Delta Dental

Shopping Smart For Dental Benefits

Finding the Right Balance to Keep Employees and Management Happy

Whether you're evaluating your current dental benefits or preparing to offer a dental plan for the first time, choosing the best program for your needs can be a bit of a balancing act.

A good dental benefits program should help you balance your company's needs with the expectations of your employees. While you're under pressure to manage costs and provide a competitive package of benefits, your employees are looking for flexibility and good coverage.

The challenge of finding this balance is made more difficult when you consider the number of options available in the dental benefits marketplace today. So where do you start?

Popular and Preventive

Before diving in, take a step back and determine the role dental benefits play (or should play) in your compensation package.

Dental benefits are second only to medical insurance in popularity among employees, according to a 1999 study conducted by LIMRA International, a global association that provides research, consulting and other services to insurance and financial services companies.

More than being merely popular, dental benefits are also good for your employees' health. People with dental insurance visit the dentist nearly twice as often as those without, according to the National Center for Health Statistics. When patients visit the dentist for regular, periodic checkups, they and their employers save on - and often avert the need for - higher-priced treatment procedures.

There is little dispute that preventive care leads to real savings. One study, examining 15 years of claims data, indicated that every dollar spent on prevention saved four dollars in treatment. The American Dental Hygienists' Association came up with a figure that was even higher: For every dollar spent on prevention in oral health care, $8 to $50 is saved in restorative and emergency procedures.

Dental coverage is considerably less expensive than medical coverage and might help an employer reduce expenditures on health care. Dental costs a dime on the medical-coverage dollar. As more studies show the importance of oral health to general health, that 10-cent investment could save employers real dollars down the road.

Considerations and costs

There are a number of factors to consider when looking at the overall affordability of dental plans, including such things as administrative expenses and discounts from dentists.

Look for a dental benefits company with administrative expenses at appropriate levels. Low administrative expenses could mean that the company operates efficiently, but look closely to see if it is implementing cost-management strategies such as monitoring propriety of care or watching for over billing and fraud. Some companies may boast low administrative costs, but if they are only able to do so because they've eliminated important cost-management controls, employees could see higher out-of-pocket expenses in the long run.

Also look for a dental carrier that can show evidence of its relationship with its network of participating dentists. Specifically, ask to see information about the size and turnover rate of dentists participating in the company's networks. When a carrier can prove that it has a solid relationship with dentists, that's a good indication that the company will be able to negotiate good discounts with those dentists.

What can you do?

A smart dental benefits shopper is an educated shopper. Watch the trends. If you have a sense for the utilization rates and fee trends for dental work in your area, you'll know if a prospective carrier bids too low for your business hoping to make up the difference with subsequent rate hikes at renewal time. You'll also know if a plan's rate increases are in line with the market's norm.

Before making any final decisions, ask for the facts on an insurer's average rate increases. Request a history of rate increases on commercial business over the past three or four years. This will give you a good indication of a carrier's price stability.

Details, details

Does your current or prospective dental benefits company specialize in dental benefits? Or does it include dental benefits as part of a line of insurance and financial planning options? It might seem like a decision of convenience to choose a single company to provide medical and dental coverage, life insurance and retirement plans. However, any gains in convenience could be lost if cost management and quality assurance are compromised. A company's expertise with medical plans or other benefits does not necessarily carry over to dental plans, so make sure you rigorously evaluate all of your options.

While dental benefits companies do not control the treatment practices of individual dentists, dental companies do what they can to standardize dental treatments and procedures. For example, dental benefits companies can require that dentists adhere to the accepted professional practices developed by supervising regulatory agencies as a condition for participating in that company's dental benefits network.

What can you ask?

Although insurers can't guarantee the quality of care provided by every dentist in their networks, don't be afraid to ask direct questions about the insurers' standards that lead to quality of care, and how these standards are communicated to dentists through provider agreements and other written contracts.

You should also find out what remedies are available to employees who are unhappy with the dental work they receive. Do enrollees have access to a complaint-review board? If so, who sits on the board? And who pays for investigations or for dental work that has to be redone?

Some carriers offer no options for enrollees to voice concerns or disagreements about dental treatments, a fact that could lead to dissatisfaction with both the quality of dental care and benefit plans themselves.

Reviewing dental benefits plans

Dental carriers typically offer one or more of three basic types of plans; the preferred provider organization (PPO), the dental health maintenance organization (DHMO) and the fee-for-service plan.

The original dental benefits plan and the one that continues to dominate the market is the fee-for-service plan. Under this type of plan, employers and/or their covered employees pay a monthly premium to an insurance carrier, which is responsible for reimbursing dentists for the services they provide. Fee-for-service plans allow employees the most freedom in choosing their dentists, which is why they have remained a popular choice. If the main concern for you or the employees you're covering is the freedom to choose your dentist, a fee-for-service plan is probably your best choice.

Dental preferred provider organizations (PPOs) are a good option for groups seeking lower cost advantages while providing enrollees with a high level of freedom of choice in selecting providers. Enrollees have the freedom to visit any dentist that is part of a network established by the dental benefits company or, for higher out-of-pocket costs, can visit any non-network dentist.

Dental health maintenance organizations (DHMOs) give subscribers access to a select group of dentists, with even greater cost savings. This type of program is a good choice for groups seeking lower costs with an emphasis on prevention and a pre-selected network of dentists from which to choose.

In each of these dental-coverage categories, premiums are split more evenly between employer and employee than is typically the case with medical premiums. Also, employees generally pay a higher portion of the fees for restorative procedures, so there is an incentive for them to seek preventive care which is often reimbursed at a higher rate.

That's just what dental benefits are structured to do - control costs by encouraging the prevention of problems and illness. Most dental problems are preventable, and helping patients to seek regular, preventive treatment greatly decreases the chance that they will need more expensive restorative work.

Whether it's a fee-for-service, PPO of DHMO plan, coverage of specific services can vary. Some dental benefits programs cover diagnostic and preventive services only. Others cover the full range of dental services, from preventive to basic and major care.

Preventive care usually includes annual bitewing x-rays, semiannual cleaning and polishing and, possibly, semiannual fluoride treatments plus sealants for employees or their dependents 18 years of age or younger. Basic dental care includes restorations and basic oral surgery. Major care includes crowns, root canals, prosthetics, complex restorations and advanced oral or maxillofacial surgery.

In addition, many insurers offer riders for popular extras, like coverage for orthodontics or cosmetic dentistry. For a little additional cost, riders enable you to customize or supplement your basic dental benefits package.

Right for you

In the end, finding the right dental benefits program is a combination of many factors. In addition to matching a plan with your company's and employee's wants, look closely at other issues such as cost management and rate stability, size and convenience of the network of participating dentists, ease of administration, customer service and company reputation.

Knowing what to ask and how to communicate your company's wishes makes it that much more likely that your dental insurance will do what it's meant to do: attract good employees and help them preserve their oral health, keeping them on the job in tip-top shape.

Delta Dental Can Help You

Delta Dental is America's oldest and largest dental benefits provider, covering more than 42 million people in 75,000 companies and organizations. And these numbers are growing every day. For more information about finding the best dental benefits program for your company, log on to www.deltadental.com.

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