In a survey summary, Segal offers the following suggestions for dental plan sponsors:
- Review covered procedures, and exclusions and limitations – This can ensure up-to-date procedures are covered based on acceptable dental procedures and practices, so that both appropriate care is provided and costs are controlled, Segal says.
- Offer a Dental Maintenance Organization (DMO) or Dental Provider Organization (DPO) – Providers in dental networks agree to provide services at discounted fees.
- Lease an insurance company’s dental network – Some insurance companies will do this for plan sponsors who want to self-administer their plans, and network access fees have become highly competitive, according to Segal.
- Convert to a self-insured plan – Advantages of self-insurance can include improved cash flow when claim experience is low, reduced administration fees, and avoidance of state mandates and insurance premium taxes.
- For scheduled plans, update the schedule – Schedules provide fixed maximum dollar coverage for dental expenses, the summary explained. Outdated schedules provide low levels of dental coverage or allow dentists to charge inappropriate amounts for procedures that are no longer relevant.
Segal found that 82% of group health plans in the survey offer dental coverage. Of those, 54% provide access to a dental network. The average network utilization, as measured by the percentage of dollars paid, was 59%, according to the survey summary.
Only 17% of the group health plans that offer dental coverage offer a scheduled design. The other 83% offer a reasonable & customary plan design.
The survey summary is here .
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