A focus on dental plans will ensure that everyone remains happy

When you’re smiling, the whole world smiles with you. So the song tells us. This is especially true when people can show off healthy teeth and gums.

“Good oral health contributes positively to your physical, mental and social well-being – and to the enjoyment of life’s possibilities – by allowing you to speak, eat and socialize unhindered by pain, discomfort or embarrassment,” the Canadian Dental Association observes. Poor oral health has even been linked to heart disease, diabetes, respiratory illness and cancer.

The challenge is that dental care does not fall under the Canada Health Act. This means that most services are paid out of pocket or with the support of a dental plan. The Canadian Institute for Health Information found in 2011 that 59% of private dental care expenses were covered by insurers.

It shows why dental care remains one of the most valued pillars in an employee benefits plan.

Knowing how the plan is used can be one of the first steps in deciding how the support should be structured. Some employees, for example, tend to use dental plans more than others. Recent research by Green Shield Canada found 20% of claimants accounted for 54% of costs.

The demands on a plan will also reflect employee demographics. About 35% of the costs to care for an employee’s young children will involve restorative work, with preventive care at 25%. Once these children become teenagers, 22% of costs involve restorative work, and 17% goes to prevention. Orthodontic treatments then begin to emerge at 17% of costs. Compare this to employees in their 50s, where 25% of costs can be traced to restorative work, and 23% goes to periodontics (involving the structures that support teeth).

There is also a gap to consider between the sexes. Preventive procedures account for the second-highest costs among women, but fourth-highest for men. “Is this male apathy?” the authors muse. “Or are women just doing what women do; they go to the doctor … and turns out they also go to the dentist.”

The effects can reach even wider than that: “What’s happening in plan members’ mouths may provide a view to what’s going on in their bodies.”

When it comes to controlling costs, however, one of the most important facts will involve the way dental bills are structured. Dental cleaning fees are based on 15-minute increments known as scaling units. Unfortunately, some dentists have been known to submit invoices for the maximum values allowed in a benefits book. This can be controlled by setting annual deductibles or capping the number of covered visits per year.

Employees are further encouraged to police such expenses if they are expected to pay a small share out of personal pockets, through something known as a co-payment. Even if the benefits plan covers the majority of costs, employees are more likely to focus on affordable options when making a direct payment at the cash register.

The amount that plan holders will pay can vary depending on the type of care. X-rays, cleaning, fillings and root canals are usually offered with an 80/20 cost-sharing structure, with 80% paid by a plan, according to the dental association. The cost of major procedures such as crowns and bridges are typically split down the middle.

But you can be sure that any well-structured plan will keep everyone smiling.

Top Tips:

• Establish a maximum value of dental cleanings per year, to help ensure dentists don’t bill patients for an excessive number of scaling units.
• Introduce a co-payment. X-rays, cleaning, fillings and root canals are typically structured with an 80/20 cost-sharing structure. Major procedures such as crowns and bridges are typically split down the middle.
• Track the demographics of employees and their families. They can offer insights into the cost of care to come.