Managed care bites benefit! Dental benefits may not be extracting the same amount of dollars as core benefits, but it's still important to keep them brushed and flossed

Business & Health, May, 1991 by Martha Glaser

What's more, 78 percent of dental plans surveyed by Hewitt Associates include orthodonture.

Another preventive service that's also getting more attention is coverage for sealants--especially on the West Coast and in the Midwest, says Delta's Gribben. The service usually applies to children up to the age of 14, with the sealant applied only to cavity-free molars. The U.S. Defense Department's CHAMPUS dental program, which Delta handles, has just added the sealant benefit.

The other side of the coin is that payers generally are not adding coverage for cosmetic services. However, says Foster Higgins' Eicher, "I imagine most dentists are doing more cosmetic work than ever before. But that's not to say the plans are paying for it; rather it's the patients who are. But I'm also sure that the dentists are trying to figure out how they can get the plans to pay."

From the Tooth Fairy

In Eicher's opinion, more companies are putting dental into "cafeteria" or health care "flex" plans that come under Section 125 of the Internal Revenue Code. Flexible spending accounts allow for a "pot of pre-tax money for the employee to use as he wishes for dental, vision or drugs" and the like, he says.

According to Gribben, there's been an increase in cafeteria plans overall--"as many as 40 percent of our employers have them," he says. Under this system, a company may offer two dental plans, "one being a full benefit that costs the employee so many points," says Gribben, "and then another with a lesser benefit structure that may appeal to people in some circumstances or at certain stages of their lives."

Gribben has no statistics on who chooses what, but Delta's marketing department reports that when the choice is between more versus less comprehensive dental coverage, "the larger families and those with higher incomes tend to go with fuller coverage."

And, the report continues, when a plan allows an employee to pick dental as opposed to other benefits, "the older the population is, the more it tends to go for vision and prescription drug programs rather than dental. That's the consensus."

In general, says Eicher, "dental benefits are probably one of the most popular employee benefits, because most employees go to the dentist every year. And their families do as well. So it's a very visible benefit."

Self-insurance on the cusp

More corporations are going with self-insurance for health care. Foster Higgin's latest survey puts the ratio at 59 percent of employers in 1990, up from 52 percent the year before. These companies "are saving the cost of state franchise taxes, which add up to 2 to 3 percent of gross premiums," sayd Davis, "and then the Company keeps the 'float' on the cash payout."

Self-insurance keeps the company's benefits "at least consistent; without it they'd have to eliminate some benefits, and dental would be the first to go," claims Fields at United Dental. "Dental is important, but insurance has to cover someone with a heart attack a heck of a lot faster than someone who needs an amalgam."