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Dental
What’s In It For Me?
Incentives in Dental Benefits
by Jean Arballo
Your customers may be asking themselves, “What’s in it for me?” when considering their benefit options during open enrollment. They understand the importance of offering a strong benefits package–attracting a talented, competitive workforce. But, they also need to understand the importance of keeping their workforce healthy. What’s in it for them? A happy and healthy workforce means a happy and healthy bottom line.
But, what does a healthy workforce have to do with dental benefits? According to the Surgeon General, our mouths speak volumes about the state of our health. Did you know that when a dentist diagnoses periodontal disease, other serious problems might also be lurking? Left unchecked, many of these problems may result in a health crisis that takes a huge toll on an employee’s quality of life and a huge bite out of an employer’s healthcare budget.
Fortunately, the mouth can serve as an early warning system. Some dental plans work to draw the connections between oral health and overall health because they believe the advantages of packaging medical and dental benefits together go beyond simplified administration. In fact, research has linked gum disease to complications for pre-term birth, diabetes, heart disease, and stroke, according to a 2000 report by the Surgeon General.
Continuing healthcare cost increases will continue to affect your customer’s financial health. Here is some information you can share with customers to demonstrate the enormous financial toll that the following health issues could have on their bottom line.
Pre-Term Birth
Pregnant women with gum disease are seven times more likely to give birth prematurely, according to a study published in the Journal of the American Dental Association. Direct healthcare costs for premature births can be 15 times higher than those for a healthy, full-term baby at $41,610 versus $2,830, according to the March of Dimes).
Diabetes
Gum disease may not only be a risk factor for diabetes; it may also put diabetics at a higher risk for additional gum problems. Studies show gum disease may complicate the body’s ability to control blood sugar levels. In 2002, per capita medical expenditures for people with diabetes were more than five times higher than for those who did not have diabetes at $13,243 vs. $2,560, according to the Centers for Disease Control.
Cardiovascular Disease
Bacteria present in gum disease may help trigger the formation of blood clots, which can contribute to a heart attack or stroke. In 2006, the cost of cardiovascular disease and stroke is estimated to be $403.1 billion by the end of the year, according to the American Heart Association.
Oral Cancer
The American Dental Assn. reports that more than 25% of oral cancer occurs in people who do not smoke and have no other risk factors. Early detection can help avoid high treatment costs and could even save a life; only half of all patients with oral cancer survive more than five years, according to the Oral Cancer Foundation.
In addition to the tremendous medical and financial toll, these health crises can take a devastating emotional toll on those involved. Although they may understand the importance of integrating medical and dental care, tight healthcare budgets may simply not permit them to make such a change.
Incentives for the Customer
However, new options in the dental benefit marketplace can make integration a new and exciting possibility for your customers. One benefits provider is offering a medical claim integration credit. Clients who package medical and dental plans through this insurer can qualify for a medical integration credit up to 0.5%. Even better, customers have access to an even higher credit of up to 1% if they bundle medical and dental with the provider’s disease management programs for diabetes and cardiovascular care. Also, a claims credit could provide greater financial incentives than those offered by simply bundling discounts.
Incentives for Members
So you’ve convinced your customers of the importance of oral health, what’s next?
What about the actual members? They may also need incentives for seeking proper oral care. By using the same consumer-centric approach used in the health benefits industry, dental benefit plans are beginning to provide financial incentives for healthy behavior.
One dental benefits carrier launched a new DPPO offering that reward members who receive preventive dental care by increasing their benefits. This is an exciting and valuable new option considering that, according to the National Association of Dental Plans (NADP), the maximum benefits available to consumers have changed very little in the past 10 years.
These plans allow employers to choose from dental plan modules that offer employees varying incentives for receiving preventive dental care. Their benefits increase in the following plan year when members receive any Class I service in year one, which includes preventive care services, such as cleanings, oral exams, and X-rays.
This particular plan offers these incentives in three different modules:
Module 1: Members who receive preventive care in any year can earn a higher dollar maximum in the following year, up to a certain level set by the employer.
Module 2: Members who receive preventive care in any year get higher benefit levels for certain services in the following year. Depending on the plan design, the increased benefits could apply to Class II services, which include basic dental care, such as fillings and basic restorative services or Class III services, which include major services such as crowns, bridges, and root canals. Each year that the members are enrolled in these plans and continue to receive preventive care, their benefit levels increase in the following plan year until reaching a pre-determined level set by the employer.
Module 3: Members receive preventive care with increased benefit levels in the following year. Unlike the other modules, if members do not continue to receive preventive care after getting an increased benefit level, their benefit level will decrease in the following year. However, the benefit level will never fall below the original benefit level.
Such innovative benefit designs can give your customers the flexibility they want and the incentives that their employees will value. Giving members the ability to increase their benefit levels in the following year will not only promote preventive dental care, it could also increase the access to care by removing financial barriers that may have prevented people from going to the dentist in the past.
In conclusion, while research has continued to demonstrate a connection between oral health and overall health, some customers and their employees may need an even greater incentive to make dental care a priority. Innovative options in dental plan design could offer the financial incentives to help your customers make dental benefits a priority and their workforce take the important step toward a healthier lifestyle.
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Jean Arballo is a sales manager for CIGNA Dental of Southern California. She is located in Glendale, Calif. and can be reached at jean.arballo@cigna.com or at 818-546-5328. |
