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NEW ORLEANS—“The dental benefits industry is moving forward as the Affordable Care Act unfolds,” with a growing number of employers shifting toward self-funded plans and defined contribution approaches, “just as they’re doing with their health plans,” said Chuck Misasi, senior vice president at dental plan provider
Careington International Corp., at the 2013 EBN Benefits Forum and Expo, held Sept. 22-24, 2013.
Misasi noted that dental care is the second-most-requested employee benefit, after health care, and it, too, is being transformed. The following are among the major shifts:
“Employer dental contributions will continue to erode as voluntary dental becomes the norm,” Misasi said. “Private exchanges will be expected to provide a better buying experience, with more plan options, price transparency and comparison information.”
Among the options increasing in popularity, he said, are dental discount plans that use in-network-only providers, with lower out-of-pocket costs and no deductibles. These plans, which are either voluntary or employer-paid, may be more affordable for low- to middle-income employees.
Other options include indemnity plans with preferred-provider organizations (PPOs), and approaches that use health reimbursement arrangements (HRAs) to fund defined contribution dental plans. “A limited-purpose HRA can be used for dental and vision care,” Misasi noted. “Group plans can be purchased on an exchange with pretax dollars.”
Different options are increasingly available on dental exchanges such as
DentalInsurance.com. Dental plans can also be packaged with medical plans that are available on the
growing number of private health insurance exchanges run by benefits consultancies, brokers and insurance providers.
Another advantage of private exchanges is “they allow employees to search for a plan with a network that includes their dentist—if that’s their preference—or, conversely, to search for a new dentist who participates in a favored plan or who is located nearby.”
As new dental-plan designs and delivery systems emerge, “a low-cost, high-value, transparent and Amazon-like shopping experience will be in demand for dental and other benefits,” Misasi predicted.
Projected Dental Cost Trends: 2013 and 2014
Schedule of allowance plans (list of covered services with fixed-dollar amounts)
Dental provider organizations (DPOs)
Dental maintenance organizations (DMOs)
2014 Segal Health Plan Cost Trend Survey
Pediatric Oral Care: Now an ‘Essential Health Benefit’
The Affordable Care Act requires nongrandfathered, fully insured small group plans to provide 10 essential health benefits (EHBs), including pediatric oral health and vision services.
Small businesses that select medical coverage that includes the pediatric dental EHB can keep their current dental plan or opt for stand-alone dental coverage that excludes pediatric preventive care, explained
Jolynne Williamson, assistant vice president of group dental products at
Guardian, a dental benefits provider.
“There are a number of advantages to purchasing a stand-alone dental plan, rather than relying solely on the pediatric benefit that comes within a medical plan,” Williamson said. For instance:
The ACA defines a small employer as an employer having at least one but no more than 100 employees. However, it provides states the option of defining small employers as having at least one but not more than 50 employees in plan years beginning before Jan. 1, 2016.
Self-insured small group plans, large group plans, and grandfathered plans are not required to offer essential health benefits.
is an online editor/manager for SHRM.
Related External Resource:
Affordable Care Act, Dental Benefits Examined, American Dental Association
Related SHRM Articles:
Costs of Routine
Dental Services Vary Widely, Analysis Finds,
SHRM Online Benefits, October 2011
Tips for Evaluating
Dental Provider Networks,
SHRM Online Benefits, March 2011
Dental Benefits Undervalued Without Effective Communication,
SHRM Online Benefits, August 2009
Put New Teeth in Dental Coverage, Report Recommends,
HR News, March 2008
Related SHRM Resource:
Request for Proposal (RFP) - Managed
SHRM Online Health Care Reform Resource Page
Wellness Programs Resource Page
SHRM Online Outsourcing Resource Page
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