Dental Insurance

Indemnity Plans

These plans are the most popular among both employees and employers because the insured has the choice to visit any dentist across the nation. This is especially ideal for those who are away at school or have to travel for work; you’ll always have a dentist near you covered.

Key features:

• No network limitations, so any dentist can be selected
• 100% coverage for preventive care
• Lower participation limits
• No required employer contribution
• Claims are paid directly to the dentist/employee (80th-90th percentile of UCR)
• Lower group premiums
• Pooled risk products
• Two-year rate guarantee
• Top-rated insurance providers

Preferred Provider Organizations (PPO)

Some choose to add on a PPO to a traditional dental plan, as it allows the insured to pick a dentist of their own choosing. If a PPO dentist is selected, the insured benefits from discounted fees and has a guarantee of no balance billing above the negotiated rates.

Key features:

• Reduced care costs with PPO provider
• No balance billing above covered amount
• No referrals needed for general dentist or specialist

Managed Care Dental Programs (DHMO)

DHMOs provide the insured and their dependents access to a large network while still offering reduced costs. If desired, each member of the family could technically pick their own dentist. However, out-of-network choices result in a large reduction in benefits.

Key features:

• No annual maximums
• No annual/lifetime deductibles
• Increased benefits
• Lower out-of-pocket costs

Freedom-of-Choice Programs

Century is a recognized industry leader in Voluntary Dental Programs. Based on years of feedback from employers and employees throughout the country, we designed a unique voluntary dental program. The program allows employees to receive dental care from either a traditional indemnity plan or a managed care program (the DHMO)

Through these, there is an option to switch between an indemnity plan and the DHMO plan during the year. There is no intervention during this change. This plan is a great option for companies that have employees spread out around the country, as a dentist will always be available.

Direct Reimbursement Plans

With this plan, the employer funds dental coverage directly. So, dollars are reimbursed according to how much the employee spent on their care, not by the service. Any dentist can be chosen through this plan.

More Information

Below are just a few of the issues that need to be examined when looking at the design of dental programs and the carrier that will insure and administer the program. We’ve learned that truly successful dental plans have to please the employer, the insured, as well as the dentist.

Access

Most people become very comfortable with their family dentist. People are very particular about who is putting their fingers in their mouths! For a dental program (especially an employee-paid plan) to be a complete success, your employees must have access to the dentist of their choice. Dental plans that require the insured to use a limited list of providers can create access problems if your organization has more than one location, sales people on the road, or dependents away at college.

Participation

The minimum participation needed for voluntary dental plans is 20% of the eligible workforce. Voluntary programs that require 50% or higher participation run the risk of not meeting participation. The average enrollment percentage for our clients is 60%. This is substantially higher than the industry average. We credit this to our educational—not sales-oriented—enrollment process.

Solid Plan Design

Some dental plans have "holes" in the coverage. As an example, one very popular program covers only one exam per year. Dental programs should cover two cleanings and two exams per plan year. Proper plan design ensures employee satisfaction and promotes quality dental care.

Employer Costs

For voluntary dental programs no employer contribution is required towards the premiums. Some employers will subsidize the cost, but it is never required. The only employer costs are those associated with the administration of the plan such as the additional payroll deduction, forwarding the premium each month to the insurance carrier and adding/deleting employees each month. These costs are offset by the savings the employer receives as a result of the reduced payroll taxes from the Section 125 plan.

Claims Payments

Many dental programs look the same on the surface but have premiums that are vastly different. Examine how the carriers are reimbursing the dental providers. Well-designed indemnity plans reimburse the dental provider based on reasonable and customary charges, not a fee schedule. This reimbursement should be based on where the service is performed (the dentist's office location) and the charges should be paid at the 80th – 90th percentile of reasonable and customary. Claim data should be updated every six months to stay current.

Plan Designs for Virgin Risks

Companies that put in virgin dental programs (new dental plans with no prior coverage) experience extremely high utilization in the first year. Clearly, everyone who needs dental work will immediately rush to their dentists as soon as the plan starts! As a result, virgin dental programs need to be designed to deal with this adverse selection. Dental plans that don't tend to incur excessive premium increases after the first year. Properly designed plans can expect normal dental trend.

Rate Guarantee& Stability

Many plans come with an initial two-year rate guarantee.

Claims & Customer Service

Timely and efficient handling of claims is one of the factors that will affect how employees receive their benefits. Dental claims can be highly automated which saves the carriers administrative dollars. The carrier needs to be turning claims around quickly and be responsive to all customer service calls.

The Bottom Line

Dental programs need to perform at a high level to keep all insured satisfied. Employers that implement dental programs are doing so to provide a much-desired benefit, enhance their benefit package and promote goodwill. Century will design, implement, and service your dental program to help your organization meet those objectives.