My son played Sir Studly in our recent community theatre production of "Once Upon a Mattress." He convinced me to join the chorus as a lady-in-waiting. Anticipating three months of quality mother-son bonding time, I readily agreed. I never dreamed, however, how physically demanding the constant singing, dancing and curtseying would be on my body. Even my cheeks hurt as the director constantly exhorted the cast to smile, smile, smile!
As I grinned through the pain, I was thankful my parents took such good care of my smile as a child. Evidence shows a link between good oral health and good physical health. This month's checklist focuses on some of key features benefits managers may want to evaluate when comparing dental benefits programs.
Maintaining good oral health is connected to maintaining good physical health. By carefully evaluating your dental program, you can help employees and their families get the best value for this benefit in these difficult economic times.
Benefit | What to watch out for |
PPO dental network Identify which dentists are the most popular. | Without a good network match, employees may pay more in balance billing. If you are self-funded, ask potential carriers to reprice dental claims to validate their contractual arrangements. Hold them accountable for delivering as promised. |
Dental claim vs. medical claim | Read the fine print. What does the carrier consider a dental claim versus a medical claim? |
Oral surgery | Is any coverage provided for oral surgery or does it only fall under the medical plan? |
To-go features | Does the carrier provide a benefit feature for banking unused dental maximums? Is there an additional charge for that feature? Carefully read the limitations of carrying over unused maximums year over year. |
Family share plans | Does the carrier allow a family to share the dental maximum among all family members? What are the limitations? |
Diagnostic & preventive | Is the deductible waived for preventive care? How often are cleanings allowed? Does the carrier provide additional benefits for special situations such as pregnancy or people with diabetes? |
Frequency of cleanings | Are two cleanings allowed per year or does the plan specifically limit coverage to once every six months? |
Orthodontic age | Is orthodontic coverage available for children only or can adults access coverage? |
Balance billing – above usual & customary charges | What is the usual and customary percentile? If claims are currently being processed at the 80th percentile, make sure all vendors accurately bid a matching percentage. |
Out of network | Will out-of-network claims be paid at a maximum allowable basis or at a usual and customary limit? |
Periodontics & endodontics | Some carriers will cover these services as a basic service, while others place it in the more costly major services category. |
Waiting periods for major services and orthodontia | Watch for waiting periods on major services such as crowns and orthodontia. If you have prior coverage, negotiate with carriers to remove these waiting periods. |
Credit for deductibles | If changing carriers, will the new vendor give credit for deductibles already satisfied? |
Claims experience & reporting | Check the carrier’s claims experience and network performance reports. Determine if there are any additional costs for ad-hoc reports. |
Exclusions | Read the carriers exclusions in their policy. Make sure to identify any potential benefit changes. |
Contributing Editor Laurie S. Miller is president of Miller, Buettner & Parrot, Inc., an employee benefits consulting firm in Rockford, Ill. The firm consults with over 50 public entities and also has a large corporate practice. She can be reached at
