Of the possible group benefits offered by employers, employees often say Dental insurance is one of the most desirable benefits. And, for employers looking into adding to their benefit offerings, the predictable and relatively low premiums associated with Dental insurance make it an excellent option.
For a general comparison of plan types and features, see Dental Benefits Overview.
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. When evaluating carriers, also compare traditional plans to discount networks such as Dental Health Discount Benefits.
Whether planning to pay a portion of the cost of the coverage for employees or provide the coverage as 100% employee-paid, employers should know the answer to some questions before making a plan decision.
1. 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 the 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 also be scrutinized to make sure they provide the desired amount of provider choice. Employers should know the turnover rate for network dentists, whether specialty services such as pediatric dentistry, orthodontics, periodontistry, and endodontics are included, and whether any network restrictions apply to specialty services.
2. What are the covered and excluded services under the plan?
The employer will want to pay attention to what specific areas of service the plan will cover. For example, some preventive services pay for a teeth cleaning but exclude fluoride treatments or sealants. If orthodontic services are covered, they might exclude coverage for cosmetic procedures or for adult patients.
3. Will the plan provide coverage for pre-existing conditions and extended treatments that began before the effective date of the coverage?
Clarify whether waiting periods or exclusions apply to ongoing treatments started prior to enrollment, and whether any exceptions are made for in-progress procedures.
4. What percentage of the cost of the premium goes toward administrative fees and what percentage goes toward the payment of benefits?
Understanding the carrier's administrative loading and how much of the premium funds actual claims helps evaluate value. Ask for a breakdown or a summary of administrative fees versus claims payouts when comparing proposals.
5. Exactly how will service coverage be paid?
Employers need to know what rate services will be covered at. Take a plan that says it pays 100% on dental cleanings as an example: clarify whether that means 100% of what the serving dentist charges or 100% of the insurer's usual, customary, and reasonable (UCR) allowance. Differences in UCR schedules between companies can affect out-of-pocket costs for employees.
6. Are communication materials, IVR enrollment, online enrollment, and other forms of enrollment support offered by the Dental insurance provider?
Find out what enrollment and ongoing communication support the carrier provides, including employee materials, online tools, and customer service. Good enrollment support can improve participation and reduce administrative work for your HR team.
7. 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 a minimum participation rate for group pricing; others will offer a plan regardless of participation. Confirm any minimums before presenting the plan to employees.
With careful consideration, employers can pick a dental plan that meets both employee and company needs. Employers in dental-related industries may also want to review specialized offerings such as Dental Supply Wholesaler Insurance when relevant to their business.
If you want assistance comparing options or getting a price, talk to an agent.
Frequently Asked Questions
Does dental insurance usually cover routine cleanings?
Most dental plans cover routine cleanings, but coverage can vary on frequency limits and whether coverage is based on the dentist's charge or the insurer's allowance.
Are orthodontic services commonly included in employer dental plans?
Some employer dental plans include orthodontic services, often with separate lifetime maximums or age limits, while others exclude orthodontics or limit it to children only.
Can employees use any dentist with a group dental plan?
It depends on the plan type: PPO plans typically allow out-of-network care at reduced benefits, while HMO or network-only plans may restrict coverage to participating providers.
What should employers ask a carrier before selecting a plan?
Ask about provider networks, covered and excluded services, payment rates (UCR vs. billed charges), administrative fees, enrollment support, and minimum participation requirements.