Employee Dental Benefits

jaymar insurance dental

Dental plans consistently rank as the #1 requested benefit by employees after medical coverage. As popular as Dental is, however, we recognize that your budget constraints are a major factor when determining the overall benefit offering.  We help design a plan that offers the best possible benefits that is within your budget.  While recognizing that employee contributions help purchase richer benefits overall, we help you in determining an affordable level of employer and employee contributions to assure the program’s success. Dental can be provided on an employer paid, contributory or on a purely voluntary basis.

Dental plans are structured in the following ways:

Preferred Provider Organization (PPO) plans

Employees can choose any dentist under this plan, however, their out-of-pocket expenses are reduced when using an in-network Dental provider. Participating providers have agreed to accept discounted fees compared to their higher standard fee schedule.  A certain level of reasonable and customary usually the 80th or 90th percentile,  determines the level of payment when using a non-network provider.

Dental Health Maintenance Organizations (DHMO) plans

These managed dental plans are designed to offer employees dental services through a network of participating providers that result in substantially reduced out-of-pocket costs compared to PPO plans. There is no coverage when using a non-network provider. Each insured in the family can choose a different dentist. The plans generally include 0 co-pays for all or most diagnostic and preventive care as well as most routine procedures.  Co-pays increase as the cost of procedures increases.  There are:

 

    1. No annual maximums
    2. No annual or lifetime deductibles

 

A variety of DHMO schedules are usually available through the carriers that offer this type of program

The premiums for DHMO plans are substantially less than PPO plans.

 

Dual Choice Plans

 

This program offers employees a choice of enrolling in a PPO plan or DHMO plan.  Once chosen, the plan for the employee will remain in force for one year and a different plan choice can be made during the open enrollment the following year.

Employees whose dentist is in the DHMO network may find it very advantageous to enroll in the DHMO plan because:

    1. the out-of-pocket costs are much less in this plan
    2. any employee contributions under the DHMO plan are far less than those for the PPO plan

 

Employers often find the dual choice plan less costly overall than a PPO plan because:

 

    1. the DHMO premiums are far less than PPO premiums and savings are achieved when any employee enrolls in a DHMO plan vs. the PPO plan
    2. for experience rated accounts generally with 100+ enrolled employees, claims experience is not considered when rating a DHMO plan.  Increased enrollment under a DHMO plan is advantageous because renewal rates under a DHMO plan usually rise at a lower rate than experience rated PPO plans.

 

Indemnity Plans

This plan is reserved for groups in an area where there are no dental networks or where a small network is very insignificant. Employees have the freedom of seeing any dentist.