I want to start off by talking about why maintaining good oral health is so important for all of us. If not taken care of, your teeth can have an adverse effect on other areas of your overall well-being.
I want to make sure you understand this point. Offering Dental Insurance as part of your company’s employee benefits plan will help you in the long run.
Good or bad oral care can directly affect overall health. When your employee’s health requires a claim against your company’s Group Health Insurance Policy it can drive up your Group Benefits Rates. Did you know that heart disease and diabetes can affect you or your employees, and these diseases can have a direct correlation to oral health?
What do heart disease and diabetes have in common with oral care?
When bacteria builds in the mouth, a condition called periodontitis – which is an infection of the gums – sets in . When the condition is serious the inflammation it causes has been shown to have a direct, negative effect on the bodies ability to control blood glucose levels. The inflammation that results from periodontitis also is a factor in the progression of diabetes.
Another major problem associated with bad oral health and periodontitis doctors are now strongly recognizing, and that is that gum disease and heart disease are indeed directly related. It is a fact that 91% of patients with heart disease also have periodontitis. Inflammation in one part of the body such as the mouth can throw off the balance of your body’s natural defenses.
You Can Lower Group Benefits Costs by Providing Dental Insurance
One could make a strong argument that good oral health can cut down and reduce large medical claims. Good dental care can also reduce the possibility of an avoidable illness throughout the years.
Unfortunately, very few people make the connection between improper dental care and its contribution to the onset and progression of diabetes and heart disease, but it certainly does. Brushing twice a day and flossing once a day is something we all must do in conjunction with regular routine dental exams and treatment.
Here’s the bad news when it comes to dental health in our state and why it is imperative that we provide good dental coverage here at home.
The top five states with the worst dental health scores, starting with the worst, are:
- Mississippi (88.4)
- Louisiana (74.6)
- West Virginia (70.2)
- Tennessee (67.0)
- Alabama (62.4)
As a state, we need to do better.
I need to be completely honest and I want to make one thing clear when talking about dental insurance.
No dental insurance plan is going to cover absolutely everything. There will always be some out of pocket expenses when dental procedures are needed.
The question one must ask oneself is this; Is the price paid towards the insurance in a year worth the amount of what it will save me in dental bills? Most often the answer is an overwhelming yes and the benefits and savings are huge. If you have healthy teeth and only need a cleaning once or twice a year then maybe dental coverage isn’t for you and you should just pay for these services. But what if something appeared out of the blue and you had no coverage? Then it’s too late.
I would like to now explain how to decipher the way most dental plans are designed.
UCR – What is it?
It stands for usual, customary or reasonable fee.
The “usual” fee is the amount a dentist will charge for a particular procedure. The “customary” fee is what the insurance company will pay for any given procedure. The “reasonable” fee may differ from the first two and takes into consideration any complications of severe and unusual cases. What does this mean when picking a dental plan? All plans pay claims based on a percentage of determined UCR, the location of where the plan is being used has its own calculated numbers for UCR. The higher the percentage of UCR the plan pays then the better the plan will pay out towards services rendered.
The most common plans on the market have always been what I like to refer to as 100, 80, 50 plans.
In this basic illustration, Preventative Services pay 100% on exams and simple cleanings, sometimes x-rays are included. Basic Services include 80% coverage for fillings and extractions, often root canals are covered in this category, which can be quite expensive.
Here in Mississippi, a root canal on average costs roughly $600 -$800 dollars. Major Services would pay 50% on things such as dentures, partials, bridges, and crowns. With these plans, there will typically be a twelve month waiting period and an annual max benefit of usually $1000 to $2000 per year per member.
Although these plans have always been the standard, today new plans without waiting periods are becoming more commonplace. Annual deductible charges usually apply to any services other than preventative.
Waiting periods are simply another way of putting a pre-existing limitation of coverage on paying for services. In order to keep claims versus premium out of the red as much as possible the more expensive procedures are not covered until the insurer has had ample time to collect some offsetting premiums. Dental providers do this to help keep rates stable. These plans are customizable in many ways.
Dental Coverage for Braces
Orthodontic treatment (braces) coverage can be added as what is called a “rider” or option. It may sometimes be a part of or embedded in the plan contract itself. Most often it is limited to 50 percent, up to 1000 dollars. This coverage is for children. Dental coverage for adult orthodontics is usually not available.
Discount plans which are not insurance may help some with that perhaps. There will be many procedures associated that will be covered along the way. Although 1000 dollars is not going to cover braces it still will help a great deal when considering the price for the coverage.
Now let’s discuss how much variation there is when looking and comparing prices with different dentists.
Why is this important when you have coverage?
Because your coverage is limited and finding the lowest prices will allow you to have more work done before your plan maxes out for the year. The differences for the same procedures when checking with different providers are huge!
I tell my customers to make sure to take advantage of their free dental exam included in their plans. When you are done, make sure you get all procedure codes that relate to the needed recommended treatments along with their estimate. Having these procedure codes is what you will need to shop prices with other providers.
Ask other dentists what they charge and you may be very surprised in how you can increase your benefits by going to different places to save. Some people wouldn’t go to anyone but the dentist they have had, I understand that and it is up to you.
However, I am all about saving money for me and my family. If a dentist’s office has marble and leather chairs with TVs and all the pampering then you will pay for it. It’s great that they want to make you so comfortable, but let me ask you a question.
Why would you want to pay for anything but straight quality dental care and expertise?
Network preferred providers are dentists who have agreed on set prices and will give you the best price for service. When choosing a dental plan having many preferred providers in your area is something to strongly look at before making a decision on a company and its plans.
Your dental coverage will not live up to its potential without these cost saving providers.
Because dental plan benefits start over on each anniversary, it is a good idea to plan needed dental procedures for the year based on that year’s maximum annual benefit. Once you have planned your current year benefits usage try and delay future treatments for when the benefit dollars are replenished for the next year.
It is wise to keep track with providers on how much benefit you have left for the year so you don’t go over each time you visit.
Dental rates and contracts are always based on an annual term. Unfortunately, yearly increases are common when it comes to dental rates. If an employee buys an accident plan or cancer plan they don’t intend on using it. When that same employee buys dental coverage they are going to use it. While we want our employees to use their dental coverage to their heart’s content, we must also keep in mind it can and will go up at some point in the future.
What can your business do to keep price increases down for Dental Insurance?
The thing to do is have an agent that can offer many quotes each year to explore all options of price reduction by switching to other companies when necessary. Dental insurance companies can also do something called a takeover where any waiting periods are waived by the length of time spent on their previous plan. This eliminates having to wait once again for major services to be covered.
In summary, it’s sad for me to say that Mississippi is the worst in the nation for dental health. We have looked into the correlation between medical issues such as heart disease and diabetes which our state is also sadly at the bottom of the barrel when compared to other states.
You can make a difference by supplying your employees with what you can consider as the best possible coverage available.
Having an agent that can offer more than just a one or two options of companies can help greatly in ensuring that you are doing your best for your people’s smiles and their health.
For more information on how oral health impacts overall health you can read the Mayo Clinic’s article Oral Health: A window to your overall health.
For more actionable information on how to lower your company’s Group Benefit’s rates see our article, Strategies To Lower Group Health Insurance Rates.