A Smile Can Make Your Day
The Right Dental Plan Makes a Difference

by Michael Sigal
A smile can make your day. With consumers wanting more choice and flexibility from their benefit package, helping your clients select the right dental plan may be just the way to keep employers and consumers smiling and happy.
    Dental benefits are the second most requested specialty benefit after prescription drug benefits, and are the best selling. Yet, only about 50% of the United States population is covered by some form of dental benefit. A recent national survey indicates that roughly 40 million workdays are lost each year due to dental related problems. The right dental plan can help your clients improve productivity by reducing absenteeism caused by oral health problems and give added choice to their employees.
    Dental coverage has traditionally been offered via a health maintenance organization (DHMO), a preferred provider organization (DPPO), or through a traditional indemnity plan. A recent Mercer study revealed that employers will once again face double-digit increases for medical and specialty health product lines. As a result, you may find that more employers are choosing a DHMO or DPPO options for dental coverage.

Dental HMOs
DHMOs are similar to managed medical plans. Like a medical HMO, they focus on disease prevention through regular check-ups, education, and appropriate oral hygiene. Co-pays are limited and consumers select a practitioner from a network of providers. Referrals are required for specialty care. DHMOs offer lower costs for employers and employees. Consumers also get relief from filing claims and paperwork.

Dental PPOs
During the past several years, DHMO membership growth has slowed. Dental PPO programs have grown exponentially as consumers have sought more flexibility and choice within their dental plans. While PPO plans provide additional flexibility in choice of dental providers, they may have deductibles and coinsurance provisions and they are generally more costly to the employer and employee than a DHMO plan.

Dental-Choice Plans
Dental choice plans feature more expansive benefit options and flexibility than the standard dual choice between one plan and another. Choice plans work by allowing consumers to shift -- monthly if they desire – between a DPPO plan and a DHMO plan. Under a choice plan, employees are not locked into any one plan. They can get the economic benefits of a DHMO with low, fixed co-payments and no annual maximum or move to access a more widespread DPPO network with a limited annual maximum. Most DPPO plans also offer an out-of-network component that enables the member to see any licensed dentist.
    The benefits accrued within each product remain distinct to that plan, giving consumers the flexibility to get the most appropriate dental care. For example, suppose a consumer enrolls in a DPPO and reaches $400 toward a total $1,000 annual maximum. Later, the member decides to switch to the DHMO and use this benefit without a maximum. If a decision is made to switch back to the DPPO at some point during the year, the member will resume benefits at the same level (in this case, $600 in available benefits).
    Businesses gain from a dental choice plan as well. They get to respond to employee concerns about lack of choice, while saving money. Some dental choice plans are sold with blended rates, giving them a lower per member per month cost than a traditional DPPO plan.

All plans are not alike
When suggesting a dental plan for your customers, it is important to consider several factors:
1. Which plan makes the most sense? Some companies are better suited for a DHMO since they want to expand their health benefit offerings at a very minimal cost. Companies with a large number of employees who need significant dental work may want a DHMO since these plans do not require an employee to satisfy a calendar-year deductible or limit an employee to annual or lifetime benefit maximums. Choice plans may be good for employers that already offer both a DHMO and a DPPO and may be considering a shift from a DPPO to a more restrictive product offering. A choice plan provides an opportunity to test out employee use and satisfaction with a DHMO.
    Plan design is also critical. While almost all plans cover preventive care, plans vary on how they handle reconstructive and oral surgery and cosmetic dentistry. At first glance, some plans may seem "too good to be true" when it comes to cost by offering limited coverage for important specialty dental procedures. Savvy brokers look at the fine print of any plan.
2. What is the provider network like? In this era of increasing consumer demand for choice and access to services, one of the critical elements in selecting the right DHMO for your clients is its provider network. Plans with a broad network will give members options and help improve satisfaction with the product.
3. Is there administrative ease? Regardless of the plan, customers want the administration of their plan to fit their needs and be as simple as possible. Brokers should consider plans that offer the following:
• Multiple administrative options that include management by the plan, by the employer, or joint efforts.
• A single bill for both products
• Online access for consumers and clients to check eligibility, membership or change providers
• A single member services number for all questions regardless of product line
• Standard claim forms for both products to increase member and provider satisfaction
• Online access to information, health tips, claims data and other features for both employers and employees
    Brokers may also want to explore how the dental carrier interacts with the employers' health insurance company. Selecting a carrier that can integrate dental and medical benefits will give your clients additional administrative ease. Also, it could lead to added cost savings since certain oral-health problems require treatment from a dental professional and another medical professional. Integrating the two services can facilitate a more streamlined care management approach in these situations.
    In this era of consumer demand for choice, brokers encourage companies to offer dental benefits as a way to broaden flexibility in their benefit packages. From dental choice plans to DHMOs, dental benefits keep employers and employees smiling.
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Michael Sigal is a director with CIGNA Dental and has more than 12 years of dental sales experience. He has worked for a variety of dental insurers in California and can be reached at (714) 428-5661 or via email at michael.sigal@cigna.com.