A
frequently overlooked reason for employee absences or poor
work performance is dental disease or discomfort. And as every
human resources professional knows, days lost can mean money
lost. In addition to promoting oral health, a quality dental
benefits plan can aid in the recruitment and retention of
employees. Dental benefits are consistently cited as one of
the most sought after employee benefits.
Ask
yourself the following questions before selecting a new dental
insurance plan:
1.
Will
employees retain the freedom to choose their own dentists?
2.
Is
the type of treatment determined by the patient and the
dentist?
3.
Does
the plan cover diagnostic, preventive and emergency services?
Will it cover preventive services such as sealants and
fluoride treatments, which may save patients money in
the future? Will it provide for full-mouth x-rays?
4.
What
type of routine dental care is covered? Does the plan
cover crowns and bridges, braces, root canals, oral surgery
and treatment of periodontal diseases.
5.
What
major dental care is covered? Does the plan cover dentures,
implants or treatment for TMJ disorders?
6.
Will
the plan allow for referrals to specialists? If so, will
the dentist be limited to a list of specialists from which
to choose?
7.
How
does the plan provide for emergency treatment? What provisions
are made for emergency care when you are away from home?
There
are numerous models of dental plans. In general, they can
be divided into two categories: fee-for-service and managed
care.
Fee-for-Service
Dental Insurance Plans are typically freedom-of-choice
arrangements under which a dentist is paid for each service
rendered according to the fees established by the dentist.
Managed
Care Dental Insurance Plans are cost containment systems
that direct the utilization of health care by a) restricting
the type, level and frequency of treatment; b) limiting the
access to care; and c) controlling the level of reimbursement
for services.
Texas
Dental Insurance Plans
Which Plans Work For You?
INDEMNITY
Dental
HMO type plans
Use
the dentist of your choice.
Use
a participating dental office.
Monthly
rates:
$20-35/single
$50-90/family
Monthly
rates:
$5-18/single
$10-35/family
Waiting
periods:
6 month for basic services, can be eliminated for self-employed
people.
- 1 year for major services
Many
plans have no waiting periods; some plans have a six
month wait for crowns and dentures.
Deductibles:
$50-150 per year
No
Deductibles.
Maximum
Benefit Per Year:
$1000 - $1200
No
Annual Maximum Benefit Limitations.
Claims:
Dentists charge usual fees and submit claims to insurance
carrier, which pays a percentage of the allowable covered
charges.
No
claims to file. You pay the reduced fees the dentist
has contracted to accept with the plan.
Typical
benefit plan:
80% or 100% - Preventive services
80% - Basic services
50% - Major services
Healthcare Consultants can assist you in setting
up and administering a Group Dental Insurance Plan as
part of an overall benefits program for your firm. Please
call an HCI America consultant at 713-626-2838 or click
to email.
