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Benefits of offering a dental benefit plan to employees

 Dental insurance or a dental benefit plan is considered a highly sought-after benefit for employees. Therefore, it makes financial sense to have a dental benefit plan in place to recruit and retain employees.

 In addition, dental health is a very important part of an employee's overall health, and many days lost due to an employee's dental problems or ailments represent a financial loss to the employer.

Unlike most medical conditions, dental diseases and treatments are low-risk, predictable, and inexpensive. These factors help to offer dental insurance to employees as a good economical option. 

Dental disease can be prevented with maintenance and often only involves maintenance costs such as x-rays and examinations. Due to the diagnosis in the early stages of the disease, treatment is inexpensive. 

With these financial factors in mind, dental insurance options can also be self-financing. History shows no extremes in the cost or use of this form of employee compensation.

Choosing the Right Dental Insurance

Choosing the right dental plan involves many factors that must be carefully considered.

Dental insurance is an agreement between the employer and the insurance company. Most plans offered by dental insurance companies allow for partial reimbursement of the cost of dental work. 

Many tariffs also advise against certain types of treatment or allow access to certain dentists. To take these points into account, you need to go through the plan very carefully and with great care. For example, choosing a dentist is not the same as choosing a "list dentist," or if the plan doesn't cover a treatment, it's wrong to conclude that your regular dentist is incompetent.

Many plans do not cover pre-existing medical conditions. Some may not cover implants etc. Due to these conditions, it is possible that the final treatment is only partially paid for or, in insurance jargon, that the LEAT (rented expensive alternative treatment) is reimbursed. 

Dental plans differ in how they determine the UCR (customary, customary, and reasonable) in a given geographic area. The UCR can vary from plan to plan and from company to company even though they operate in the same area. Therefore, establishing this UCR level would define the patient's responsibility. 

With some plans, the patient may have to pay more, with others, they may have to pay less, depending on which plan the employer offers.

Important factors when purchasing dental insurance

An employee should ask themselves the following before finalizing a plan:

• Would employees like to retain the freedom to choose their dentist?
• Is the type of treatment determined by the patient and the dentist?
• What routine and preventive dental care is covered? 
• Does the plan cover braces, oral surgery, crowns and bridges, root canals, and periodontitis treatment?
• Does the plan cover all diagnostic, preventive, and emergency services? 
• Including preventive services, H.sealants, and fluoride treatments, which could result in future financial savings for the patient. Are you expecting a full X-ray of the mouth?
• What types of major dental procedures are covered? 
• Does the plan cover implants, dentures, or treatment of TMJ disorders?
• Does the plan allow referrals to specialists?
•  If so, was the dentist limited to "the" list of specialists to choose from?
• Are emergencies included in the plan? 
• What are the arrangements for emergency care when the patient is on tour?
• What percentage of the monthly premiums go to the actual care and not to the administration?

Dental insurance coverage should be considered, but should not be the deciding factor in the choice of treatment.

Dental Insurance Plan Templates

There are numerous dental tariffs. There are two kinds:

Managed Care and Fee for Service.

Managed Care dental plans are limited forms of dental insurance designed to reduce costs and payments. They tend to limit coverage by restricting access to healthcare through restrictions (by a predefined dentist, specialist, hospital, or treatment lists) and by restricting the scope, type, and frequency of treatment (usually in the form of clauses in the insurance policy).

Paid Dentist Plans offer free choice options where one can choose their dentist and the fee is paid by the dentist.

Types of dental insurance

Managed care dental plans

PPO (Preferred Provider Organization) plans are plans that require the patient to select a dentist from a provided list. These dentists have agreed to reduce their fees through a contract with the insurance company. Some PPO plans also allow patients to be treated by unlisted dentists, penalizing the patient with excessive co-payments and higher deductibles. PPOs are typically less expensive than compensation plans in their class.

Consider the following when considering a PPO dental plan.

• What is the percentage of the premium that is used for administration?
• Will the discount encourage patients to change their usual dentist? 
• Does the amount of discount the dentist gives affect the number of treatment options available to the patient?
• What is the employer's responsibility if the plan affects the choice or treatment of the dentist?
• According to what criteria are the dentists selected for the plan? 
• Do you have a sufficient number of contract dentists? 
• What is the geographic distribution of dentists? 
• Does PPO Dental Insurance offer referrals to specialists? 
• If so, are dentists limited to just one “list” specialist?
• How does the plan provide for emergency treatment? 
• If so, how does the plan address emergencies outside of the geographic area?

Dental Health Maintenance Organization (DHMO) or per capita rates are designed so that the patient does not receive any monetary payment upon receiving treatment. These plans pay dentists on their "list" a fixed monthly amount of money per enrolled family or individual, regardless of visits.

 In return, dentists offer certain types of treatment free of charge to the patients they see, all other types of treatment require a co-payment. In this way, the DHMO rewards dentists for keeping their patients in good health, thereby keeping costs down. This type of plan is one of the cheapest. factors to consider when reviewing a DHMO plan.

• What is the percentage of the premium that is used for administration?
• Does the employer have access to sufficient information to determine the level and scope of treatment for each worker?
• What is the occupancy percentage for patients in this plan? 
• The average wait time for a first appointment and the average length of time between appointments should be given due consideration.
• What is the dentist/patient ratio for the DHMO plan? What are the selection criteria for dentists in the program? 
• What is the geographic distribution of dentists?
• What percentage of dentists are selected among applicants? How many dentists have recently withdrawn from the program?
• What is the remuneration for dentists? 
• Is the compensation sufficient for the needs of the insured patient group? 
• What precautions are there for dentists in the event of unforeseen claims?
• What are the benefits for patients who need specialist care? 
• How are professionals selected and paid? 
• Does the plan have enough specialists?
• Does the program offer emergency treatment? 
• If so, is it available outside of the geographic area?

Paid Dental Plans

The Direct Reimbursement (DR) plan is a self-funded dental insurance benefit plan that reimburses patients for the actual cost of dental work. It is not based on the type of treatment received. 

The patient has complete freedom in choosing a dentist. Employers are required to pay a percentage of actual treatment costs but are not required to pay monthly premiums to employees who do not need the service.

 In addition, the employer is relieved of any responsibility to make treatment-type decisions based on prior plan selection or sponsorship. The Direct Reimbursement Dental Insurance Plan is the preferred dental insurance method of the American Dental Association.