Group dental insurance has grown significantly over the last 25 years, with 68% of employers with 20-99 employees and over 90% for larger employers offering coverage. However, participation rates are only around 36% due to limitations in medical expense coverage. The major providers of dental coverage are insurance companies (30% of enrollment), dental service plans like Delta Dental Plans (25% of coverage), Blue Cross and Blue Shield plans, managed care plans which now provide most dental coverage through PPOs or DHMOs, and large employers who self-fund plans administered by third parties. Discount plans provide members with discounts on dental services but are not considered insurance. Key contractual provisions in dental plans include eligibility, benefits covered, payment methods,

1. Group Dental
Insurance
MGT 341
Odbayar Byambaa
Professor Trisha De
Mesa
S

2. Introduction
S Group Dental Insurance
S Grown significantly last 25 years
S 68% of employers with 20-99 employees
S more than 90% for larger employee
S but only 36% participation rate
S due to the disparity in medical expense coverage

3. Providers of Dental Coverage
S Insurance Companies.
S Dental Service Plans
S Blue Cross and Blue Shield Plans
S Managed Care Plans
S Self-Funded Plans

4. Insurance Companies
S This is the major provider of dental coverage
S Indemnity or PPO basis
S Offered independently or other group insurance coverage's
S Benefits are frequently subject to the same provisions and
limitations
S Account for about 30% of overall dental enrollment

5. Dental Service Plans
S State dental service plan
S Delta Dental Plans or Delta Plans
S Write approximately ¼ of the dental coverage
S Nonprofit organization
S Sponsored by state dental associations

6. Blue Cross and Blue Shield
Plans
S Has contractual arrangements that are similar to those
that dental service plans
S Other cases benefits are paid on an indemnity basis
S Also has their own medical plans

7. Managed Care Plans
S Most of the dental coverage is now provided through this
plan
S Can be obtained from
S PPO
S DHMO

8. Self Funded Plans
S Common for large employers
S Administered by the third party
S Often a dental insurer
S Direct reimbursement
S One problem
S Lack of control over utilization

9. Discount Plans
(cannot be classified as insurance plan)
S Referred to as a referral or access plan
S Provides members with discount on the purchase of
professional services
S Monthly fee such as $5 or $7
S Discounts are often in the range of 20 to 30 percent.

10. Contractual Provisions
S Eligibility
S Benefits
S Benefit Payment Methods
S Exclusions
S Limitations
S Predetermination of Benefits
S Termination

11. The End
Thanks for Listening