Employees cite dental or vision insurance as the third most important benefit in making a job decision,1 behind only health insurance and a retirement savings plan.
That’s why it’s important for you and your benefits consultant or broker to ask the right questions when assessing a current or potential dental insurance company.
What types of funding are offered?
Dental plans are usually funded in one of two ways. With a fully-insured dental plan, the insurance company is paid a monthly premium. The premium may be paid in three possible ways:
Employees are usually responsible for a deductible and a copayment or coinsurance. The insurance company takes on the risk of paying for the rest of the claims up to an annual cap, after which the employee is responsible for the full cost of treatment.2
The second option is a self-funded plan. In those cases, the employer will assume the responsibility of paying for claims. Employers with hundreds or even thousands of employees are able to spread the risk of paying for expensive claims over a larger number of people. An employer may handle the payment of claims and other administrative services, or may outsource them to a dental insurance company, in order to obtain the benefits of their expertise and network or to reduce the employer’s financial exposure.3
What plan designs are available?4
Look for a company with plans available in your area and make sure their plan designs are flexible enough to fit your employees’ needs and your company’s objectives.
Find a plan design that allows you to choose what services and what percentage of treatment costs are covered. Below is what a typical plan covers5 but you can work with the dental insurance company to adjust the percentage covered in each of the categories to fit your company and employees’ needs.
The plan design should also allow you to adjust certain financial terms such as waiting period duration and annual maximum based on the need of your company and your employees.
Consider your employees’ needs when deciding whether to cover additional features like orthodontics and dentures. You may also want to choose enhanced benefits for employees with certain medical conditions that would benefit from additional oral health care. Because oral health has an effect on overall health,6 these enhanced preventive measures can also help you and your employees save money on health care.
Here are some instances in which additional care may be beneficial:
Although you will want to choose an insurance company with a large network of dentists, it’s important to find out how much more it will cost employees when they visit a dentist who is out of the network.
How strong is the network?
As you evaluate dental insurance companies, consider the advantages of a large nationwide network. You can give employees more dentists to choose from and provide them with greater access to care, which results in higher in-network utilization rates, which can add up to meaningful savings.
Make sure to find out what percentage of dentists participate in the insurance company’s network nationwide. A larger network increases the chance your employees’ current or potential new dentists are in-network. It also allows employees to see a dentist when working remotely, traveling or during an emergency. By visiting an in-network dentist, your employees are protected from balance billing and can save money because those dentists have often agreed to lower fees. It also saves you money on claims.
Also, consider how dental insurance companies describe the structure of their networks. Some companies may lease their network from a third-party to cover underserved populations, which can limit their oversight and result in lower dentist credentialing standards. You should look for a company that owns its network and is committed to recruiting and credentialing its dentists directly, has high credentialing standards, and regularly verifies that those standards are maintained.
What is its history and level of expertise?
Look for a dental insurance company with a strong reputation and a high level of dental knowledge. The company should be up to date on the latest dental research and use credible, evidence-based data to help shape coverage options and review claims. By using this data on utilization and reimbursements, the insurance company can create better products and help control costs.
How does the insurer help manage costs?
The real cost-value measure of dental insurance includes more than premiums. You should also consider the insurance company’s:
How strong is its account management?
Make sure the dental insurance company has representatives who can answer your questions quickly while providing personalized service. Also, see if their digital tools make it easier for you by improving customer service and efficiency for billing, claims, enrollment, communication and employee education. Their digital tools should save you and your employees time by making it easy for employees to find a dentist, access their ID cards and more.
Delta Dental protects more smiles than any other dental insurance company, with the largest network of dentists nationwide. Find more about why Delta Dental is the right choice for this highly requested employee benefit.
Get additional resources from Delta Dental
Looking for more information? Delta Dental can help keep your and your employees’ smiles healthy with these articles:
1https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_470_wbs2-10jan19.pdf?sfvrsn=c5db3e2f_10, Figure 16