Smile, you've got options: stable costs may distract employers from small but significant changes in dental benefits plans

HR Magazine, Nov, 2004 by Martha Frase-Blunt

* Service. Look for ways carriers make administration easy for HR. For example, make sure they provide good reporting on utilization and a high level of responsiveness to employees. How easy is it to add or subtract members as the workforce changes? How easily understandable is the plan for employees?

Although dental plans are not offering many innovations in coverage these days, Album says, "Our customers' expectations about service are increasing. They want us to minimize any hassles that might crop up and increase the ease of plan administration for our subscribers." He adds that since employers aren't going to save significantly by changing their dental plan design, "service becomes the Holy Grail."

Benefits administrators should choose "a plan that allows them to easily grasp all the limitations and exclusions and how they are administered," says Album. "Then they can communicate this to employees--for example, suggesting that they obtain pre-authorization for procedures so there are no surprises." This could circumvent a common source of employee complaints: discovery that a portion of a claim is not paid because the fee for the particular service exceeds what the plan allows as "reasonable and customary," forcing the worker to pay the difference.

In another nod to better service, many large carriers offer employees web access to information about their dental coverage.

Also, carriers often fine-tune their flagship dental HMOs (DHMOs) and dental PPOs (DPPOs) to benefit employees. One such variation is the "swing plan," which allows employees to switch from a DHMO into a DPPO any month of the year, without having to wait for the annual open enrollment period.

* Provider numbers, diversity and quality. Ask about size and quality of the provider pool. How many offer weekend hours? What technologies and new materials are available? Does it include specialty practices such as pediatric dentistry?

* Reputation. Learn how employees view the carrier to ensure that it will add perceived value to your benefits package.

Employers who are offering a dental plan for the first time should not gauge employee use and return on investment in the first couple of years, Barnett cautions. "The first year you offer it, everyone will use it right away. Many will not have seen a dentist in years, so there will be a lot of checkups and treatments initially, but this spike will find a normal level within two or three years." He notes that "carriers are pretty sophisticated about underwriting, so ask for a prorated or guaranteed rate for the first years" to help control the costs of high initial utilization.

DHMO and DPPO Plans Lead Market

After selecting a carrier, an employer can choose which of the carrier's dental plans will best serve its employees. DHMOs and DPPOs are the most popular options for medium to large companies.

Papa John's International Inc. of Louisville, Ky., gives employees a choice of joining CIGNA's DHMO or DPPO. The DHMO is the lowest-cost option. It requires employees to select providers within a network, and they pay no deductibles or co-pays. The DPPO lets employees go out of network as they prefer, but it does include deductibles and co-pays, says Annette Calhoun, director of benefits for the pizza restaurant chain.