Dental is a consumer-driven benefit

In the medical benefits arena, a move toward consumer-driven products is expected to help
alleviate the double-digit cost increases purchasers have paid in past years. Companies
adopting consumer-driven plans want to control costs by involving their employees
in the health care decision-making process to make them wiser consumers. The dental
benefits industry has been less affected by the consumer-driven trend because it has not
experienced skyrocketing premium increases and because dental is intrinsically a consumer-driven benefit.

Dental plans are typically designed with low or no copayments for diagnostic and preventive
services to encourage enrollees to visit the dentist regularly to take care of any problems
at an early stage. Copayments are usually introduced starting with basic benefits and
increase in the major services category. For example, a common plan design covers basic
services at 80 percent and major services at 50 percent. This plan design controls utilization because the enrollee has an investment in selecting appropriate care; the more services rendered, the more the enrollee shares in the cost.

Another important component of consumer-driven plans is educating enrollees about how to be better health care users. With dental, enrollee communications should focus on how to make the most of the plan. Under all plan designs — fee-for-service, PPO and prepaid plans — the enrollee benefits financially by going to a network dentist because these dentists have contracts with the carrier that limit their fees and require them to meet the highest professional standards. When an enrollee has a choice between two dental benefit plans, the carrier should clearly communicate each plan's cost savings and dentist access. These plans offer a clear choice, allowing the dental care consumer to decide what combination of factors is most important for his or her family. To give enrollees maximum flexibility, purchasers can select an option that allows the enrollee to buy up from a plan with a restrictive network to one with more freedom of choice or even a plan that allows switching from one plan to another, as frequently as every month.