Offering a group dental insurance plan as part of a employee benefits package is helpful for attracting and retaining valued employees. There are various types of group dental insurance plans so employers can offer something that works within the overall benefit package.
Managed Care dental plans
Managed Care dental plans are cost-containment plans that control cost by restricting the type, level and frequency of covered treatment, limiting the access to care and controlling the level of reimbursement for services. Within that are:
- Preferred Provider Organization (PPO): One type of Managed Care plan is a PPO program. Patients select a dentist from a list of providers (network) who have agreed to discount their fees. These plans can be fully insured or self-insured.
- Dental Health Maintenance Organization (DHMO): Another type of Managed Care plan is a DHMO plan, which pays contracted dentists a fixed amount per enrolled family or individual, regardless of utilization. Dentists agree in return to provide specific types of treatment at no charge (or occasionally with a copayment). These are typically the least expensive dental plans.
Consumer-driven dental plans
Following a growing trend in medical benefits offerings, many carriers are beginning to offer a consumer-driven dental plan. One example is a dental flexible spending account (FSA). Reasons to consider offering a consumer-driven plan include:
- The tendency to be more customizable for employers and flexible for employees
- Employees have incentives to seek preventive care, which lowers both employee and employer costs in the long run
- Employees have more awareness of what they spend on dental care, giving them more reason to be financially responsible
Employer and employees both benefit
Group dental insurance plans are valuable to employers if they offer:
- Inexpensive, yet appropriate benefits
- Opportunities to integrate with medical plans under one vendor
- Strong networks
- Good savings and value
- Hassle-free administration
Employees value group dental insurance plans if they provide:
- Ease of use
- High-quality care
- Quick claims processing
- Flexibility and choice in coverage
- Excellent customer service
Health Care Reform Implications
The health care reform legislation generally applies to group health plans, but many plan sponsors wonder how it affects dental coverage. Dental benefits are not subject to the Affordable Care Act as long as:
- They are provided under a separate policy.
- Or, if dental benefits are included in the health plan, participants must have the right to waive the dental coverage and the dental coverage must cost the participant an additional premium (cannot be included in the cost of the health coverage).
However, self-insured dental benefits that are not elected separately from health coverage must comply with health care reform. Notable provisions that would impact these dental plans include:
- Lifetime and annual limits—The Affordable Care Act restricts lifetime and annual dollar limits on “essential health benefits.” Included in those essential benefits are “pediatric services, including oral and vision care.” Plans must consider what age falls under “pediatric” dental benefits, whether orthodontia is included in those benefits and what treatment limitations may be allowable (such as two teeth cleanings per year, but without a dollar amount specified).
- Dependent care to age 26—This provision requires plans that cover dependent children to continue coverage for qualified dependents until they reach age 26.
Plan sponsors should determine whether or not their current dental plan is exempt from the Affordable Care Act. It may make sense to adopt a different dental plan in order to avoid having to change the current plan design. For any changes made related to health care reform requirements, be sure to update plan documents and communicate changes clearly to plan participants.
Though rising benefit costs may be squeezing your dollars, your employees (and potential future hires) likely see the benefit in dental coverage. Moreover, a quality dental care package can actually help reduce medical coverage costs by preventing illness and disease.
For more information on dental care, visit The National Association of Dental Plans (NADP) at www.nadp.org or the American Dental Association at www.ada.org.
Confused? Have questions?
We understand it can be overwhelming. We’re here to help. Simply call us at (732) 389-4313, or send us an email using the contact form on this page. We’ll gladly tell you about group dental insurance plans that can help keep your employees happy and motivated.