Group Dental Insurance

At a Glance
Dental insurance helps pay for dental care and preventive treatment. Group dental frequently comes bundled with group medical coverage. However, it is also available on a purely voluntary basis in which the premiums are fully paid by the employee.

Most managed-care dental plans are organized around a network of providers. Employees may go outside the network if they are willing to pay more out of pocket.

Generally, dental insurance costs less than 10 percent of medical insurance: $1,000 to $1,500 per employee, with the employee typically paying from 50 percent to 75 percent of the premiums. Businesses frequently set up flexible spending accounts (FSAs) or health spending accounts (HSAs), so employees can pay for services with pretax dollars.

Do I need to Offer Dental Insurance?
Dental insurance is not mandated by regulation. So unless you are obligated to provide this coverage through an agreement with your employees (such as a collective bargaining agreement) you are not obligated to provide dental insurance.

Human resources experts, however, consider group dental coverage one of the must-have employee coverages. More than 80 percent of small businesses offer it, according to the Society for Human Resources Management.

Why It's Important to Employees
Employees value dental insurance for a variety of reasons. Here are three of the most common reasons:

1. To Pay For Costly Care. Dental care can be a simple cleaning and x-rays. Or, it can involve costly orthodontic care to crowns and oral surgery. Dental insurance generally pays all or a portion of the charges related to these services.



2. To Maintain A Healthy Mouth. Studies show that regular dental check-ups and cleanings help maintain a healthy mouth. That's why many insurance planscover check-ups every six (6) months. Some will even pay for a check-up immediately after coverage becomes effective.



3. To Protect Their Children. Younger family members will benefit from regular professional dental care. Dental insurance can be a very affordable way to protect against the cost of regular check-ups.

More Information
Here's a brief summary of the main forms of dental insurance available in today's market.

Dental Health Maintenance Organization (DHMO)
Typically, the least expensive of type of plan. All services are provided by professional dentists who agree to provide specific treatements and services to patients at no charge. Some services, however, may require a co-payment.

DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.

Indemnity Plan
Indemnity plans typically allow the patient to go to the dentist of their choice. These plans generally pay a portion of the dentist's fee or a set dollar amount (usually, whichever is less).

Payments may be made to the insured member or, by assignment, directly to the dentist. If there is a difference between the amount paid and the dentist's full charge and the amount paid, the individual is generally responsible for the difference.

Preferred Provider Organization (PPO)
Through a PPO plan, each individual selects their dentist from a network of dental providers who have agreed by contract to reduce their fees. As a result of this fee agreement, PPO plans are generally less expensive than indemnity plans.

Individuals are allowed to obtain treatment from dentists outside of the PPO (out-of-network or non-participating dentists). Services provided by out-of-network providers, however, are generally subject to higher deductibles and/or co-payments that are paid by the indivdual.

Scheduled Benefit Plan
A scheduled benefit plan reimburses the insured for a specific amount based on a fee schedule. Any additional amount charged by the provider is the responsibility of the insured. For example, if the insurance reimburses $47 for a cleaning, and the dentist charges $60 for a cleaning, the insured would be responsible for the difference of $13.

Scheduled benefit plans typically include a calendar year maximum, a deductible and waiting periods on certain procedures.

When coverage is issued, the insured receives a schedule showing every covered procedure and the amount that will be reimbursed for each procedure.

Discount Cards
Discount cards are offered as a way to lower the out-of-pocket cost of dental care. They are not insurance, and simply allow for the patient to obtain discounted fees on services provided.

These cards are attractive for companies that do not want to incur the cost of a group dental plan, but want to provide some level of dental support for their employees. The cost of the discount cards is not significant.

Which Plan is Right for My Company?
Each of the above plans has merit - it depends on the specifics of your employee population, budget and benefits strategy.

Do you want to see if you can get a better price on your group dental plan? Or are you ready to add group dental to your employee benefit program?

Either way, we're ready to help. Consult with a Marsh SBI Insurance Representative to determine the preferred plan for your company.