Right after health insurance is selected by a company for group benefits, the next question is typically "what about Dental?".
Health insurance is a very important benefit as the risk is potentially hundred's of thousands of dollars for more serious issues. Although people are very aware of their medical benefits, they tend to perceive more value from group dental insurance.
Dental benefits are used regardless of illness or injury and therefore, employees tend to be more aware of them. Let's take a look at Dental insurance for California groups.
First, dental insurance is really a commodity for group benefits.
This means that it tends to be very similar from carrier to carrier within product type (HMO, PPO, or Indemnity). California dental carriers have recently rolled many different dental plan options and price points but they are comparable.
The first real decision to make is what type of Dental plan to offer. Ideally, you select an option like EmployeeElect from Anthem Blue Cross where you can offer all the dental plans with a fixed contribution from the company.
Let's first look at three different models
and how they differ.
HMO Group Dental Insurance
HMO plans, on average, tend to be less
expensive (sometimes considerably so) than PPO
or indemnity plans. HMO plans also tend to have
richer benefits but the trade-off is has to do
with the providers you are able to access and
how that access is handled. With HMO dental
plans, you are typically dealing more with
dental hygiene groups and some dentists. The
offices are going to be busier. This works if a
person is very flexible in the dentists they can
use and are more concerned with cost. It also
works if a person only expects very basic dental
needs (cleanings, fillings, etc). HMO plans are
more likely not to have waiting periods for
services. Accessing coverage is more structured.
You choose a Primary dentist or dental group up
front. Dental care with specialists is managed
through the primary dentist.
PPO Group Dental Insurance
PPO plans are usually more expensive than HMO plans. They usually involve more cost sharing in the form of deductibles or co-insurance. You have a wider list of dentists to access and more flexibility in changing providers or using dentists in other areas. You can refer yourself out to specialists and even change your general dentists as you like to another provider. PPO dental plans usually have a cap on benefits that the carrier will pay up to in a calendar year that runs from $1000 to $2000 on average. PPO plans have two sets of benefits...one for in-network dentists (those that participate in the carrier's PPO network) and out-of-network dentists (those that do not participate). There can be considerably larger out of pocket expenses when using out-of-network providers.
Indemnity Group Dental Insurance
Indemnity plans are more similar to PPO plans
but there is no network to stay within. There is
one set of benefits applied to all dentists
according to the benefits of the policy.
Indemnity plans are more expensive than PPO
plans on average and are not as popular in the
market due to this. They may see a resurgence as
the trend of dentists not participating or
dropping out of PPO networks continues.
How Group dental insurance plans breakdown
Group dental insurance plans typically break down into three main areas:
1) Preventative dental
This typically includes cleanings and x-rays.
The dental plans will usually cover these
preventative services at 100% when in-network.
Sometimes there may be a small copay. You can
expect to pay more for out of network providers
with a PPO. With HMO dental plans, you will have
to stay in the network in order to have any
2) Minor Dental services
This typically includes fillings and extractions etc. As a rule of thumb, dental plans on the individual market will pay about 60-70% of these services (in-network). Out-of-network benefits will be less. There may be smaller waiting periods for such services of 3-6 months depending on the plan. This means that you need to be on a dental plan for a period of time before they will cover such services.
3. Major Dental services
This typically includes services such as root
canals and root planing etc. Generally speaking,
dental plans will pay around 50% of these
services (in-network). There are typically
waiting periods (especially for PPO and
Indemnity plans) of 12 months on average.
Administration of Group dental plans
The same eligibility and AB 1672 requirements apply to dental group insurance as health. This includes participation, contribution, and size of group. There are some plans offered by California carriers called
Voluntary plans which do not have these requirements. They are essentially individual plans which are grouped under the umbrella of a company plan.
Voluntary dental works well when the Group does not pay the premium for dental but wants to provide an option for employees to add dental coverage that the employee will pay for.
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