Who Can Benefit From Group Dental Plans?

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Group dental insurance is typically offered through employers and may be a more cost-effective option than individual insurance. Typical coverage includes preventive visits and a range of treatment options.

Many plans have limits based on the plan administrator’s “usual, customary, or reasonable” fee schedule. These limits may or may not reflect area dentists’ fees for the same services.

Employees

Many employers offer dental insurance as part of their employee benefits package. While not necessary for every business, this type of coverage is essential to an overall health and wellness program. It helps employees manage out-of-pocket dental care costs and encourages routine dentist visits, which can help detect and treat minor issues before they become more serious.

The cost of a group dental plan varies based on the size of the company and the level of coverage and can be shared between employer and employee. Some programs may include no deductible for in-network preventive services and lower monthly premiums for those who visit in-network providers. Others may require a deductible and limit annual benefits.

Some dental insurance plans exclude certain conditions and treatment options, including whitening procedures, which may not be medically necessary for all patients. However, these limitations are only sometimes universal, and you should be able to find an insurance provider that offers a broad network of dentists, reasonable annual maximums, and no pre-existing condition exclusions.

Offering your employees access to affordable group dental plans for small business can give them peace of mind and make it more likely they’ll follow your other health and wellness recommendations. And because oral health is linked to overall physical health, it’s a good idea for everyone to have regular checkups and cleanings.

Employers

Group dental insurance is an essential benefit for employers because it incentivizes employees to care for their teeth and gums. Studies have also shown that oral health can impact overall physical health, so treating dental issues can help prevent more serious diseases.

Employers can select the right coverage for their business from a wide range of options, including different deductibles, coinsurance, and maximums. These options affect the bottom line; only you know what is best for your company. However, it would help if you constantly compare your choices to ensure you choose the best plan for your company.

Large group plans typically have the most comprehensive coverage, including major restorative procedures like crowns and bridges. These plans are designed for businesses with 50 or more employees.

Small and mid-sized group plans usually provide a more limited range of services but are still essential to offer. These plans are designed for businesses with between 25 and 100 employees.

Employers can choose from various dental plans to suit their needs, including Preferred Provider Organization (PPO) and dental Health Maintenance Organization (HMO) plans. These plans are similar to traditional health insurance, with a network of providers and a list of services the plan covers. They may have a lower premium but often require a copayment or fee for non-preventative visits.

Individuals

When evaluating group dental plans, individuals should consider their tolerance for cost-sharing and interest in a more extensive network of dentists. A dental Preferred Provider Organization (PPO) may be a good option if you prefer low cost-sharing and a lower monthly premium. A dental Health Maintenance Organization (HMO) may be better if you choose higher cost-sharing and a more comprehensive benefit package.

Some group dental insurance plans are based on a table or schedule of allowance that assigns a dollar amount to each procedure. The program then reimburses the dentist based on that fee. This is a “usual, customary, and reasonable” (UCR) fee. However, the fees charged by dentists can vary widely from one region to another. The result is that the patient is often balanced billed for the difference between the UCR fee and the dentist’s actual charge.

Other dental insurance plans are based on capitation or a predetermined payment to dentists. These are commonly referred to as Managed Care Plans. These typically offer a limited network of dentists and do not reimburse on a fee-for-service basis. However, they are less expensive than traditional dental insurance.

Families

Typically less expensive than individual dental insurance, group plans can help families reduce out-of-pocket costs. These plans often cover preventive care like cleanings and checkups to stop problems before they become more costly. Group dental benefits also cover major restorative procedures such as crowns and bridges.

The type of plan a family selects depends on their needs and budget. For example, a family may choose a project with a higher annual maximum to offset significant expenses. They may also select a plan to minimize out-of-pocket costs.

For clients with existing medical coverage, explore whether the group dental plan can be coordinated with their health insurance. Many QHPs offer a group dental benefit. In this case, your client can use the same benefits portal to find, view, and compare dental, vision, and medical benefits.

Group dental insurance is a policy that covers a percentage of the cost of preventive and restorative services for a set population, usually employees or members of an organization. Group dental insurance is generally less expensive than individual dental insurance and can be paid for via payroll deduction.