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Whether your client is evaluating its current dental benefits or preparing to offer a dental plan for the first time, choosing the best program for their needs can be a bit of a balancing act. A good dental benefits program should help balance company's needs with the expectations of its employees. While companies are under pressure to manage costs and provide a competitive package of benefits, 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, clients should take a step back and determine the role dental benefits play (or should play) in their 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 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. Employers should 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. Encourage clients to watch the trends. If they have a sense for the utilization rates and fee trends for dental work in their area, they'll know if a prospective carrier bids too low for their business hoping to make up the difference with subsequent rate hikes at renewal time. They'll also know if a plan's rate increases are in line with the market's norm. Before they make any final decisions, have them 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 both a good indication of a carrier's price stability. Details, details Does your client's 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 to rigorously evaluate all 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 and clients 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 dental preferred provider organization (DPPO), 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 your client or its employees is the freedom to choose a dentist, a fee-for-service plan is probably the best choice. Dental preferred provider organizations (DPPOs) 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 or 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, such as coverage for orthodontics or cosmetic dentistry. For a little additional cost, riders enable clients to customize or supplement their basic dental benefits package. Right for your client In the end, finding the right dental benefits program is a combination of many factors. In addition to matching a plan with your clients' and their employees' 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 client's wishes makes it that much more likely that their 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. Reprinted from Delta Dental Plans Association
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