At a time when many employers can barely afford medical insurance, why provide group dental insurance? Consider the following:
- Dental insurance promotes health. Dental health affects much more than an individual’s looks. The American Dental Association reports that studies have linked oral bacteria to heart disease, stroke, diabetes and the birth of pre-term, low-birth-weight babies. Regular dental exams can often uncover other medical conditions, which show symptoms in the mouth. For example, uncontrolled diabetes can lead to gum disease; eating disorders can cause tooth discoloration; and osteoporosis can lead to bone loss.
Regular oral exams can also detect oral cancers. Currently, only half of all patients diagnosed with oral cancer survive more than five years. The Oral Cancer Foundation says that early detection can increase the survival rate to 90 percent. Most people who develop oral cancer have used tobacco; however, about 25 percent of cases develop in people who have never used tobacco, making regular dental examinations important for everyone, not just tobacco users.
Problems with malocclusion, caused by misalignment of the teeth or a “bad bite,” and bruxism—or grinding of the teeth—can also lead to jaw pain, chronic headaches and gum loss. Regular dental exams can help your dentist detect these problems and develop a treatment plan.
- Dental insurance encourages prevention. Many medical conditions can occur unexpectedly, with catastrophic results. But most dental disease is preventable. Dental insurance plans provide higher payments for preventive care and routine treatments than for the more complex procedures needed to treat advanced dental disease. By making routine care such as exams, diagnostic x-rays, cleanings and simple restorations (fillings) affordable, dental plans promote prevention and your employees’ good health.
- Dental insurance is cost-effective. Group dental insurance costs about one-tenth of what group medical insurance costs. In 1970, dental treatments comprised 6.3 percent of total health care expenditures. By 1991, that share dropped to 4.9 percent, largely due to increased participation in dental plans, which made regular dental care more accessible.
- Dental insurance is popular. Surveys have found that dental insurance ranks just after medical insurance in importance for employees, ahead of retirement benefits, dependent care benefits, and all other benefits.
If you want to offer dental insurance to your employees, you have many plan types to choose from. Your options include:
Under this “traditional” insurance plan, the employer pays premiums to an insurance company, which then pays dentists for the treatments they provide to insureds. The plan pays dentists according to a formula—usually a percentage of the dentist’s fee, up to a “usual and customary” maximum. The dentist can bill your employees for the difference, or copayment. Most plans also have patients pay a deductible per visit or per series of treatments as well.
Preferred provider organizations (PPOs)
A dental PPO consists of a network of providers who agree to accept a certain discounted payment for their services. PPO plans give insureds financial incentives to use these “preferred providers” by paying higher percentages of claims they submit than for those submitted by non-preferred providers. Insureds pay the uncovered portion out of pocket.
Dental health maintenance organizations (HMOs)
In an HMO, dentists agree to provide specified dental services to members in return for a periodic per-capita payment—usually monthly. Payments do not depend on the number or type of services rendered, and the HMO accepts the financial risk for providing covered dental services to members.
Most plans require participants to use an HMO dentist, but some plans provide reduced benefits for members who use out-of-network dentists. A participant may have to pay a deductible, co-payment, or any amount exceeding plan coverage levels. Dental HMOs cost less than indemnity or PPO plans, but opponents say they limit choice and the way they pay providers gives them incentive to render minimal treatment.