Plan Comparison Checklist
Figuring out how to offer the highest-value dental benefits for your employees while managing costs is much easier when you use our checklist to compare features.
- While the premium rate is important, also consider the claims costs, particularly if you are looking for a self-funded solution. How will your carrier’s claims management affect this positively or negatively?
- Find out how much each insurance carrier is likely to increase rates next year and by how much? Is it likely the carrier’s reduction to claims costs will have a favorable impact on renewal rates?
- How much will employees pay out of pocket (i.e., coinsurance/copayments, deductible, share of premium)? Does the insurance carrier allow the dentist to balance bill patients? For an HMO-type plan, are there hidden charges beyond the copayments?
- Is the carrier shifting costs from the employer to the employee through network access fees, or other hidden charges?
- Consider any possible transition costs in moving to a new insurance carrier. Does the carrier make it easy to join their plans?
- Review any administrative fees charged for things like offering two plan options, network access fees, one time implementation fees or other services.
- How are dentists reimbursed? At what percentile are they reimbursed? Are costs shifted to enrollees? How does this benefit the employer? What are the company’s goals regarding how costs are balanced between the employer and by the patient?
- Does the carrier charge for services such as open enrollment assistance or educational materials or is it included in the rates?
Network and Disruption
- Does the carrier have a large network? Will most employees be able to visit their current dentist?
- Does the carrier have sufficient access to network dentists near where your employees work and live? If it is a DHMO-type plan, how many dentists’ facilities are open to new patients, what is the average wait time for an appointment at these facilities?
- Is the carrier representing the true size of their networks? Some carriers may count dentists that work in practices with multiple facilities more than once, even if they don’t practice at all locations.
- What kind of quality assessment and utilization review does the carrier perform for dentists? Does the carrier focus on quality of care and appropriateness of treatment? What kind of support does the carrier provide to educate and support their networks locally?
- Make sure the benefits reinforce preventive care. Plan designs and incentives should encourage the employee to seek preventative care, which will often reduce the need for more costly care and will also favorably impact overall health.
- Review procedure limitations and frequencies. For example, Delta Dental offers three cleanings during pregnancy.
- Determine if there are differences in exclusions – dental insurance carriers may treat pre-existing conditions differently.
- Ask about choices of programs and plan designs (i.e., PPO vs. Dental HMO). Can the employee choose between a PPO and HMO-type plan at enrollment? Monthly?
- Are there specific features you want to include such as extra cleanings each year? What about more costly procedures? Some procedures can be moved between basic services and major services, affecting your rates.
- Learn about the services offered (and at what charge) in administering your account. Will there be an assigned account manager? How knowledgeable is this person?
- What does the carrier offer in online services that can make your workload more manageable? What about online features for your employees?
- Determine what reporting will be provided to you. The reports should help you analyze how your employees utilize their benefits and how your plan design features work in encouraging certain behaviors such as using network dentists (lower claims costs) or higher than average utilization of periodontal services.
- What are the carrier’s performance promises to its clients? How does the insurance carrier measure up in meeting its service levels?
- Review how your employees will interact with the insurance carrier. Will employees have to submit claims? How easy is it to get assistance from customer service? What is the process if they have a question or complaint about services they have received?
- Learn about how customer service is offered at each carrier. What channels are offered (Web, IVR, phone)? How easy is it to do business?
- What can the carrier offer to complement the basics of plan design, network access and price? Does the carrier offer support for your organization's goals of increasing enrollee health and managing costs?
- Does the carrier provide a Wellness program? Does it have engaging content through different media and channels your enrollees use frequently? Can it provide educational content based on risk level assessment?
- Does the carrier support enrollees through various means of engagement such as children's dental health, multilingual support and multiple channels of communication including traditional media, social media and personal contact?