A grocery store is an ideal place for comparison shopping, allowing consumers to select from multiple versions of similar products. As consumers peruse the aisles, each product’s package is an attempt to entice them to buy. The packaging, which may read, higher fiber, lower cholesterol, and all-natural flavors, does not reflect the core value of the product, but is rather an inducement. The ingredients are the critical elements, and the only way to recognize exactly what is in the food is to “check the label.”
While there is no grocery store for employee benefits plans, the concept remains the same: the most important part of the decision process to select any benefit is to “check the label.” When it comes to dental plans, one size does not fit all, but many brokers and employers are tempted to simply compare prices and do a basic review of each plan’s “packaging” (e.g., deductible, annual maximum, coverages, and programs like Rollover), without drilling down into the plan “ingredients.” Though it’s not always obvious, these ingredients can differ dramatically from plan to plan and have a major impact on the value of the plan to employers and their employees.
Smart comparison shopping among dental carriers can help uncover differences in plan designs, provider networks, claims management, plan administration, service and technology — all critical ingredients that affect the value and effectiveness of a dental benefits program. It is important to not only recognize the differences, but to understand what they mean. If a carrier promotes enhanced benefits or boasts a larger network, what do they actually mean? What value do they actually provide? By searching for specific program information beyond the costs and plan basics, one can identify critical differences between carriers. After a deep dive into the details, a plan that may have been appealing from a first glance may become the clear second choice after the disparities and shortcomings are exposed.
“By moving beyond cost analysis, and taking a deeper look at the ‘key ingredients’ of a dental benefits program, brokers and employers, can uncover key differences between carriers and plans that might not otherwise be seen on a plan’s attractive ‘outer package’,” says Dr. Alan Vogel, vice president, MetLife Dental Products. “Checking the label helps ensure the plan aligns with benefits objectives, costs, as well as provides value to employers and their employees.”
Plan Design — A Key Ingredient
One of the most important “ingredients” in a “healthy” dental benefits program is plan design. Though “packaging” of plan designs can lead employers to believe that plans are equal and therefore a plan with the lower rate is best, it is important to note excluded and non-covered services, inappropriate limitations, guidelines and other benefit provisions that can lower the rate, but ultimately diminish plan value.
For example, plans typically cover periodontal maintenance, which helps manage the progression of periodontal disease following active therapy (periodontal scaling and root planing). However, some plans institute a limit of two maintenance visits per year. This limitation may be appropriate in some cases, but not for all cases and does not align with American Academy of Periodontology (AAP) parameters of care. According to the AAP, “three-month intervals for periodontal maintenance have been found to be effective in some moderate to severe cases of periodontal disease.” In other words, a two-per-year limitation could dissuade employees from receiving necessary services and lead to the continued progression of periodontal disease — and potentially more complex and costly services in the future. A “healthy” plan’s label should allow up to four periodontal maintenance visits per year, which aligns with generally accepted parameters of care, and can help reduce long-term plan and employee costs, and encourage employees to maintain their oral health.
Another way brokers and employers can be smart comparison shoppers of dental benefits plans is by “checking the label” on new benefit features. What may look great on the outside can detract from appropriate plan design or add little value. For example, many plans now cover additional routine cleanings for pregnant women and people with diabetes. While research suggests a relationship between periodontal disease and complications with diabetes, an additional routine cleaning may not help manage ones dental health that is compromised by diabetes. It may be that no additional cleanings are necessary, or that periodontal scaling & root planning is the needed service.
In addition to key differences in plan design not generally advertised, these two examples underscore another critical point: the importance of an appropriate plan design to drive value and costs. As employers share more costs with employees and employees assume more responsibility and ownership of their health and benefits decisions, plans need to be designed to help employees get and/or stay healthy, and avoid future costly surprises.
Making the “Healthy” Choice
Brokers and employers can study each plan and compare specific strengths and weaknesses with the needs of their particular audiences in mind. A thorough review of information can afford brokers and employers the opportunity to ask insightful questions prior to making a decision.
Dental is a highly utilized benefit that helps create employee loyalty. Therefore, it is important for brokers and employers to take the time necessary to review all the information at their disposal when selecting a plan. “Brokers and employers have the opportunity to learn about new coverage innovations that add value and employee satisfaction, while using their prior knowledge to examine basic plan components to help ensure that the plan also covers the basic attributes of a “good” dental plan,” says Dr. Vogel. “It’s a little more complicated than comparing the nutrition facts on two jars of peanut butter, but taking the time to thoroughly examine the options can help employers and brokers achieve the ideal benefits outcome.”
To learn more about “checking the label” on dental benefits plans click here.