Essential Questions for Choosing Dental Benefits as a Small Businesses

Want big dental coverage on a small-business budget? You just need to ask the right questions.

Small businesses have big dreams and big hearts. But in some cases, not very big budgets. However, you can find an affordable group dental plan for your growing business, whether you have one employee, 100, or some number in between. You just need to ask the right questions when shopping around. This guide can help you get the answers you need to find a plan that feels custom-made for your team — and your budget. 

Below you will find questions you can ask about benefits, the network, costs, and customer service and administration.

Benefits

If you’ve already set a budget for employee dental insurance, that will help you and your plan provider determine the scope of coverage you can offer. But don’t forget that you do have some options!

If a particular type of service, such as preventive care, is important to you and your team, start with that and work your way up to your limit.

• Is there a choice of dental programs and plan designs? If yes, can employees choose between them during enrollment?

• Can they switch plans? If yes, is there a specific time frame (i.e., within a certain window of time or only during annual enrollment, etc.)?

• Think about any specific coverage you would want included for your team. Would you consider more costly procedures? Carriers can add some procedures to basic services at an added cost.

• Find out about procedure and frequency limits, and if there’s an option to enhance particular preventive benefits for your team, such as an additional cleaning per year, etc.

• Do they offer a plan based on age or other demographics of employees (i.e., if you have a mostly young workforce that grew up with sealants, do you want to start with a preventive-only plan)?

•  Do they deduct (or penalize) for benefits used under a prior carrier’s plan (i.e., orthodontics)?

• Is there a waiting period before coverage begins?

• Do the benefits included in the plans you’re considering support preventive care?

• Do the benefits support preventive care?

• Are pre-existing conditions are treated differently or excluded?

• Do some procedures require pre-authorization?

• Who has the final say on treatment decisions: the employee and his dentist or the dental plan? Some plans may require providers to take “the least expensive alternative treatment approach.”

• Does the plan allow referrals to dental specialists?

• What coverage, if any, is offered when employees see non-network dentists?

• Are there any special benefits you want included in your plan?

Network

For your employees, some of the shine of having new dental insurance may be dulled if they have to switch dentists or use one that’s not convenient to home or work.

That’s just one of the reasons why a plan’s dentist network is worth considering when evaluating carriers.

• Ask about the size of the carrier’s network. Is it large enough to include the majority of employees’ current dentists?

• Are participating (contracted) network dentists

  conveniently located near work or parts of town where employees live?

• If you’re considering a DHMO plan type, ask if one is available. Also, find out how many of the dentists are accepting new patients.

• Some carriers may embellish the size of their networks by counting the same dentist more than once if he’s part of a practice that has multiple locations. Find out if this may be the case with carriers you’re considering.

• Does the carrier provide local support to their networks? Education?

• Does the carrier allow their contracted network dentists to balance bill patients?

• Do the carriers own or lease their networks? If leased, find out what costs, if any, would be passed through to your business.

Costs

There’s a lot that goes into determining dental premiums for your company. When shopping for a reputable insurer to partner with, consider asking about the important issues we’ve listed below.

• Inquire about each company’s claims costs. If you’re seeking a self-funding solution, this is an important issue.

• How likely is each insurance carrier to increase rates next year? And by how much?

• What will employees’ out-of-pocket costs be for expenses such as insurance copays, deductibles and the like? Ask if there are any hidden charges beyond the copayments.

• Is there a dollar “cap” or limit on the amount of coverage permitted annually?

• In an effort to give the appearance of lowering your portion of the premiums, is the carrier shifting costs to the employee through network access fees or other hidden charges?

• If you currently provide coverage through another carrier, think about possible transition costs for switching. Does the new carrier make it easy to join?

• Examine administrative fees: Are there charges for offering two plan options? What about one-time implementation fees, etc.?

• Are there hidden charges?

• Are there charges for offering two plan options

• How does the plan reimburse dentists? Are costs shifted to employees, and if so, how does this benefit your business costs?

• How are benefits for out-of-network providers calculated? What additional costs would your employees be responsible for?

• Does the carrier charge for open enrollment assistance or extras like education materials?

• To help you maximize value and monitor costs, does the plan provide assistance or tools to help you budget, analyze or even dispute the costs of dental care?

Customer Service & Administration

If you’re offering employee dental insurance for the first time, you’ll want a dependable insurance partner who can provide the guidance and assistance you’ll need — without charging you for every question or service. This partnership is important to your team as well since they will deal with insurance when they seek treatment.

• Find out if an account manager will be assigned to your business. What administrative services will be provided at no charge? What services will you have to pay for and what are the costs?

• How much experience does your account manager have? Has he worked with small businesses before? They have special needs, so make sure you’re not his first customer!

• Online services are important in this digital age. What kind of online services does the carrier offer to help you manage your workload?

• Are there any web tools, FAQs and resources for your employees as well? Can they view statements online and make payments?

• Are there any application fees? Service fees? Paper billing fees?

• Ask about the type of reporting you’ll receive and how often you’ll receive it. What kind of behavioral analyses are included, if any?

• What administrative services will be provided at no charge?

• Try to view coverage from your employees’ perspective. Will they have to submit claims? How easy is it to get help from the customer service department?

• Is there an established process if employees have questions or complaints about services they’ve received?

• Not all carriers offer assistance through all channels. Ask about capabilities or access via phone, internet and IVR. Does the carrier make it easy to connect with them in a manner that’s easy or convenient for you and your team?

Being a small business shouldn't prevent you from providing these benefits to your employees. Dental insurance is shown to make your employees happier and healthier and there are choices available to you to help it work with your situation.

Learn more about Delta Dental of Tennessee's Employer Plans and how they can be molded to fit your needs.