Employees today are very particular about the types of benefits they offer. Dental insurance is one of the employee benefits that is considered very important in the overall employee health plan. Entrepreneurs are aware that dental problems can mean financial loss.
Dental problems and their treatment are low risk compared to almost all other health conditions. This is the reason why offering a dental care plan to your employees is the right decision. Dental health problems can often be prevented through prophylaxis and require minimal costs. Once a dental problem is diagnosed at an early stage, treatment can be given immediately.
Early treatment is much cheaper than treatment at an advanced stage. Financial factors are an important consideration when deciding which health benefits to include in your employee health plan. Dental insurance plans are the most cost-effective of all health benefit plans.
How to Choose the Right Dental Insurance Package
There are many factors to consider when choosing dental insurance. But before we delve into these factors, let’s first discuss in detail what a dental insurance plan is. A dental insurance plan is an agreement between a company and an insurance provider. This agreement consists of several details relating to the benefits to be received by the employees of the company.
There are dental insurance companies that provide partial reimbursement for dental costs and exclude certain types of treatment in their plans. Companies looking for dental insurance companies must carefully sift through all the offers they receive from various companies to find the one that benefits their employees the most.
Choosing a dental insurance provider is the same as finding the right dentist for you and your family. You should consider several options before deciding on the one that best suits your needs and provides the best service.
Many plans do not cover dental conditions that existed before insurance coverage was purchased. There are also plans that don’t cover implants and other procedures. This condition may mean that dental treatment can only be partially paid for or insurance terms can be used for Lease Expensive Alternative Treatment (LEAT).
Dental insurance companies have their own way of determining UCR rates (regular, customary and reasonable) for each geographic area. Companies operating in the same geographic area may not necessarily have the same level of UCR.
This means that the UCR rate determines the liability of the patient because in some plans the patient may receive more benefits while in other plans he may have to pay more. This all depends on the type of dental plan offered by the employer.
Some Important Questions to Ask Yourself Before Choosing a Dental Benefit Plan
Ask yourself these questions as you evaluate your dental treatment plan options:
Do you have the freedom to choose your own dentist?
Do you have a say in the type of treatment to be provided?
Will routine and preventive dental care be covered? Will it cover orthodontic treatment, oral surgery, dental caps and crowns, root canals, periodontitis treatment and other dental conditions?
Will it include diagnostic and preventive services such as sealant and fluoride treatment, as well as x-rays?
Are major dental treatments such as implants, dentures and treatment of temporomandibular joint disorders (TMJD) covered?
Is specialist referral allowed? Will you be allowed to choose your own specialist or will your choices be limited to a list?
Will emergency services be covered? Will you be provided with emergency equipment during the tour?
Will a large percentage of the monthly premium be used for actual maintenance and not for administrative costs?
Every employee should carefully consider these factors before deciding on a dental treatment plan. Moreover, when deciding to get treatment, patients should consider their dental treatment plan but not just base their decision on it.
What is the Dental Insurance Package Model?
There are two models of dental insurance plans:
A. Managed Care
This type of dental plan is a form of limited dental insurance that aims to reduce costs and reimbursement of expenses. Coverage in this type of model is restricted, and access to treatment if restricted as a pre-selected list of dentists, specialists, treatments and hospitals is provided. The type of treatment and its frequency are also limited and are usually included in the coverage policy.
This type of dental treatment plan gives patients the freedom to choose their dentist, specialist, and treatment. Fees are paid in full as determined by the service provider.
Types of Dental Insurance Packages
1. Managed Dental Care Package
There are two types of plans under this type:
A. Preferred Provider Organization (PPO)
This is a plan where the patient can only go to the dentist who is included in the list of preferred providers provided by the insurance company. In this agreement, the dentist on the list has agreed to give the insurance company a discounted price for the fee. However, some PPO plans allow patients to choose their own dentist but can be subject to penalties. This type of plan is less expensive than other types of plans in this category.
Ask yourself these questions when evaluating a PPO dental treatment plan:
What percentage of the premium will be used for administration?
How does the discount affect the decision to choose a dentist? How will the discount affect the choice of treatment?
What will our employer’s responsibility be when something happens to an employee at the hands of the dentist of choice?
What factors are considered when choosing a dentist of choice?
What provisions are provided for emergency care? Are there provisions for impending emergencies outside the geographic area?
Does the PPO plan allow for specialist referrals? Are the options limited to a list of selected specialists?
B. Dental Health Maintenance Organization (DHMO)
In this type of dental treatment plan, the patient is not burdened with financial payments when getting treatment. In this type of agreement, the insurance company pays the dentist a fixed amount per month for each registered individual or family, regardless of whether or not they come to visit within a month.
Then the dentist provides certain types of treatment to the enrolled patients at no additional cost. For other types of treatment, co-payment is required. The DHMO plan encourages dentists to provide good service to patients while keeping costs low. This plan is considered to be the cheapest of all the options.
Ask yourself these questions when evaluating a DHMO:
What percentage of the premium will be used for administration?
How does the employer know how many employees benefit from treatment from a particular dentist or specialist?
What is the average waiting period for each employee to get an early appointment? What is the average period between each appointment?
What is the ratio between dentist and patient?
How to choose the dentist of choice?
How many dentists are present in a geographic area?
What is the average acceptance rate for dentists applying to participate in DHMO?
How many dentists have withdrawn from the program?
Are dentists fairly compensated? Is the compensation package commensurate with the workload?
What are the conditions for patients requiring specialist care? Are there enough specialists in the geographic area?
Are there provisions for emergency treatment? Are there provisions for impending emergencies outside the geographic area?
2. Free Dental Care Package
A. Direct Replacement Plan (DR)
This type of dental treatment plan is a self-funded one in which the patient is reimbursed for the actual cost of treatment or services. Replacement is carried out regardless of the type of treatment available. In the DR plan, patients are given the freedom to choose their own dentist. Employers pay a percentage of the actual medical expenses, but they are not required to pay a monthly premium.
This means that employees who do not require dental treatment will not receive dental benefits. In addition, employers are responsible for determining the type of care their employees need. The American Dental Association highly recommends this type of dental benefit plan.