choosing the best program can be a bit of a balancing act. The challenge of achieving this balance is made more difficult when you consider the options available in the dental benefits marketplace today.Dental carriers typically offer one or more of three basic types of plans:
1. Fee-For-Service (or Indemnity) Plan
The original dental benefits plan and the one which continues to dominate the market is the fee-for-service plan. Under this type of plan, employers and/or their covered employees pay a monthly premium to an insurance carrier, which is responsible for reimbursing dentists for the services they provide. Fee-for-service plans allow employees the most freedom in choosing their dentists, which is why they remain a popular choice. If the main concern for you or the employees you’re covering is the ability to choose a certain dentist, a fee-for-service plan is probably your best choice.
2. Dental PPO
Dental preferred provider organizations (PPOs) are a good option for groups seeking lower cost advantages while providing enrollees with a high level of freedom of choice in selecting providers. Enrollees have the freedom to visit any dentist who is part of a network
|Preventive Care Usually Includes:|
- Annual bite wing x-rays.
- Semiannual cleaning, polishing, and possibly semiannual fluoride.
- Treatment for employees and their dependents 18-years-old and younger.
Basic Dental Care Includes:
- Restorations and basic oral surgery.
Major Care Includes:
- Crowns, root canals and prosthetics.
- Complex restorations and advanced oral surgery.
established by the dental benefits company or, for higher out-of-pocket costs, can visit any non-network dentist.
3. Dental HMO
Dental health maintenance organizations (DHMOs) give subscribers access to a select group of dentists, with even greater cost savings. This type of program is a good choice for groups seeking lower costs with an emphasis on prevention and a pre-selected network of dentists from which to choose.
Whether it’s a fee-for-service, PPO or DHMO plan, coverage of specific services can vary. Some dental benefits programs cover diagnostic and preventive services only. Others cover the full range of dental services, from preventive to basic and major care. (See right-hand box.)
Riders: Many insurers also offer riders for popular extras, like coverage for orthodontics or cosmetic dentistry. For a little additional cost, riders enable you to customize or supplement a basic dental benefits package.
In the end, finding the right dental benefits program is a combination of many factors. In addition to matching a plan with your company and employees, look closely at other issues such as cost management, rate stability, the network of participating dentists, ease of administration, customer service and company reputation.
Knowing what to ask and how to communicate your company’s wishes makes it more likely your dental insurance will do what it’s meant to do — attract good employees and help them preserve their oral health.
IMPORTANT: A great value is a discounted dental plan. Our very own Bonus Card extends the Aetna Dental Access PPO negotiated rates to members. There are NO pre-existying conditions, NO annual deductibles & NO annual maximums. Cosmetics such as orthodontia and implants are covered. The Bonus Card also covers Vision with Coast to Coast, Rx discount and Telemedicine for $10/month!
Sample Discounted Fees and Savings
|Procedure Description||Usual Fee||Discounted Fee||Member Savings||% Savings|
|Routine 6 Month Check-Up|| $43|| $24|| $19||44%|
|In Depth Check-Up|| $69|| $37|| $32||46%|
|Full Mouth X-Rays|| $114|| $65|| $49||43%|
|Four Bitewing X-Rays|| $55|| $25|| $30||55%|
|Panoramic Film|| $97|| $50|| $47||48%|
|Adult Teeth Cleaning|| $83|| $44|| $39||47%|
|Child Teeth Cleaning|| $62|| $32|| $30||48%|
|Protective Sealant / Tooth|| $46|| $26|| $20||43%|
|1 Surface White Filling|| $135|| $71|| $64||47%|
|Single Crown Porcelain|| $981|| $566|| $415||42%|
|Molar Root Canal Treatment|| $919|| $522|| $397||43%|
|Perio Scaling and Root Planning|| $217|| $123|| $94||43%|
|Full Upper Denture|| $1,353|| $725|| $628||46%|
* Actual Costs and savings vary by provider and geographical area. * Dental benefit not available to Vermont residents.
Insurance Versus Dental Cost Examples
The following is a comparative example between a typical insured dental plan versus the Aetna Access Dental discount plan. This illustrates the possible out of pocket costs for each.
|First 12 Months Premium (Family)|| $627.12|
|Adult Cleaning|| $5.00|
|Child Cleaning|| $5.00|
|Routine Check-Up|| $5.00|
|Four Bitewing X-Rays|| $5.00|
|Composite (white) Filling|| $10.00|
|Molar Root Canal|| $855.00|
|Extraction (single tooth)|| $11.00|
|Total Insurance Charge:|| $2,401.12|
|Total Savings:|| $988.12|
|Annual Member Fee|| $33.00|
|Adult Cleaning|| $54.00|
|Child Cleaning|| $38.00|
|Routine Check-Up|| $28.00|
|Four Bitewing X-Rays|| $32.00|
|Composite (white) Filling|| $78.00|
|Molar Root Canal|| $474.00|
|Extraction (single tooth)|| $72.00|
|Total Discount Charge:|| $1,413.00|
The select regional average fee represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the Estimate the Cost of Care tool as of November, 2005.
* Insurance plan based on the Aetna DMO Plan. * Actual costs and savings vary by provider and geographical area. Numbers given are regional average fees.
Sources: http://newbenefits.com – New Benefits Dental Care and Aetna Dental Access® Marketing Materials and FAQ
http://cdc.gov/OralHealth – Centers for Disease Control and Prevention (statistics)
http://moreinformationplease.com – Dental Care Program Information
http://adha.org – Oral Health Statistics and Facts
http://dentalplans.com – Aetna Dental Access® Nationwide Dental Discount Program (savings information)
Compare all three discount health benefit plans and choose the one that is right for you »
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