Dental and Vision Plans

Dental Plans

Employees consider dental coverage the second most important employee benefit behind group medical coverage, so sponsoring a dental plan will help your business attract and retain employees. We'll help you understand the difference between the different types of dental plans, which insurers offer the best provider networks in your area, and help design a customized solution for your employee team. We work with all the major group dental insurers.

Which Services are covered under a dental plan?

Dental plans typically cover 3 levels of care:

DIagnostic and Preventive- covers things like routine cleanings and X-rays. These are often covered at 100%

Basic-covers things like fillings and simple extractions. Sometimes endodontics (root canal) and Periodontics (gum work) are covered at the basic level, Basic level services are typically covered at 80%

Major- covers things like crowns, bridges, and dentures. These are typically covered at 50%.

Annual Maximum- this is the cap on the amount of benefit a dental plan will pay in a year for a covered member. This typically ranges from $1,000 to $2,000.

PPO, HMO, MAC, UCR, Rollover- what do they mean?

PPO Plans cover a member both in and out of the dental provider network.

HMO plans only cover you in the plans provider network. These plans are more affordable but will limit your choice of dentist.

MAC vs UCR Reimbursement

If you use an out-of-network dentist, your costs will depend on whether your plan reimburses out-of-network dentists at Maximum Allowable Charge (MAC) or Usual, Customary, and Reasonable (UCR). Under MAC reimbursement, the insurer will only reimburse an out-of-network provider the same amount the insurer's "in-network" dentists accept for a given procedure. If the out-of-network provider's charges are higher, you will be "balance billed" for the difference. UCR reimbursements for out-of-network dentists are generally higher, which minimizes balance billing. As expected, UCR plans are more expensive than MAC-type plans.

Rollover Plans- Some plans allow a member to apply some of the unused annual maximum from a current year to the next year's annual maximum. There are usually limitations to how much can be rolled over.

Vision Plans

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