Dental Benefit Coverage
To better understand the options available to employers in providing a dental benefit plan to their employees, it is important to understand the differences between dental and medical care. These differences drive the design of dental benefit plans, and create a distinction between approaches to dental and medical benefit coverage.
Dental Disease is Not an Insurable Risk
- There is near-universal incidence of dental disease – everyone has it, and hence, everyone needs and will utilize dental care.
- Apart from trauma and pain, the patient has complete control over when, or even if, treatment will be given. The nature and amount of that treatment has considerable effect on the outcome of treatment.
- Although the need for dental care varies between individuals, the dental needs of an employee group are highly predictable. Hence, a dental plan can often be self-funded and self-administered.
- Unlike general medical disease, dental disease is generally not acute or life-threatening; hence, the financial implications of dental treatment are not catastrophic.
- Unlike many diseases, dental disease does not heal without therapeutic intervention; it is chronic, progressive, and destructive, becoming more severe over time.
- Much of dental disease is preventable, at a minimum of cost and effort. Hence, dental coverage should always have a preventive orientation.
- Dental disease generally progresses slowly. Hence dental treatment can be postponed and accumulated without symptoms for a considerable length of time.
- The onset of dental disease occurs early in childhood. Hence, coverage extended to children is important in terms of a lifetime of satisfactory oral health.
The Dental Profession is Organized Differently
- 80% of dentists are general practitioners and primary dental care providers
- The greatest percentage of dental care is rendered by one practitioner at a single site
- Almost all dental care is done on an out-patient basis
- There is a relatively small number of categories of dental auxiliary personnel [and probably a relatively small number of auxiliaries per dentist]
- There is no central facility, like a hospital, where dentists interact on a daily basis
- Dentists own, equip and operate their own "hospital," i.e., their dental office, without public subsidy
Miscellaneous Reasons that Dental is Different
- "High-tech" advances in dental care generally are not very costly, add to the efficiency and capability of care, and have not resulted in severe inflation of dental costs.
- Competition exists in the dental marketplace, since most dental care is not of an acute nature, enabling patients to seek out the best value in dental care
- The average annual amount of money spent per person for dental care in the United States is relatively small, even if restorative work is necessary.
- Dental care amounts to about 5% of annual healthcare expenditures in the United States
- Unlike the cost of medical care, the costs associated with dental care remain relatively stable; increases in the cost of dental care in the United States have been moderate
In summary:
There are significant differences between dentistry and medicine. These differences need to be taken into consideration when designing a dental benefit plan. A dental plan should not be designed as if it were a medical plan, and should not cover medical services. Ignoring the inherent differences between dentistry and medicine will result in costly mistakes in providing dental coverage to a group.
For more information about the Types of Dental Plans click [here]
Source: California Dental Association [link]
