People want more than just clean teeth We asked representatives from two top carriers in the dental industry to share details about their companies.
Stacia Almquist: VP, Network & Market Development, Unum and Colonial Life Dental & Vision
Jill Purcell: Head of Dental & Vision Products, Guardian Life
1. What are the current trends in Dental coverage? Are claims showing any trends in care, or revelations of instances of predicting health issues early?
JILL PURCELL, HEAD OF DENTAL & VISION PRODUCTS, GUARDIAN LIFE:
Dental benefits continue to be recognized for the impact they have on employees’ overall well-being and for helping them come to work feeling, thinking, and performing better. Our most recent dental study, “Dental Fundamentals: In-demand dental benefits that support well-being,” found that consumers want dental plans that help them save while making preventive care more accessible. Based on these insights, Guardian delivers modern dental benefits that are flexible, easy to understand, and offer a variety of benefit options that balance cost and access to care.
There has been increased attention to the importance of preventive care. In fact, poor dental health has been attributed to higher incidence of heart disease, dementia, diabetes, rheumatoid arthritis, and pregnancy complications, while good oral care and dental health has been linked to better overall physical and mental well-being.
STACIA ALMQUIST, VP, NETWORK & MARKET DEVELOPMENT,
UNUM & COLONIAL LIFE DENTAL & VISION:
During the pandemic some members skipped or delayed preventive services, resulting in fluctuation and increases in utilization of services such as periodontal treatments. We do expect to see utilization trends come back to a normalized level over time.
As many other industries, some provider offices are working hard to recruit and retain staff. The impact could affect services available to members.
2. Has COVID-19 changed any of your offerings or had a substantial impact on any of your plans, like a change in claims or use of benefits due to postponing care during the pandemic?
PURCELL, GUARDIAN LIFE:
The last few years have brought renewed consumer appreciation for dental benefits. Although dental visits were down overall in 2020, they rebounded in 2021 to exceed pre-pandemic levels, and nearly a third (30%) of patients with dental insurance say the pandemic caused them to value their dental benefits more.
Guardian offers options to ensure members have access to dental care when and where they need it. These include virtual care options through our partnership with Teledentistry.com, a service that allows patients to connect virtually with an emergency dentist, and Byte,® an innovative option for at-home aligners and teeth whitening. Jet Dental, an onsite provider that is part of our network of dentists, brings dental care directly to employees at their place of work.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Throughout the pandemic, many providers offered teledentistry as an option to help allay members’ fears of not being able to access dental care, especially during emergencies. We have virtual dental visits available through TeleDentistry.com. Dentists perform video examinations and prescribe medicines, if needed. Members can meet virtually with a dentist 24 hours per day, 7 days per week if there is a dental emergency or cannot visit in-person.
3. What types of plans do you offer? How do the offerings for individual and small group compare to large group plans? Are more individuals selecting to self-insure who may not have employee coverage?
There has been increased attention to the importance of preventive care. In fact, poor dental health has been attributed to higher incidence of heart disease, dementia, diabetes, rheumatoid arthritis, and pregnancy complications, while good oral care and dental health has been linked to better overall physical and mental well-being.
PURCELL, GUARDIAN LIFE:
Guardian offers an array of plan types and options to meet the needs of employers/employees and individuals/families. Employer plans can be customized according to needs and price points. Dental PPO, Managed Dental Care (Prepaid/DHMO), Indemnity, Dual and Triple Choice, Monthly Switch (between a DHMO and PPO), and Administrative Services Only Plans can be offered as voluntary, contributory, or on an employer-sponsored basis. Individuals/families can buy direct from www.guardiandirect.com.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Unum and Colonial Life offer plans that fit all size groups whether fully voluntary, contributory or employer sponsored.
Our product portfolios include group dental PPO plans, DHMO plans (available in southern California) and individual plans offered through the worksite. Group dental PPO plans may be customized to meet the unique needs of the employer and employees.
4. What changes in plans or benefits should brokers be aware of for open enrollment this year? Are more employers offering or making their plans richer?
