Dental insurance can be expensive. But small businesses can afford high-quality coverage. Most group dental plans (acquired through your employer) offer a 100/80/50 coverage formula: preventive care like cleanings is covered at 100%; basic procedures like fillings and extractions are covered at 70%; and major work like crowns is covered at 50%.
Employer Group Dental Plans
Dental insurance for small business plans typically comes in one of four types: dental Preferred Provider Organization (PPO) plans, Dental Health Maintenance Organization (DHMO) plans, Indemnity Plans, or Discount Plans. PPO plans have large networks of dentists that employees can choose from and often do not have deductibles or annual maximums for routine services. However, they usually have a copayment for procedures and a yearly maximum for major restorative services. DHMO plans have smaller networks of dentists and require that all services be provided by in-network providers to be covered. They also have deductibles and annual maximums for major services, although some products or procedures may have zero out-of-pocket costs. A best-in-class dental plan will offer more than just coverage and processing claims; it will support healthy employee behavior with tools and resources for better oral care at home and in the office. Look for a plan that has a trusted track record and focuses on customer service. Some insurance companies offer programs that wrap dental benefits into medical procedures, but this can cause unwanted disruption in employees’ lives and make managing all the different claims difficult.
Preferred Provider Organization (PPO)
A PPO (Preferred Provider Organization) is a managed care plan that works with healthcare providers and facilities. These providers and facilities contract with the insurance provider to offer services at discounted rates. This benefits the medical professional or facility and the plan participant, who can get maximum coverage and reduced costs by using in-network providers. Some PPOs also offer out-of-network care but at a lower rate and with greater cost-sharing. However, it’s important to note that PPOs usually have higher monthly premiums and deductibles than HMOs. Other managed care arrangements include exclusive provider organizations (EPOs), similar to PPOs. Still, with one important difference: they require that subscribers stick to their network of providers unless they need emergency treatment. In addition, some EPOs also require that subscribers receive a referral from their PCP before seeing specialists or going outside the network. Choosing between a PPO, an EPO and an HMO will depend on balancing the desire for flexibility with the plan’s cost.
Dental Health Maintenance Organization (DHMO)
DHMO plans are often the least expensive dental insurance options. They operate similarly to HMO health insurance and focus on preventive care. In a DHMO plan, you choose a primary care dentist who will be your first point of contact for routine visits and check-ups. They will also oversee referrals to specialists for care beyond routine dentistry. With these plans, you and the insurer share a percentage of the cost of covered services after you meet a deductible. Most DHMO plans do not have annual maximums, and you can typically find lower prices than PPOs on many procedures like fillings, root canals, and whitening. Indemnity or fee-for-service dental insurance offers more flexibility than other types of coverage but is usually the most expensive option for small businesses. You can choose any dentist with these plans, and the insurance company will reimburse you for some of your expenses.
Dental care can be expensive; without proper insurance coverage, a single procedure could cost thousands. This is why having supplemental insurance coverage can be beneficial for small businesses. A fully insured dental plan covers basic preventative services like dental exams and cleanings and a range of therapeutic procedures like fillings and crowns. These plans also usually cover orthodontic and oral surgery procedures. Providing employees access to these benefits can help drive employee satisfaction and retention. Indemnity plans offer flexibility not seen with other types of group dental insurance. These plans are not restricted to in-network providers; patients can choose any dentist they wish to see. The program will then cover a percentage of the cost based on a pre-determined fee schedule, giving employees greater predictability over out-of-pocket costs. Many people who do not have proper coverage end up with a false sense of security about their financial health, believing they can avoid paying for costly medical care by not going to the dentist. However, this can lead to serious problems down the line.
Dental insurance is an important benefit for many of your employees, and it can be a key factor in helping to attract and retain talent. While it can be expensive to provide, it’s an essential part of your overall employee benefits package. Considering group dental insurance, consider various options, including deductibles, annual maximums, and network availability. It’s also important to communicate clearly to your team about the types of dental insurance you offer and to make it easy for your employees to get the coverage they need.