance company. In this agreement, the dentists in the list have agreed to give the insurance company discounted pricing for the fees. However, some PPO plans allow patients to choose their own dentists but are subject to penalties. This type of plan is cheaper than other types of plans in this category.
Ask yourself these questions when evaluating a PPO dental plan:
What percentage of the premium will be used for administration?
What effect will the discounts have on the decision for choosing a dentist? How will the discounts affect the treatment options?
What will we be the liability of the employer when something happens to an employee in the hands of a preferred dentist?
What are the factors considered when choosing a preferred dentist?
What provisions are given for emergency treatments? Are there provisions for emergencies that will occur outside the geographical area?
Does the PPO plan allow for specialist referrals? Are the choices limited to a list of preferred specialists?
b. Dental Health Maintenance Organization (DHMO)
In this type of dental plan patients are not burdened with financial payouts when availing of treatments. In this type of agreement, insurance companies pay the dentists a fixed amount per month for every individual or family enrolled, regardless of whether or not they come for a visit within a month. Then dentists provides certain types of treatments to enrolled patients at no additional costs. For other types of treatments, co-payment is required. DHMO plans encourage dentists to provide good service to patients while keeping the costs low. This plan is considered to be the cheapest of all options.
Ask yourself these questions when evaluating a DHMO:
What percentage of the premium will be used for administration?
How will the employer know how many employees avail of treatments from a certain dentist or specialist?
What is the average waiting period for each employee to get an initial appointment? What is the average period between every appointment?
What is ratio between dentist and patients?
How are the preferred dentists chosen?
How many dentists are present within a geographic area?
What is the average acceptance rate for dentist applying to participate in the DHMO?
How many dentists have already withdrawn from the program?
Are the dentists compensated fairly? Is the compensation package at par with the work load?
What are the provision given for patients needing specialist care? Are there enough specialists within a geographic area?
Are there provisions for emergency treatments? Are there provisions for emergencies that will occur outside the geographic area?
2. Fee-for-Service Dental Plans
a. Direct Reimbursement Plan (DR)
This type of dental plan is a self-funded wherein a patient is reimbursed for actual cost of treatment or service. Reimbursements are made regardless of the type of treatment availed. In a DR plan, patients are given the freedom to choose their own dentists. Employers pay for a percentage of the actual cost of treatment, but they are not required to pay for monthly premiums. Which means that employees who do not need any dental treatment will not receive any dental benefit. Additionally, employers are responsible for determining which type of treatments their employees need. The American Dental Association highly recommend this type of dental benefits plan.
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