Dental Insurance
Why Employers Need to Offer Dental Coverage:
In an environment in which the labor force is shrinking and becoming more diverse, employers need a well-rounded benefit package to attract and retain top talent, and stay competitive
Routine dental care plays a significant role in helping you maintain good general health. This can be significant in an employer’s efforts to control health care costs in general
Though most people recognize the importance of preventative dental care, according to U.S. Public Health Statistics only two in five Americans visit the dentist each year. Dental insurance can be a necessary motivator for your employees to receive dental care
In most cases, dental insurance is only available through employer sponsored programs.
Why Employees Need Dental Coverage:
Routine dental care plays a significant role in helping you maintain good general health.
Routine dental care alone can be very costly if you have to pay entirely out of pocket.
FUNDING OPTIONS
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100% Employer Paid-Applies to group policies.
100% Employee Paid-Applies to voluntary policies. Premiums are eligible to be deducted pre-tax without creating tax consequence to employees at benefit time.
Partial Employer Paid-Also available for voluntary policies. Employers fund a specified amount for each employee.
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Group vs. Voluntary
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GROUP
Employer pays the premiums, i.e. employees may not contribute to cost.
Generally least expensive because the risk of loss to carrier is spread across a larger population.
A single bill is sent to the employer that covers all eligible employees.
Voluntary
Employee pays some portion, up to 100%, of premiums.
Rates are generally in three or four tiers depending on the number of dependents an employee wishes to cover.
Billing will show amounts for each individual, and will be sent to the employer.
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DENTAL DEFINITIONS
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Plan Year Maximum-The maximum amount the insurer will pay for any single insured person in a calendar year. This is most commonly $1,000 to $1,500.
Waiting Period-The amount of time a policy must be in force before benefits are available. This generally will not apply to preventative benefits such as cleanings.
Maximum Allowance-The most an insurer will pay for a specific service. This is a protection for insurance companies against paying more than they consider reasonable for services. UCR, or usual and customary, is another term that refers to a built in protection for insurers from paying more than is customary.
ADA Code- The number that identifies each service provided and billed by a dental provider. It is helpful to understand how dental services are billed, especially when trying to identify what your out-of-pocket costs are prior to receiving care.
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