Advantages of Offering a Dental Benefits Plan to Employees
Kinds of Dental Insurance Plans
Managed Care Dental Plans
Preferred Provider Organization (PPO) plans are plans in which the patient has to
select a dentist from a list provided to him. These dentists have agreed to
discount their fee by contract with the insurance company. Some PPO plans also
allow patients treated by dentists outside their list, where the patient is
penalized by excess co-payments and higher deductibles. PPO’s are normally less
expensive than indemnity plans in their class.
Keep
the following in mind while reviewing a PPO Dental Insurance Plan.
What is the percentage of the
premium used for administration?
Will the discount influence
patients to change their regular dentist? Will the amount of the discount the
dentist ahs to offer affect the number of treatment options for the patient?
What is the liability of the
employer in the event of the plan influencing dentist selection or treatment?
What are the criteria of
selection of dentists for the plan? Does it have adequate number of dentists
under contract? What is the geographic distribution of dentists? Does the PPO dental insurance plan provide for
specialist referrals? If so, are the dentists limited to a specialist on the
“list” only?
How does the plan provide for
emergency treatment? If so then how does the plan provide for emergencies
outside the geographical area?
Dental Health Maintenance Organization (DHMO) or Capitation
plans are designed
in such a way that the patient does not have any financial payout when he goes
for treatment. These plans pay the dentists on their “list” a fixed amount of
money monthly per enrolled family or individual, regardless of visits. In
return, the dentists provides specific types of treatment to the patients who
visit him at no charge, any other types of treatments require co-payment. This
way, the DHMO is rewarding dentists to keep patients in good health, thereby
keeping the costs low. This kind of plan is one of the least expensive.
Factors
to consider while reviewing a DHMO plan.
What is the percentage of the
premium used for administration?
Does the employer have access
to enough information for him to determine the level and amount of treatment rendered
to each of the employees?
What is the utilization percentage
for patients in this plan? Average waiting period for an initial appointment
and average period between appointments has to be given due consideration.
What is the dentist/patient
ratio for the DHMO plan? What is the criterion of dentist selection in the
program? What is the geographic distribution of dentists?
What percentage of dentists is
selected for from those who applied to participate? How many
dentists withdrew from the program in the recent past?
What is the rate of
compensation for the dentists? Is it sufficient compensation for the needs of
the covered patient population? What are the provisions made for dentists in
the event of unforeseen utilization?
What are the benefits for
patients needing a specialist's care? How are specialists selected and
compensated? Does the plan have adequate specialists?
Does the program provide for any
emergency treatment? If so, is it available outside the geographical area?
Fee-for-Service Dental Plans
Direct Reimbursement (DR) plan is a self-funded dental insurance benefit plan
which reimburses patients on actual spent on dental care. It is not based on
the type of treatment received. The patient has complete freedom in choosing
the dentist. The employers are liable to pay a percentage of actual treatment
cost, but they do not have to pay monthly premiums for employees who do not
need the benefit. Moreover the employer is free of any responsibility to take
decisions on mode of treatment due to previous plan selection or sponsorships.
Direct Reimbursement Dental Insurance Plan is American Dental Association’s
preferred method of dental coverage.
