OFFERING
SMALL BUSINESS DENTAL INSURANCE
You may have come to terms with
the health insurance plan and
carrier. Now the ancillary
benefit choices like dental and
vision come to the forefront.
These benefit types are not to
be taken lightly. Through years
of partial self funding
California health insurance
plans Employers have learned
that some between 50-70% of
their employee will not use
their health insurance plan, or
use it for just a single doctors
office visit or annual
physical. Why does this matter
to you and your company?
Because this means somewhere
between 50-70% of your employees
will not see the health
insurance plan as a benefit of
Employment at your company.
These employees, however,
statistically will be going to
the dentist and taking good care
of their teeth. A healthy
employee who never visits the
doctor therefore will value the
Employer sponsored Dental plans
much more so than the California
Small Group health insurance
plan.
Dental coverage is managed
differently than medical
coverage in the sense that it is
not underwritten based on dental
health history or condition.
Dental plans offer negotiated or
contracted rates for expenses,
which are based on schedules the
dental providers have agreed
to. The rate schedules are not
published to the public but your
pricing can be substantially
less expensive than someone who
walks into a dental office off
the street without coverage.
Since California dental
insurance is not underwritten
the way life or health insurance
is the insurance carrier must
place limitations on the amount
of benefits it can provide.
Unlimited coverage for expenses
would produce astronomical
premiums. Dental coverage in
its most popular form is PPO or
Indemnity type coverage paying
benefits in and out of network.
The fact that Employer Sponsored
Dental is subsidized for the
employees through tax deductible
premium contribution allows
Employees to gain real value
from the dental plan. If an
Employee has to pay the monthly
premium out of pocket the cost
benefit is reduced by the amount
of the total annual premiums.
Understanding Plan
Structure
Dental PPO plans usually follow
a common structure of
framework.
Deductible: An average plan
deductible per member is the $50
range.
Preventative Care: Most
often you will see cleanings and
diagnostics such as x-rays paid
twice per year covered at a
small co-pay or no cost.
Minor Services: The next
level above the preventative
care benefit is called minor
services where expenses like
fillings are covered. A common
benefit at the minor service
level on a mid-range plan is 80%
paid.
Major Services: Beyond
minor is the major expense
category including such
unpleasantries as root canals
and oral surgery. Major
services expense coverage can
vary dramatically but it is
common to see a percentage of
50% paid.
Annual Benefit Maximum:
Here’s where the rubber meets
the road. Annual benefit
maximums very commonly come in
three levels: $1000, $1500, &
$2000. Once you’ve
received the annual benefit
maximum limit on your plan you
pay 100% of the dental expenses,
not the dental insurance
company.
Dental Networks
It’s best to check with your
dentist or the provider lookup
for your dental office or
dentist to see if they accept
the dental plan you are
evaluating or enrolling. It’s
very possible they are
contracted with a limited set of
insurances or none at all. They
are all happy to bill out your
dental insurance carrier
utilizing the out of network
benefits.
