Dental Close-Up
New Trends In Dental Coverage Put the Consumer In Charge
by James Fuhrman

Consumers need more information and new benefit plan designs to be better stewards of their own dental care. Two examples of how dental plan providers are responding are roll over plans and expanded preventive care for expectant mothers.
   An expectant mother doesn’t usually consider dental health when she thinks about prenatal care, but she should. Some researchers believe that women with periodontal disease may be at greater risk of delivering preterm babies. Periodontal disease is characterized by inflammation of the gums, often persisting unnoticed for years or decades in a patient, resulting in loss of bone around the teeth. Left untreated, periodontal disease during pregnancy could be associated with higher risk for preterm delivery, which could lead to neonatal problems, as well as the possibility of life-long disabilities for the child, which result in emotional, financial, and physical burdens that tax the entire family.
Preventative care is an important cornerstone of consumer directed healthcare because it helps consumers avoid more serious health problems. Every $1 spent on dental prevention saves $8 to $50 on restorative and emergency dental needs, according to the American Dental Hygienists Association.
   The American Academy of Periodontology recommends a periodontal examination for women who are pregnant or planning pregnancy. Appropriate preventive or therapeutic services should be provided if indicated. While scientific evidence on this issue is limited, many believe that a periodontal examination by the family dentist may be a component of complete prenatal care.
   Employers should be aware of the availability of dental plans that meet the needs of expectant mothers and their unborn children. Some dental plans cover cleanings, deep scaling, and other periodontal maintenance performed by dentists as preventive care for women who are in their second or third trimester.
Pregnant women in their second or third trimester may receive additional services including the following:
• Additional routine adult prophylaxis above the standard two cleanings per year as prescribed by the dentist.
• One course (up to four quadrants) of periodontal scaling and root planing for a documented untreated periodontal condition.
• Periodontal maintenance if warranted by a history of periodontal treatment.
The most consumer-friendly dental benefit plans do not require out-of-pocket costs; do not apply fees to the benefit period maximum or deductibles; do not require waiting periods for necessary services performed by a network dentist; and do not require referrals.

Rolling Over Unused Coverage

Welcome to the start of consumer-directed dental care. As with consumer-directed care in general, dental consumers want more control over how and when they utilize their benefits and more control over their out-of-pocket spending.
   An important trend in the dental industry is to allow consumers to roll over their unused coverage from one year to the next, similar to carrying over vacation days. This benefit design moves beyond a one-size-fits-all approach by giving members the flexibility to use their dental benefits in a way that best meets their needs. The time-expanded coverage can be used towards costly dental procedures that would otherwise exceed the annual maximum benefit. It allows the consumer to control funds spent on dental care.
   Some consumers want to use their dental benefits to the maximum every year and they will spend their own money out-of-pocket when faced with a catastrophic dental event. However, a rollover plan is best for consumers who take a more prudent approach. These consumers use their dental benefits for preventive care without spending to their maximum allowable benefit each year. At the end of the year, the prudent dental consumer has benefit coverage in case they need it in the future. This consumer is protected from the costly out-of-pocket expenses of a catastrophic dental event and is not penalized for using the money once it is in an account.
   Consumers also want services to be available when they need them. A good rollover dental plan helps them keep out of pocket expenses lower. It also helps build a long-lasting relationship between the consumer and the carrier. The plan should be easy to understand and use and the consumer should not incur additional expenses to participate in the program.
   Brokers should check whether the dental plan has limits on the type of services that are allowed, consequences for early member termination of dental coverage, a bonus for in-network use, and rules on changes in group plans.
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Jim Fuhrman, who is executive vice president of UnitedHealthcare Dental, is based in the company’s Santa Ana office. He can be reached at jfuhrman@uhc.com.