How Does Dental Insurance Work? A Quick Primer

If you’re a small-business owner and your head is spinning from reviewing various proposals of medical coverage for your employees, here is good news:

Dental insurance plans are much easier to understand.

They are relatively straightforward and specific in terms of covered procedures, out-of-pocket expenses and terminology.

This quick primer for business owners or human resources managers explains how dental insurance works. Subscribers and members with group coverage will find this information useful, too.

In a Nutshell: How Dental Insurance Works

Dental insurance helps pay for care by a dentist for issues related to teeth and gums. Examples of dental services range from regular oral exams to fillings, root canals, crowns and more.

Members pay a monthly premium in exchange for insurance benefits. When they need dental treatments, the insurance company pays for some or even all of them.

Who Pays the Monthly Premiums?

As the employer, you can choose to

1. Pay your employees’ monthly premiums in full,
2. Share the cost with your employees, or
3. Shift the costs of the monthly premiums to your employees.

What’s The Risk?

Like with any insurance policies (homeowners, car, medical, etc.), there are two risks:

1. Members pay the monthly fee whether or not they get dental work done.
2. The dental expenses may exceed the insurance benefits, so the members will pay out-of-pocket costs in addition to the monthly premiums.

In most cases, insurance saves the members money. It protects their assets from financial hardship in case of expensive dental procedures.

How Much Do the Monthly Premiums Cost?

Typically, monthly premiums depend on three key factors, such as 

1. The number of members covered. Rates differ for individual vs. family plans and the total number of employees.
2. The type of plan. In general, the higher the insurance benefits, the higher the monthly premiums. Delta Dental of Arkansas offers four different types of dental plans for small businesses. [Mid-size and large companies are encouraged to contact our Sales and Account Management team for a customized quote.]
3. Location.

Dental Services Covered by Insurance

Most dental insurance companies pay benefits based on a 100/80/50 structure for Preventive or Diagnostic, Basic and Major dental procedures.

• 100% of preventive or diagnostic dental care with no out-of-pocket expenses to the members. A waiting period is typically not required.
• 80% of basic dental procedures after the member has paid the deductible. A waiting period may be required for basic dental procedures. 
• 50% of major dental procedures after the member has paid the deductible up to an annual maximum. The member pays the remaining cost. A waiting period may apply.

Not all dental procedures are categorized equally. What one insurance company classifies as “basic,” another might consider “major.” Be sure to compare and understand what’s covered when reviewing insurance policies.

Network Provider

The above payment structure typically applies to care obtained from a network dentist or in-network dentist. Benefits are often less for services provided from an out-of-network dental provider.   

Dental Procedures Not Covered By Insurance

Most dental insurance companies don’t cover the costs for cosmetic procedures like teeth whitening, tooth shaping, veneers and gum contouring. Cosmetic procedures are not considered medically necessary because they are designed to improve the look of teeth, but not necessarily their health.

Policies differ, so review any proposal carefully for exclusions, exceptions and special riders.

Special Cases: Implants and Braces

Some policies, usually higher-priced premier plans, will cover implants and/or orthodontic services like braces and retainers. But they tend to come with limits and exclusions. They may not cover orthodontic treatment begun before the coverage period and have a lifetime maximum.

Again, be sure to compare policies.

Bonus Lesson: Carryover Benefits

Congrats. You’ve just mastered the basics of dental insurance policies.

Here is a bonus lesson: Carryover Benefits.

• Some dental insurance companies, including Delta Dental of Arkansas offer carryover benefits. They allow you to carry over a portion of unused annual maximums into the next year. This helps pay for costlier, major services if needed.
• We’ve dedicated a separate blog to carryover benefits. All our dental plans for group clients include carryover benefits to help you and your employees save even more money.

Delta Dental Offers Many Dental and Vision Insurance Plans for Small Businesses

Check us out.

Delta Dental of Arkansas offers an extensive portfolio of dental and vision insurance plans specially designed for small businesses. With as few as 2 employees, you can get started with your goal of offering an attractive employee benefits package.

We deliver valuable benefits at affordable rates, eliminate complicated benefits administration and cover more than the bare minimum with rich plan designs—that’s the Delta Dental Difference®.

And we keep things easy for our small-business dental and visions plans:

• Simple application
• No underwriting
• Online benefits management, including premium payments
• Option to sign up for voluntary plans where employees pay 100% of the premiums.