Many dental policies have reduced coverage for certain procedures resulting in higher out-of-pocket costs for plan members.
Are you aware of these coverage gaps?
In addition, there are unique benefits and provider networks available that improve access to dental care.
When selecting a dental benefit plan for your group clients, do you know what benefits and services you should you expect to have included? What kinds of dental benefits and services will protect your clients best?
Here is a look at important dental benefits and services to ask for when you are selecting your dental insurance partner.
US-Mexico Dental Network
Does your dental benefits plan automatically include both a US and Mexico Dental Network for all members and plans?
When we talk to benefits brokers and employers, we learn that a combined US-Mexico Dental Network provides employees in a variety of industries with more access to high-quality dental care from preferred provider locations at prices that fit members' budgets.
Complementing a US network, a Mexico Dental Network with contracted providers from Cancun to Guadalajara and all across the US/Mexico border can improve access for members and personalize the dental care experience.
When members visit a provider in a Mexico Dental Network, members should be able to just pay their copay or coinsurance as they do in the US.
Dental offices in a Mexico Dental Network should also be responsible for submitting a claim in English, using American Dental Association procedure codes, and billed in US dollars.
Each provider in a Mexico dental network should have passed regular equipment and office sterilization audits. This ensures that your members enjoy the same standards of care and patient protections in the U.S. and Mexico. Often Mexico contracted providers receive some of the highest audit results when compared to their counterparts in the US.
Unlimited Covered Dental Benefits
When considering dental insurance plans for your group, make sure you have a fully insured dental plan with no calendar year benefit maximum and robust coverage, so employees don't run out of covered benefits.
In recent years researchers have learned more about the connection between good oral health and total body health. Oral health has been linked to diabetes, heart disease, osteoporosis, pneumonia, and even fetal development. Dental benefits are about a lot more than just a great smile.
That's why ensuring that employees don't run out of covered dental benefits is good healthcare.
Off Renewal Dental Plan Changes
Secondly, it’s important for employees to have access to a Plan Change Benefit, so employees can move to a plan with no annual maximum if they exhaust their annual maximum on their current plan.
During the plan year employee members enrolled should be able to change from one employer plan to another, one time, off-renewal with no qualifying event required. We should expect this kind of flexibility.
4 Cleanings Per Calendar Year with Periodontal (Gum) Therapy
Your plan should also cover two regular cleanings and two periodontal maintenance cleanings (four cleanings during a calendar year) to prevent the need for more serious procedures. Those who have previously experienced gingivitis, or periodontitis disease are eligible to have two regular periodontal cleanings in addition to two regular cleanings.
The U.S. Center for Disease Control reports that pregnant women have a much higher instances of gum disease.* Pregnant women with diagnosed periodontal disease will also benefit from the additional periodontal maintenance cleanings.
Full Series Dental X-rays Every 3 Years
Often dental plans only cover full series x-rays every 5 years. Make sure your plan covers full series x-rays every three years so that the dentist can catch existing problems sooner, even oral cancer.
Full mouth dental x-rays (FMX) are an important part of your dental care. These radiographic images give your dentist a complete picture of your mouth, including your teeth, gums, and jaw bones. They allow your dentist to check for potential issues or plan treatment for an existing problem.
Implants Covered Standard
Your clients' dental plans should include implants covered standard. Many dental plans will require that you request that implants are included. There is often a premium load. Find a dental plan that includes implants without charging additional premium. Otherwise, your clients' employees may be responsible for the full cost of the implant out-of-pocket it is not a covered service.
Crown and Bridge Replacement Every 5 Years
As you design your dental plan, be sure that your plan covers the replacement of a crown every 5 years. Some dental plans are reducing this benefit to replacement every 10 years---Crowns can cost well over $1,000, the difference between 5 and 10 years can mean thousands of dollars out-of-pocket for employees.
Dental Implant Prosthesis Replacement Every 5 Years
Replacing the implant prosthesis that goes over the implant post is also costly. Ask your plan benefits administrator to include 5-year replacement for this service, rather than the 10 replacement years many insurance companies offer.
Dental/Partial Replacement Every 5 Years
Just like the services above, your dental plan design should include the 5-year replacement of worn or broken dentures and partial dentures. It is important to avoid benefits that only replace these prosthetics at up to 10 years.
Composite (white) Fillings on Molar Teeth
Many employees today want to have white, composite fillings in their mouth instead of silver ones due to health concerns. Unfortunately, many dental insurance plans do not cover composite fillings on back or molar teeth. They say it’s cosmetic. Don’t accept that. Insist that your plan cover composite fillings on molar teeth.
Sealant Frequency
Ask that your dental insurance plan covers sealants every 3 years, rather than once per lifetime. This allows you to make sure employees and their dependents can get new sealants after the old ones no longer provide protection.
Periodontal Scaling and Root Planing (Per Quadrant)
While it's far from the most enjoyable way to spend an hour, root scaling and planing is a necessary treatment for advanced gum disease. The early stages are called gingivitis, when bacteria living in the plaque along your gums release toxins. Those toxins trigger an immune response that leads to inflammation.
It’s important to be able to treat each quadrant of the mouth every 12 months if this service is needed. Many dental insurance plans only cover these services every 24-36 months, so be sure to ask before enrolling.
You have a choice in designing your dental benefits, so make sure you ask for these important benefits and services when designing your dental plans.
These dental benefits can add up to thousands of dollars in savings, improved access to dental care and much happier employer groups.
Please contact our team members if you'd like to learn more.
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