Put New Teeth in Dental Coverage, Report Recommends

By Kathy Gurchiek March 4, 2008

Employers looking to do a better job of managing costs associated with the dental coverage they provide—and possibly to add value to that coverage—should re-evaluate their plan design, suggest findings from a recent survey on dental benefits.

Analyzing dental claims and use can provide insight into which of the employer’s plan design changes are most likely to realize savings and help participants the most, according to a report by The Segal Group Inc.

The findings released February 2008 are based on a national survey Segal conducted during fall 2007 with 340 group health plans of its clients. Among those surveyed, 82 percent provide dental coverage.

Dental coverage is the third-most-utilized health care coverage. Medical and prescription coverage take the No. 1 and No. 2 spots, respectively, and dental health is linked to medical health.

“Sometimes the first sign of a disease shows up in your mouth,” says a report at MayoClinic.com.

“In other cases, infections in your mouth, such as gum disease, can cause problems in other areas of your body,” and conditions such as cardiovascular diseases, eating diseases and certain cancers may be linked to oral health, the Mayo Clinic reports.

The Segal report notes that pregnant women with gum disease have an increased risk for delivering pre-term, low-birth weight babies and that the mother may be at risk for coronary artery disease and stroke.

“Any dental plan type can include disease prevention measures,” which not only help participants prevent gum disease and manage their oral care but also might “identify potentially costly medical conditions early enough for individuals to take action,” Segal reports.

Among Segal’s recommendations to employers for making changes to their dental plans:

  • Review what dental procedures your plan covers, as well as coverage exclusions and limitations.
  • Use a dental network. Dental provider organizations and dental maintenance organizations are similar to health maintenance and preferred provider organizations; 54 percent surveyed use them.
  • Convert to a self-insured plan. Potential advantages include improved cash flow when claims are low; reduced administration fees; and avoiding state mandates and insurance premium taxes.
  • Lease an insurance company’s dental network.
  • Offer a scheduled design. It provides fixed maximum dollar coverage for dental expenses. Only 17 percent of plans Segal surveyed do this.
  • Update your dental schedule to avoid paying “inappropriate amounts” for procedures no longer considered relevant or to avoid paying for a low level of coverage.

Dental procedures are dropped and added to the American Dental Association’s procedure code list every year, Segal notes in its report. Also, the value of dental schedules doesn’t keep pace with inflation—a special concern for plans with a low level of coverage because excessive out-of-pocket costs for preventive care could cause people to delay that care.

The long-term result for postponing preventive care, the report said, can be high-cost, complex treatments.

Kathy Gurchiek is associate editor for HR News. She can be reached at kgurchiek@shrm.org.



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