Of the possible group benefits offered by employers, employees often say Dental insurance is one of the most desirable benefits. For employers looking to expand benefit offerings, the predictable and relatively low premiums associated with dental plans make them an attractive option.
Employers should comparison shop for a carrier offering a dental insurance plan that’s applicable to the needs of their workforce and a good value; for an overview of plan types and options, see Dental Benefits Overview.
Whether planning to pay a portion of the cost of coverage or offer a 100% employee-paid plan, employers should know the answers to some specific questions before making a decision.
What dental service providers will be allowed?
The employer should find out if the plan has a preferred network of dental providers and how the network affects coverage. For example, if dental care is received outside the preferred network, some plans will pay nothing; some will pay a reduced benefit; and others will pay regardless of the provider but have discounted network providers available.
Plans that have a preferred network should be carefully reviewed for provider choice and turnover. Employers should know the turnover rate for the network dentists and whether the network includes specialty services such as pediatric dentistry, orthodontics, periodontics, and endodontics. For more on choosing plans tied to provider types, see Dental Clinics and Offices Insurance.
What are the covered and excluded services under the plan?
Employers will want to pay attention to which specific services the plan covers. For example, some preventive services pay for a teeth cleaning but exclude fluoride treatments or sealants. If orthodontic services are covered, plans might exclude cosmetic procedures or limit adult coverage. Employers should also compare whether the plan includes discount or savings options such as Dental Health Discounts Benefits as an alternative or supplement.
Will the plan provide coverage for pre-existing conditions and extended treatments that began before the effective date of coverage?
Confirm any waiting periods, exclusions, or limits on treatments that began prior to enrollment so employees know what to expect for continuity of care.
What percentage of the premium goes toward administrative fees versus the payment of benefits?
Ask the carrier for the plan’s funding breakdown so you understand how much of the premium is allocated to administration, commissions, and claims.
Exactly how will service coverage be paid?
Clarify how the plan defines payment levels. For example, if a plan says it pays 100% for dental cleanings, determine whether that means 100% of the dentist’s charge or 100% of the insurer’s usual, customary, and reasonable (UCR) allowance. Comparing UCR allowances across carriers can make a significant difference in the quality of coverage.
Are communication materials, IVR enrollment, online enrollment, and other enrollment support offered by the dental insurance provider?
Enrollment support can affect take-up rates and administrative burden. Verify the provider’s communication options and any associated costs.
Will the plan require a specific amount or percentage of employees to enroll if the plan is offered as a 100% employee-paid benefit?
Some carriers require minimum participation to offer group rates. Confirm any enrollment thresholds before offering the benefit.
With careful consideration, employers can pick a dental plan that meets both employee and company needs. One of our insurance brokers can also be beneficial in helping to come up with a checklist of considerations when comparing dental plans and carriers, or you can talk to an agent.
Frequently Asked Questions
Does dental insurance cover routine cleanings and exams?
Most dental plans cover a percentage or full cost of routine cleanings and exams, but coverage details and frequency limits vary by plan.
Are orthodontics usually included in employer dental plans?
Orthodontic coverage is optional; some group plans include it for children, adults, or both, while others exclude orthodontics entirely.
Can employees keep their current dentist under a group dental plan?
That depends on whether the dentist is in the plan’s network; out-of-network coverage and payment levels will vary by carrier.
How do waiting periods affect coverage for major procedures?
Many plans impose waiting periods for major services like crowns or bridges, so check timing and any pre-existing condition rules before enrollment.