PURCELL, GUARDIAN LIFE:
We have recently introduced innovative plans in 23 states and hope to be able to bring them to California in the near future. The products, some of which are the first of their kind, focus on preventive and corrective care and can help reduce physical and mental health risks tied to poor oral health.
In our Guardian Inflection Point report, 44% of respondents making changes to their dental plans are looking to add coverage.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Unum and Colonial Life Dental Plans Offer:
• A national network of more than 120,000 unique providers
• A recruitment team enhancing the quality and availability of in-network services for members
• A carryover benefit designed to reward employees who take care of their teeth
• Extra cleanings for pregnant women in the 2nd or 3rd trimester
• Adjunctive pre-diagnostic testing for members 40+ years old who demonstrate risk factors for oral cancer
• Online wellness tools – provider search, digital ID card, member benefits, dental cost estimator and access to claims information
• Access to virtual visits available 24/7 when employees have a dental emergency or cannot visit the dentist in-person Combined billing and administrative service with other Unum or Colonial Life products, including Life, Disability and other group and voluntary benefits.
Throughout the pandemic, many providers offered teledentistry as an option to help allay members’ fears of not being able to access dental care, especially during emergencies. We have virtual dental visits available through TeleDentistry.com.
5. How many provider locations do you have?
PURCELL, GUARDIAN LIFE:
For PPO, we have 133,040 dentists.
For DHMO, we have 10,919 dentists.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Our PPO dental network has more than 425,000 access points nationally with over 88,000 unique locations and 120,000+ unique providers. In California, there are 12,000 unique locations and more than 16,000 unique providers.
We started marketing DHMO in Southern California in 2021. The network currently has 661 unique locations, 663 unique providers and continues to grow.
6. Do you reimburse for out-of-network dentists if an insured chooses to go outside of your network?
PURCELL, GUARDIAN LIFE:
Reimbursement for out-of-network dentists would depend on the plan chosen. However, generally, non contracted dentists are reimbursed using Guardian’s reimbursement schedule. Reimbursements are calculated using a combination of industry, third-party and internal claims data for each CDT code and geographic location.
Reimbursement amounts are calculated using the dentist’s submitted amount and the number of times a specific service is submitted in a zip code area. We use Guardian’s 90th reimbursement schedule as our standard. We can pay claims using different percentiles of Guardian’s reimbursement schedule, such as the 50th, 70th, 75th, 80th, 85th, or 95th percentile. We update our reimbursement data every six to 12 months.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Yes. PPO plan members can access the provider of their choice, in or out-of-network. Members will have lower out of pocket costs with an in-network provider.
Our DHMO plans have in network benefits only, with emergency services available out of network as needed and approved.
7. What percentage of your network is open to new enrollment? How many offices does this represent?
PURCELL, GUARDIAN LIFE:
For PPO, in 2021, we had 133,249 dentists, and 93.6% of those participating dentists were accepting new patients.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Our PPO network is 99% open to new patients, while our DHMO network in Southern California is approximately 90% open to new enrollment.
8. What happens if a member is in the middle of orthodontic treatment and they lose their coverage due to a job change or other circumstance?
PURCELL, GUARDIAN LIFE:
If a member’s coverage ends while treatment is in progress, benefits will be paid to the end of the month in which the coverage ends.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
If a member has a PPO dental plan, it pays the lesser amount of 25% of the orthodontia lifetime maximum or 25% of the total billed amount upon initial banding. Remaining benefits are paid in monthly installments at 50% of the allowed amount until the plan orthodontia maximum benefit has been met or the braces are removed, whichever comes first. If a member were to leave the dental plan mid-treatment, coverage would be discontinued, and they would move to a new dental carrier to pay the remaining benefit.
We will resume orthodontic benefits from the prior plan and continue to pay the benefit until the lifetime maximum is met. A new member’s history of orthodontic benefits is obtained from the previous carrier’s report or by requesting the information directly from the provider. For plan members without prior orthodontic coverage, waiting periods for orthodontia may apply.
If a member has a DHMO plan that includes an orthodontia benefit, the member responsibility is based on the copayment.
9. What are your annual and lifetime maximums if any? What is the plan deductible?
PURCELL, GUARDIAN LIFE:
Guardian offers annual maximums ranging from $500 to $5,000. Historically, the most common annual maximums are $1,000 and $1,500.
