Offering a good dental benefits plan is smart economically since employee absence and illness is often related to dental disease or pain. Most medical problems are unpredictable and expensive, whereas most dental problems are predictable and inexpensive to treat. Dental benefits are often listed as one of the most important employee benefits. It makes good sense to invest in a dental insurance plan for your people.
- Will employees be free to choose their own dentists?
- Is the treatment determined by both the patient and the dentist?
- Does the plan cover diagnostic, preventive and emergency services? What about full-mouth x-rays?
- What routine dental care is covered? Does the plan cover crowns and bridges, braces, root canals, oral surgery and treatment of periodontal diseases? How much is the co-payment for these types of services?
- What major dental care is covered? Does it include dentures, implants or treatment for TMJ?
- Does the plan cover pre-existing conditions?
- Does the plan permit referrals to specialists? If so, is the choice limited to a list of designated specialists?
- How does the plan handle emergencies at home and during travel?
- What percentage of monthly premiums goes to actual care and not to overhead?
The two main types of plans are Managed Care and Fee-for-Services. Managed care plans restrict the type, level and frequency of treatment, limit access to care and limit reimbursement for services. Fee-for-Service dental plans are
freedom-of-choice arrangements under which a dentist is paid for each service, according to his/ her fee schedule.
Preferred Provider Organization (PPO) programs have the patients choose a dentist from a network who have agreed to discount their fees. PPOs are usually less expensive. Be sure to ask if the PPO has enough dentists under contract to adequately serve your company and in what geographic area.
Dental Health Maintenance Organization (DHMO) plans pay selected dentists a fixed amount (per enrolled family or individual, whether they use the dentist or not.) The dentists agree to provide certain treatments to the patient at no charge (for other treatments, a co-payment is due). Be sure to find out the utilization rate for patients and the average waiting period for a first appointment.
Direct Reimbursement (DR) is a self-funded dental benefits plan that reimburses patients according to dollars spent on dental care. It allows the patient to choose any dentist they wish. Instead of paying monthly insurance premiums, even for employees who don't use the dentist, employers pay a percentage of actual treatments received.
Many insurance companies have a yearly maximum of a $1000.