Health Insurance News
Dental Plans: Key Features to Compare to Make the Right Choice
Dental insurance frequently is cited as among the types of benefits most sought after by employees. With relatively low and predictable premiums, dental insurance is an excellent choice for a company looking to add to its benefits offerings.
Whether the employer contributes to the cost of coverage or offers it on an employee-pay-all basis, comparison shopping among carriers will help guarantee selection of a plan that is both appropriate for the workforce's needs, and a good value. The following are among the considerations to keep in mind when comparing dental insurance plans:
- Which dentists will employees be able to visit? If the plan has a "preferred" network of dental providers, what does that mean: will the plan pay no benefit (or a reduced benefit) for care received outside the network, or will it pay benefits regardless of provider, with network providers offering a discounted fee? What is the turnover rate for dentists who participate in the network? Does the network include a range of dental specialists (e.g., orthodontists, endodontists, periodontists, pediatric dentists)? If an employee is referred to a specialist, do the same network restrictions apply as for primary care dentists? Issues such as these define the extent to which employees have provider "choice."
- What specific services are covered/excluded? For example, do "preventive services" include sealants and fluoride treatments, in addition to cleanings? Are orthodontics covered, including services for adults and those of a non-severe nature commenced largely for cosmetic purposes?
- Does the plan cover services for pre-existing conditions, or for treatments that commenced before the effective date of coverage (potentially a significant limitation on payment of orthodontic benefits)?
- At what rate are services covered? If, for example, a plan pays 100% for cleanings, does that mean 100% of the fee charged by the dentist who provides the services, or 100% of the "usual, customary, and reasonable" (UCR) fee for the services, as determined by the insurance company? If the latter, it might be instructive to compare the UCR allowances of the plans under consideration if available.
- What percentage of the premium cost actually goes to the payment of benefits, as compared to administrative fees?
- If offered on an employee-pay-all basis, does the plan require a certain percentage of the workforce to enroll? What enrollment support does the insurer provide (e.g., communications materials, online or IVR enrollment)?
As your insurance broker we can facilitate your dental plan comparison shopping by providing a checklist of considerations. The items suggested above represent only a starting point in helping to make sure that the dental plan you choose is the right one for your employees and your business.
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