Second Opinion How to be a Dental Insurance Advocate… And Why By Mike Peninger

Second opinions are common in healthcare; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dentists to share their opinions on various topics, providing you with a “Second Opinion.” Perhaps some of these dentists’ observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession.

–– Thomas Giacobbi,
DDS, FAGD, Dentaltown Editorial Director

But, as a dentist, why should you care about the growth of the dental insurance industry?

It’s simple. Dental insurance coverage is a powerful factor that can influence whether – and how often – people seek out dental care. The more people in your community who are covered by dental insurance, the better your business, and the overall public health of your community should be.

According to Oral Health in America: A Report of the Surgeon General (September 2000), while 70 percent of individuals with dental insurance reported seeing a dentist in the past year, only about 51 percent of those without dental insurance visited their dentist. Conversely, 14 percent of people without insurance had gone five years without a dental visit, compared to only six percent of those with coverage.

Now, where do most people who have dental insurance obtain it? At the workplace. According to the same surgeon general’s report, 59 percent of employees in medium and large businesses at that time had access to some form of workplace-based dental insurance; the availability was lower in smaller businesses.

But in the six years since that report was published, dramatic changes have taken place in the employee benefits landscape. As the cost of medical insurance has soared, many employers, large and small, have felt a real squeeze on their benefits budgets. In order to maintain medical coverage for employees, some employers have sacrificed so-called “ancillary” benefits such as life, disability and dental insurance. Small businesses and start-ups that might have added a dental benefit have hesitated because of that squeeze.

In response to that economic pressure, dental insurance providers, such as Assurant Employee Benefits, have worked hard to craft new products to keep employer and employee costs as low as possible. One development of particular note has been the growth of what is known as “voluntary” dental insurance. That refers to products sold through the workplace but paid for in full by the employee.

This type of dental insurance is commonly offered by most dental insurers, but there are still many smaller employers who do not make it available to their employees. According to LIMRA International, only 48 percent of employer groups with five to 99 employees include dental coverage as part of their employee benefits plan.

There are lots of advantages to voluntary coverage for both employers and employees. But with benefit brokers and employers placing so much emphasis on medical insurance, the word isn’t always getting through.

That’s where you come in.

The Benefit of Benefits

Voluntary dental insurance is paid for by individuals, but purchased through the workplace. The employee and the employer both enjoy significant advantages over individual purchases on the open market. Here are some of the most important:

Advantages for Employers

• Employees pay the full cost of the premium.
• Dental insurance is the second-most requested employee benefit, after medical insurance, according to “Dental Care Coverage in the U.S.: A Review of Current Literature” by LIMRA International.
• American business loses 100 million work hours a year to dental health problems, according to a 1996 article in Health Insurance Underwriter magazine.
• Insurance promotes preventive care, which can put a stop to restorative treatments down the line that not only cost more but cause more employee downtime.
• Premiums are paid via payroll deduction with pre-tax dollars; a tax advisor should be consulted about potential advantages for a company’s bottom line.

Advantages for Employees

• Employees get group rates and access to carriers’ dental networks.
• Convenient payroll deduction means it’s virtually impossible to be cancelled or charged a late fee because of a missed premium payment.
• Pre-tax premium payments can often save employees money, too; again, a tax advisor should address this question.

Some employers offer some form of direct reimbursement rather than a dental insurance benefit. Assurant Employee Benefits believes that dental insurance does a better job of both promoting preventive oral care and protecting the employer’s interests.

Traditional dental plans usually cover routine preventive services (two exams, two cleanings and one set of bitewing X-rays) at 100 percent to encourage dental health maintenance – which ultimately saves the plan money. Many direct reimbursement plans may leave employees with some out-of-pocket costs for the same services.

Reimbursement plans also require an employer to act as an insurance company (or paying a third-party administrator to do it for them) – paying claims, administering the plan, and policing utilization for signs of abuse. A lot of employers, particularly smaller businesses, don’t have the time or resources for that, and employees end up with no dental plan at all.

The Audience in Your Chair – and Elsewhere

Why not take a brief moment to promote the virtues of dental insurance when you encounter someone who has influence over workplace benefit decisions? This may be a business owner, a senior executive, a manager or a human resources professional at a local employer.

Likewise, a patient without dental insurance might be highly motivated to take a message about the value of voluntary dental benefits back to his or her workplace.

There are other opportunities to spread the word, too. Think about the other activities in which you are involved, outside your practice, in which you interact with people in such influential positions. Are you active in social-civic organizations such as Rotary or Kiwanis? The local chamber of commerce? What about the myriad non-professional networks people have, ranging from sports fantasy leagues to church groups, homeowners’ associations to college alumni clubs?

Owners and managers of small businesses, in particular, are often unaware of how easy and affordable it can be to provide a voluntary dental insurance plan to their employees – or how much benefit such a plan can bring to employees and to the business.

Today in the U.S., health care accounts for 16 percent of the Gross National Product (GNP). That is anticipated to rise to 25 percent by 2012. That means the workplace benefits budget squeeze on dental insurance isn’t going to go away any time soon. Voluntary dental benefits can play a critical role in ensuring that people continue to have dental coverage – and continue to get the important dental care they need.

When you share that knowledge with people who can make a difference, you’re not just helping yourself. You’re promoting better oral health care in the community. When you get right down to it, it’s not all that different from reminding people to floss.