By: Gallardo Dental

Photo Credit: On Pixabay, CC0 license.

A Dental insurance or dental benefit plan is viewed upon as a much sought after employee benefit. So financially it makes sense to have a dental benefit plan in place to recruit and retain employees. Moreover, dental health is a very important part of overall employee health and man days lost due to dental problems or dental discomfort of an employee equates to financial loss for the employer.

Unlike most medical conditions, dental maladies and treatments are low risk, predictable and low cost. These factors contribute to offering dental insurance to employees a good option financially. Dental diseases are preventable by maintenance and often involve only maintenance costs like x-rays and examinations. Treatment is rendered cheap due to diagnosis in early stages of the disease. Keeping these financial factors in mind, dental insurance options can also be self funded. History does not show any extremes in costs or utilization of this form of employee benefit.

Selecting the right Dental Insurance Plan

Selecting the right dental plan involves a lot of factors which have to be considered with due care.

Dental insurance plans are basically agreements between the employer and the insurance company. Most plans offered by dental insurance companies allow for part reimbursement of dental treatment expenses. Many plans also discourage certain kind of treatments or allow access to certain of dentists. To consider these points one has to go through the plan very carefully with a toothcomb. For example choosing a dentist is not same as choosing a dentist from “the list”, or if the plan does not cover one kind of treatment, it is wrong to infer that your regular dentist is incompetent.

Many plans do not cover pre existing conditions. Some may not cover implants and so on. Due to these preconditions, the final treatment may be paid for in part only or in insurance parlance you might be reimbursed for LEAT (Lease Expensive Alternative Treatment). Dental insurance plans vary in fixing the UCR (usual, customary, and reasonable) in a certain geographical area. UCR may vary from plan to plan and company to company despite operating in the same area. Therefore fixation of this UCR level would define the liability of the patient. In some plans the patient may have to pay more and in some he may have to pay less depends upon the plan the employer has offered.

Important factors while finalizing on a Dental Insurance Plan

An employee has to ask himself the following before he finalizes on a plan:

Would the employees like to retain the freedom of choosing their own dentists?

Willthe mode of treatment be determined by the patient and the dentist?

Whattype of routine and preventive dental care is covered? Does the plan cover braces, oral surgery, crowns and bridges, root canals and treatment of periodontal diseases?

Will the plan cover all diagnostic, preventive and emergency services? Including preventive services viz. sealants & fluoride treatments, which might result in financial savings to the patient in future? Does it provide for full-mouth x-rays?

What forms of major dental care is covered? Does the plan cover implants, dentures, or treatment for temporomandibular disorders?

Does the plan allow for specialist referrals? If so, has the dentist be limited to “the” list of specialists to choose form?

Does the plan provide for emergencies? What are the provisions made for emergency care when the patient is on tour?

What percentage of monthly premiums goes into actual care and not to administration?

Dental Insurance benefit coverage should be taken into consideration but should not be the deciding factor in choosing the treatment.

Managed care and Fee-for-service.

Managed care dental plans are restricted forms of dental insurance which aim at reducing costs and payouts. They tend to restrict the coverage by limiting the access to care by restrictions (by predefining dentist, specialist, hospital or treatments in form of lists) and restricting level, type and frequency of treatment (usually in form of clauses in the coverage policy).

Fee-for-service dental plans have a freedom of choice options where one can choose their own dentist and the fee is paid as fixed by the dentist.