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Dr. Jeffrey R. Leidy DDS
10 Dec 2019, 01:05:55 (2 days ago)
Employees nowadays are very much particular about the kind of benefits that they are offered.
Dental insurance is one employee benefit that is
considered to be very important in an employee's overall health plan. Employers are aware that dental problems can mean financial loss.
Dental problems and their treatments are low risk compared to almost all other
health conditions. This is the reason why offering a dental plan to your
employees is a sound decision. Dental health concerns can often be
prevented through prophylaxis and only involve minimal costs.
Once a dental problem is diagnosed in its early stage, treatment can immediately be administered.
Early treatment is considerably less expensive than treatment during advanced stages.
Financial factors are important considerations when deciding
on which health benefits are to be included in your employees health plans.
Dental insurance plans are the most cost effective of all the health benefits plan.
How to Choose the Right Dental Insurance Plan
There are a lot of factors to be considered when choosing a dental insurance.
But before we go through these factors let us 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 is comprised of several
details pertaining to the benefits that a company's employees will receive.
There are dental insurance companies that give partial reimbursements for dental expenses and exclude certain types
of treatments in their plans. A company looking a dental insurance company
should carefully sift through all the offers that they receive from various companies
to find one that will best benefit their employees. Choosing a dental insurance provider is similar to finding the right dentist for you and your family.
You have to consider several options before deciding on one
that best suits your needs and provides the best
A lot of plans do not cover dental conditions that have been existent before insurance
coverage was purchased. There are also plans that do not cover implants and
other procedures. These conditions may mean that dental treatment may only be paid
partially or an insurance parlance may be availed for
the Lease Expensive Alternative Treatment (LEAT).
Dental insurance companies have their own way of
determining the UCR level (usual, customary, and reasonable) for each
geographical area. Companies operating within the same geographical area may not necessarily have the same UCR level.
This means that the UCR level defines a patient's liability because
in some plans a patient may receive more benefits while in another plan he may
have to pay more. This all depends on the type of dental plan that is offered by the employer.
Some Important Questions to Ask Yourself Before Choosing a
Dental Benefits Plan
Ask yourself these questions as you evaluate your dental plan options:
Will you have the freedom to choose your own dentist?
Will you have a say in the type of treatment that will be administered?
Will routine and preventive dental care be covered?
Will it cover orthodontic treatment, oral surgery, placement of dental caps and crowns,
root canals, treatment of periodontitis and other dental
Will it cover services that are diagnostic and preventive in nature such as sealants
and fluoride treatments, and x-rays?
Will major dental care such as implants, dentures and treatment of temporomandibular joint disorder (TMJD) be covered?
Will specialist referrals be allowed? Will you be allowed to choose your own specialist or will your choice be limited to a list?
Will emergency services be covered? Will you be provided emergency provisions when on tour?
Will a large percentage of monthly premiums go into actual care and not into administrative expenses?
Every employee should carefully consider these factors before deciding on a dental plan. Additionally, when deciding on getting treatment, patients should consider their dental plan but not solely base their decision on it.
What are the Various Dental Insurance Plan Models?
There are two dental insurance plan models:
a. Managed Care
This type of dental plan is a restricted form of dental insurance which aims to reduce costs and
reimbursements. Coverage in this type of model is restricted, and
access to care if limited as a list of preselected dentists, specialists, treatments and hospitals
is provided. Types of treatments and their frequency are also limited and usually
indicated in the coverage policy.
This type of dental plan gives patients the freedom to
choose their dentist, specialists and treatments.
Fees are paid in full as determined by the service provider.
Types of Dental Insurance Plans
1. Managed Care Dental Plans
There are two kinds of plans under this type:
a. Preferred Provider Organization (PPO)
This is a plan wherein a patient can only go to a
dentist that is included in the preferred provider list provided by the insurance company.
In this agreement, the dentists in the list have agreed to give
the insurance company discounted pricing for the fees.
However, some PPO plans allow patients to choose their own dentists but are subject to penalties.
This type of plan is cheaper than other types of plans in this
Ask yourself these questions when evaluating a PPO
What percentage of the premium will be used for administration?
What effect will the discounts have on the decision for choosing a dentist?
How will the discounts affect the treatment options?
What will we be the liability of the employer when something happens to an employee in the hands of
a preferred dentist?
What are the factors considered when choosing a preferred
What provisions are given for emergency treatments?
Are there provisions for emergencies that will occur
outside the geographical area?
Does the PPO plan allow for specialist referrals?
Are the choices limited to a list of preferred specialists?
b. Dental Health Maintenance Organization (DHMO)
In this type of dental plan patients are not burdened with financial payouts
when availing of treatments. In this type of agreement, insurance companies
pay the dentists a fixed amount per month for
every individual or family enrolled, regardless of
whether or not they come for a visit within a month.
Then dentists provides certain types of treatments to enrolled patients at no additional costs.
For other types of treatments, co-payment is required.
DHMO plans encourage dentists to provide good service to
patients while keeping the costs low. This plan is considered to be the cheapest of all
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