Dental benefits offer a lot of advantages to employer and employees. Dental insurance encourages preventive dental care, which saves an estimated $4 for every $1 spent. And since oral health affects overall health, encouraging your employees to take care of their teeth and gums could help reduce your medical costs. Dental insurance also costs only about one-tenth of what medical insurance costs. No wonder nearly 90 percent of large employers offer dental benefits!
Dental coverage comes in a wide variety of forms: from fully insured plans to employer-funded reimbursement accounts, to employer-paid voluntary programs, to individual or family plans.
Most insurers offer managed care plans designed to encourage wise use of dental benefits, with lower out-of-pocket costs for preventive services such as exams, x-rays and cleanings. Many plans also offer benefits for orthodontics, but pay a lower percentage for orthodontics than for restorative services such as fillings, root canals, etc.
We offer a full range of dental benefit solutions for groups of any size, including:
• Group Dental Insurance
• Voluntary Dental Insurance
• Self-funded Dental Plans
• Dental Discount Plans
Group Dental Insurance
Under this “traditional” insurance plan, 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 insured for the difference, or co-payment. 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 insured financial incentives to use these “preferred providers” by paying higher percentages of claims they submit than for those submitted by non-preferred providers. Insured pay the uncovered portion out of pocket.
Dental health maintenance organizations (HMO’s): 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.
Voluntary Dental Insurance
We can set up a group dental insurance plan on an employer-paid or voluntary basis for your group. Under a voluntary plan, employees pay 100 percent of premiums through payroll deduction. They get the cost advantages of a group plan, plus the convenience of payroll deduction. They get the cost advantages of a group plan, plus the convenience of payroll deduction. If the plan is set up under a premium conversion cafeteria plan, the employees’ needs, with options ranging from including or omitting orthodontic coverage to using either larger or smaller PPO (preferred provider organization) networks.
Self-funded Dental Plans
Some employers opt to self-fund their employees’ dental benefits. A self-funded plan can give you more control over your benefit program.
A direct reimbursement plan, or dental health reimbursement arrangement (HRA), the employer reimburses employees directly for their dental care expenses, eliminating the role of the insurance company. Under a reimbursement plan, 90-95 cents of each dental benefit dollar pays for benefits. This compares to about 70-85 cents under a traditional insured program, which also must cover insurer overhead and profit.
Dental reimbursement plans give employers greater control over their benefit program and cash flow. As with an insured plan, your costs for qualified dental expenses (which excludes cosmetic procedures) and administration are tax-deductible, and employees receive reimbursements tax-free. Under a direct reimbursement plan, the employer reviews claims, makes payments and handles compliance with benefit laws. Alternatively, you can hire a third-party administrator to handle administration. If you’re interested in exploring dental reimbursement plans, we can evaluate your company’s needs and design a plan for you.
Dental Discount Plans
Not insurance, discount plans typically give participants discounted rates for dental care in exchange for an annual fee. Depending on the plan, members can save 15 to 20 percent off average costs for a variety of dental services, such as fillings, braces, exams and routine cleanings. Plans often discount the cost of cosmetic procedures, which most dental insurance plans exclude. Members must go to a participating dentist who has agreed to offer services at a discounted price.
