What do employees misunderstand about dental benefits?

What is an effective date?

The effective date refers to the day an employee is eligible to start using your dental plan.² For most employer-sponsored dental plans, the effective date is the first day of the month after the employee starts their job. Effective dates can vary by dental benefits provider and plan type. Make sure to inform employees that are new to the plan when they can begin using their dental benefits.

Dental coverage emphasizes preventive care. As a result, once your employees reach their effective dates, they can usually begin using their benefits to cover preventive services like exams and cleanings. 

What types of services are usually covered under dental insurance?

There are usually three categories of coverage and it's important for employees to understand the difference between them. Knowing the differences can help employees avoid surprise bills and make smart care decisions.

• Preventive care: cleanings, X-rays, exams – usually 100% covered

• Basic care: fillings, simple extractions – typically covered at 70–80%

• Major care: crowns, dentures, root canals – often covered at 50% or less

What is a deductible and an annual maximum?

• A deductible is the amount the employee pays out-of-pocket before the plan starts covering certain services. Some plans have no deductible for preventive care, which includes things like cleanings and dental exams.

• An annual maximum is the most the plan will pay in a calendar year. Once it’s reached, the employee pays full cost for additional services until the plan resets next year.

Can employees still see their current dentist?

If your plan includes a preferred provider organization (PPO), employees can often visit any licensed dentist, but they’ll save more by seeing someone in-network. Encourage employees to use the “Find a Dentist” tool to check if their provider is in-network.

What is a waiting period?

After employees reach their effective date, they still may not be eligible to receive benefits for all dental treatments — especially more expensive care like crowns or dentures.³ Although it’s more common with individual plans,⁴ some employer-sponsored plans have a benefit waiting period. This is the amount of time before employees are eligible to use their full coverage. 

For example, if your plan has a six-month waiting period for basic non-preventive services, such as a routine tooth extraction or a filling, it wouldn’t cover those services during that time. Some plans will waive the waiting period if the employee had dental coverage in the past 30 to 60 days.

As with effective dates, waiting periods can differ from plan to plan. Some employer-sponsored plans have no waiting periods. If your plan does have them, educate your employees that are new to the plan on any benefit waiting periods.

Why are there waiting periods in dental benefit plans?

While they may seem annoying, it helps keep the cost lower for everyone (including you!) Dental plans use waiting periods to help manage risk. Without them, someone could enroll, get expensive treatment immediately, and then drop the plan. Waiting periods help keep monthly premiums lower for the whole group.

What if a procedure isn’t covered?⁵

If an employee needs major dental work, advise them to check their coverage. In addition to waiting periods, some dental plans may not cover select procedures such as teeth whitening or orthodontia. To ensure your employees aren’t surprised by their bill, advise them to ask their dentist for an estimate. They should also check with their dental plan provider to see what is covered before undergoing any major dental work. Even if the procedure is not covered due to a waiting period, it may be more costly to delay treatment if the problem worsens.

How can employees avoid unexpected dental bills?

Many employees avoid care because they feel like they don't understand how to "use" dental insurance. The following steps can help employees take control of their benefits. 

• Use an in-network provider

• Ask for a pre-treatment estimate

• Check the annual maximum and deductible status

• Confirm coverage for specific procedures before treatment

Empower your employees to ask questions! The more they understand, the more value they’ll get — and the more they’ll appreciate your benefits package.

Sources:

¹ https://hbr.org/2017/02/the-most-desirable-employee-benefits

² https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/library-of-terms.html

³ https://www.deltadental.com/us/en/protect-my-smile/dental-benefits/library-of-terms.html

⁴ https://www.investopedia.com/articles/personal-finance/122315/6-dental-insurance-plans-no-waiting-periods.asp

⁵ https://www.thebalance.com/dental-insurance-waiting-period-2645722