Dental plans for California group health
insurance
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.
Some basics about Group dental insurance
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
coverage.
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.
You can run your
California
Group Dental Quote here
to view rates and plans side by side from the major carriers...Free.
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!
