While many employed adults have large group medical insurance plans, somewhat fewer have access to group dental insurance. Large companies are more likely to offer it than smaller firms, as well as to pay more of the premium cost, according to Dental Plans, a trade association. Those companies that provide coverage to their workforce may offer either an indemnity plan or managed care options.
Indemnity plans pay a set dollar amount for a menu of possible services, no matter what the dentist actually charges. So, for example, if the employee needs a root canal and the dentist charges $1,200, but the plan only allows payment of $800, the employee would be responsible for paying the balance.
Managed care can be a preferred provider organization (PPO) or a dental health maintenance organization (DHMO). The PPO plan has a list of dentists that have agreed to offer a discount to the participants, while the DHMO requires that employees obtain dental care from specific contracted providers. With these plans, the coverage often pays a portion of the cost. For example, if the worker is enrolled in a dental PPO and sees a participating dentist for a root canal, the plan might cover half the cost. However, if that dentist charges a discounted rate of $1000 instead of $1,200, the insurance will pay $500, and the patient would still be responsible for $500.
According to research conducted recently by two benefits providers, even for workers who have dental care coverage, there is a gap in usage and understanding of the offering. One study by Lincoln Financial Group showed that while most plans cover annual (or more frequent) check-ups and cleaning visits, many covered individuals aren’t using the offered benefit. Many of the people who responded said they needed more information from their employer about what is covered, plus a list of local in-network dentists.
The workers may simply not be aware that even though the plan has a deductible and a copayment, preventative care measures like cleaning and exams are offered at no charge. The other problem is finding dentists who “accept” the insurance, meaning that they are part of the network. That’s one reason employees are asking for more information.
Like medical insurance, dental coverage costs are on the rise. Some smaller companies have shifted the benefit from their core benefits to the voluntary group of options, leaving the employees responsible for the expense, but with the assistance that a group discount gives them. Employees may not be uniformly taking advantage of their dental insurance (going to the dentist is rarely at the top of the priority list until it rises for a reason). Still, it is a wanted fringe benefit for many.
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