If a plan covers orthodontics, Guardian will pay a separate lifetime orthodontic maximum for the orthodontic services. The lifetime orthodontic maximum ranges from $1,000 to $2,000. A lifetime maximum is the maximum amount that
Guardian will pay for covered services for a member while he or she is insured on the plan.
Individual deductibles range from $0 (or no deductible) to $300, with $50 historically being the most common.
Note: Annual and lifetime maximums and plan deductibles are determined on a case-by-case basis.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
On PPO plans, our annual maximums vary from $500 to $5,000, depending on the group’s needs and size. Deductibles can also vary, including no deductible, annual flat dollar per insured or per family, and flat lifetime deductible per insured.
We also offer the ability to include a Carryover Benefit as a standard plan feature. The Dental Carryover Benefit is designed to incentivize and reward members with an opportunity to increase their individual annual maximum for taking care of their teeth with preventive services. We will credit the Carryover Benefit to the member’s account for the next year if they submit claims for preventive services and if the member’s total benefits received are less than the group’s threshold amount within one benefit year.
There is no annual or lifetime maximum on DHMO plans.
10. What percentage does your plan cover for: preventive costs, root canals, crowns?
PURCELL, GUARDIAN LIFE:
The percentages for the listed services vary by the selected plan design and request for benefits by each planholder. Historically, the most common percentages are 100% for preventive, 80% for root canals, and 50% for crowns.
We provide online tools to help members take better care of their oral and overall health, available at guardianlife. com.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Preventive Costs
• Preventive care is covered at 100% in PPO plans. We offer various options such as covering preventive care at 100% in network and 90% when visiting out of network providers.
• DHMO plans cover most preventive services with no copayment.
Root Canals
• In PPO plans, root canals are covered as a basic service. The coinsurance percentage for basic services is most sold at 80%. Our plans are flexible, and we can offer varying coinsurance percentages based on the employer’s needs.
• DHMO plans cover many root canal procedures at copayment levels that will vary based on the plan selected.
Crowns
• In PPO plans, crowns are covered as a major service. The most common coinsurance percentage for major services is 50%.
• DHMO plans offer a variety of crown procedures covered at various copayment levels based on the plan selected.
11. Do you provide dentist cost and quality transparency tools?
PURCELL, GUARDIAN LIFE:
Yes. We provide online tools to help members take better care of their oral and overall health, available at guardianlife.com. Guardian offers a convenient Dental Cost Estimator tool to empower dental plan members to make better decisions to help improve their oral health and use their benefits wisely. With just a few clicks of the mouse, members can receive cost estimates on dental procedures – before treatment – and compare the financial impact of visiting dentists either in or out of their network.
LMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
For plan participants, the personalized, secure plan member website accessed through www.UnumDentalCare.com or www.coloniallifedental.com provides access to an array of online tools and information necessary to manage coverage.
The sites feature a Dental Cost Estimator tool that members can use to find the costs for dental procedures in their zip code area. The costs displayed provide an idea of what providers may charge but does not specifically provide the reimbursement amount used when processing claims. Members can also view their Benefit Summary, which provides specific information about plan coverages. The California required Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) provides a summary of the benefits and coverage.
12. Who can readers contact for more information?
PURCELL, GUARDIAN LIFE:
Contact: Jill Purcell, Head of Dental & Vision Products, Guardian Life.
Jill_Purcell@glic.com, or visit https://www.guardianlife.com/dental-insurance/group.
Material discussed is meant for general informational purposes only. DentalGuard Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. GUARDIAN® and the Guardian Logo® are registered trademarks of The Guardian Life Insurance Company of America.
ALMQUIST, UNUM & COLONIAL LIFE DENTAL & VISION:
Contact: Group Dental Insurance Plans and Coverage | Unum Individual & Group Dental & Vision Insurance for Employees | Colonial Life
CLA:
Plan administrator support – 800-256-700
Unum:
• Los Angeles, CA Field office: 800-772-3081
• San Diego, CA Field Office: 800-431-3838
• San Francisco, CA Field Office: 800-367-6166