Statistics have shown that patients with dental coverage will seek out required care on a far more regular basis than those without coverage. As a result, employer-provided dental benefit plans have played a significant role in protecting the oral health of Canadians.
Recently the focus of dental plan coverage has begun to change. Employers are becoming increasingly concerned about the costs of doing business, including the costs of providing their employees with comprehensive health and dental benefit packages.
In response, plan carriers have developed new dental plans. Unfortunately, some of these new plans may include restrictions that could seriously impact your oral health. The information here has been provided to help you understand your dental plan and the impact that any changes in your dental benefit coverage may have on you.
We hope that it will assist you when you are evaluating your plan, and the coverage it provides. For further information, talk to your employer or plan carrier about the coverage you have. Be a partner in your oral health, and discuss the treatment you require with the dentist of your choice.The Purpose of Dental Plans
Dental plans are simply a means to help you to pay for your dental treatment. Employers provide health and dental benefits for a variety of reasons, including the promotion of good health. They also view health and dental plans as a way to keep their workforce healthy and fit, and to attract and retain top-notch employees.
You should be aware that dental plans are actually a mechanism whereby your employer prepays all or a portion of the costs of your dental care in advance, as part of your compensation package. This is economically advantageous for you, because most health and dental plan premiums are tax exempt. In other words, you are not required to pay income tax on the health and dental plan component of your compensation package in all provinces except Quebec.
It is important to remember that dental plan coverage is not just a form of insurance. Actually, it is an economic benefit that your employer contracts with a plan carrier to provide on your behalf.
It is also important to remember that you are a partner in your oral health, and that treatment and care decisions should be made by you and your dentist based on your actual needs, independent of your dental plan coverage. Your dental plan is not a treatment plan.
Your dental plan may not cover all of the costs associated with the specific treatment you require. Treatment decisions should be made in consultation with your dentist. You should be aware of what is covered in your dental plan, but you should not let this factor alone determine your care. Only you and your dentist can decide the treatment plan that's right for you.
Some dental plans restrict coverage to the least expensive procedure that can be used to treat a particular dental problem provided it is a professionally acceptable alternative.
However, that least expensive procedure may not necessarily provide the best long-term solution to your dental problem. You should base your treatment decisions on your dental needs, and not on the coverage in your dental plan.
If in doubt, talk to your dentist about the course of treatment that's right for you, and have him or her prepare a treatment plan to submit for a pre-determination of benefits.
Managed Care Plans
Managed care plans were first developed in the United States, primarily to help employers control the cost of providing health and dental benefits. Cost control is achieved by limiting the coverage for care or by restricting your access to the dentist of your choice.
Most managed care dental plans require you to select a dentist from a list provided by your employer or plan carrier. These dentists have usually agreed to provide treatment at reduced prices. Both factors can severely impact the quality of care you receive through your dental plan.
Remember, your treatment and care should be based on decisions that both you and your dentist of choice make on your behalf, and must not be decided by anyone else but you and your dentist.
Restrictions on Your Choice of Dentists
You always have the ability to go to the dentist of your choice. But you should ask your employer if the treatment you require will be covered by your plan if your dentist is not on your employer's list, and explain that you have an established relationship with your dentist. Your coverage will depend on the contract that your employer has signed with the plan carrier.
Maintaining a long-term relationship with your dentist is one of the two keys to good oral health. It is important for your dentist to know you, your family, and your health history. This knowledge will influence treatment planning, and help your dentist render optimum treatment.
It is reasonable to expect that your employer will provide a dental plan that places no restrictions on your choice of a dentist, and provide comparable benefits for the same premium if you choose to visit your regular dentist rather than a dentist on a list provided by your employer.Flexible Benefits
An increasing number of employers are moving toward flexible benefit plans for their employees. This type of benefit program allows employees and their families to choose the type of coverage they prefer from a list of benefit options provided by the employer.
Usually the number of available options exceeds the maximum number that an employee can choose. You then have to decide on the type of benefits you need, from life insurance to dental coverage, and the direction that you want your plan to take.
How do they work?
Employees are usually given a number of "points" to spend on their benefit package. Rather than providing one benefit plan for everyone, your employer allows you to customize the plan that best meets the needs of you and your family, within certain guidelines.
Some plans allow you to spend your points any way you wish. This is called a "cafeteria" type of plan. Other plans provide you with a core program of benefits at the outset, before allowing you to add options to these benefits based on your particular needs. A third type of plan allows you to choose a particular package of benefits from within a variety of available packages.
Why be concerned about with flex plans?
When you choose the benefits you want within a flex benefit system, you are creating a benefit package that will meet your needs during a particular stage in your life and that of your family. Throughout life, our needs change. The benefit plan that you choose today may be in place for quite some time. It is important to choose wisely and to consider your long term needs, to protect both you and your family.
What type of coverage should I select?
You can't diagnose your own dental problems, only your dentist can. If you don't visit your dentist for regular preventive care and check ups, it can take a great deal of treatment to correct a dental condition - once you become aware of it. It is therefore important to include preventive dental coverage in the list of benefits you choose. It not only protects you, but it protects your family.
Remember, a dental plan is a non-taxable benefit. A dollar spent on a dental plan is worth more than paying for dental care with after-tax, out-of-pocket dollars. Statistics have shown that patients with dental coverage will seek out the care they require on a far more regular basis than those who don't have coverage.
The cost of prevention is always far less than the cost of neglect. So, if you plan to visit your dentist for regular care, you should include a dental benefit component in your flex plan.Other Options
You don't need a dental plan to visit your dentist for regular preventive care or treatment. Many dentists will accept credit cards or post-dated cheques as payment for the services they provide. However, if you want to prepay the cost of your dental care, you should be aware that there are only a few individual dental plans available.
Most plan premiums offered by employers are tax exempt, and in most cases you won't find a private dental program that can compare favorably in cost with a group plan offered by your employer. So if you have a dental plan in your mix of benefits, consider yourself lucky.
(material from CDA)