Oral health offers many clues to overall health. Not only can poor oral health lead to the obvious problems like tooth decay and gum disease, it can also lower the body’s resistance to infection, contribute to heart disease, and even may be linked to certain cancers and rheumatoid arthritis. Of course, any one of these can lead to missed time at work and significantly impact productivity.
Dental insurance plays a key role in employee benefits packages—not only in preventing issues associated with oral health, but also by boosting employee morale and providing a sense that the employer cares about employee well-being.
Many plans will cover exams and cleanings twice per year, which may or may not be subject to a deductible (generally called ‘Type I’ services). ‘Type II’ or ‘Basic’ services usually include fillings and other minor procedures, while ‘Type III’ services usually include restorations, crowns, oral surgery, and more.
Typically, plans cover Type I services in full, Type II services at 80 percent, and Type III services at 50 percent. There are annual maximums usually ranging from $1,000-3,000 of benefits paid. Orthodontia coverage for both children and adults is also available.
Additionally, the employer can designate assignment for services to specific type categories. This increases employee coverage for certain procedures, but it also increases the premium to the employer.
Employer-paid dental insurance is just what it sounds like: the employer pays the entire premium for the employee. The employer may also opt to share the premium expense with the employee, as they often do with medical premiums. With the cost of benefits rising at a rapid pace, employers may opt to make their dental plan voluntary and completely employee-paid (‘contributory’). These plans usually have benefits that are less robust than employer-paid plans due to the likelihood of adverse selection. In order to save on premiums, an employer may also choose to self-fund their dental plan. In this case, a TPA is usually hired to facilitate eligibility and claims.
Please allow us to illustrate which plan may make the most sense for your organization.