"Fifty-seven percent of the population today does have some form of dental benefit," says Chuck Misasi, senior vice president of sales and marketing for the Careington International Corporation. "That does include employers as well as private insurance. The market has been relatively flat for the last 10 years."

In a session titled "The Evolution of Dental Benefits in an Exchange-Driven Marketplace," part of EBN's Benefits Forum & Expo, Misasi says employers must be creative when dealing with shifting dental options within their health care offerings. What's more, they must think independently.

"Self-funded enrollment actually surpassed fully insured for the first time in 2011," Misasi says. "We believe the Affordable Care Act does create incentives for employers to move from fully insured. More will move to self-funded and consumer-driven health plans as it gets fully implemented. ... What we don't know is how the ACA will affect future enrollment and future offerings. There are a lot of unknowns. Depending on where the dollars are for voluntary benefits, dental and other voluntary [products] may be left off the table."

More and more, the cost of dental care is being passed on to the employees, he says. In 2011, 20% of employees had their dental benefit completely covered by their employer. That number had been cut in half a single year later, and Careington expects that trend to continue. There's also correlation on the other end: Those for whom dental coverage is completely voluntary saw their numbers double from 2011 to 2012.

"With the expansion of private exchanges for health insurance," Misasi says, "there will be more defined contribution plans emerging, and the dollars that are available for voluntary benefits will be stretched. What does this mean for the future? Employer dental contributions will continue to erode, voluntary dental will become the norm ... and the other thing that the exchanges will do for dental is it will be a better buying experience, we expect."

Every exchange will aim for the simplicity of an Amazon.com-like experience, with participants making more comfortable, better-informed decisions. Employers, many with relief, can distance themselves further from being dental benefits providers.

And with new offerings will come new ways of paying for them. Health savings accounts, health reimbursement accounts and consumer-driven health plans in general will have a profound effect on dental plans, Misasi says. HRAs in particular, if administered properly, can ensure employees have sufficient dental care while removing loads of employer cost and responsibility.

"An HRA can be used in place of, or to replace, a self-funded or insured dental or vision plan. If you're self-funding your dental, and you know what your risk is, you're still participating voluntarily in that. An HRA could be utilized to cap your exposure as an employer and still provide a very strong offering to employees," Misasi says.

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