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Blue notes blog

Understanding and getting the most out of your group dental benefits

Dental health is an important part of your overall health. Two of the keys to getting the most out of group dental coverage are understanding the dental landscape in Alberta and educating your employees to make sure they are being the best dental consumers possible every time they go to the dentist. We hope that this information will help you develop an understanding of your group dental benefits.

Dentists chair

The dental landscape

The Government of Alberta announced that the Alberta Dental Association and College (ADA&C) has introduced a new fee guide effective January 1, 2018. The intent of this fee guide was to eventually provide standard rates for all dental services in Alberta. Because the rates included in the guide were on average about 8.5 per cent less (based on an average of 60 procedure codes from a 2016 dental association survey) than those currently being charged by many Alberta dentists, the hope was that dental fees across the province would be lowered and Albertans and plan sponsors alike would realize dental savings.

While some dentists have adopted the new ADA&C guide, following the guide remains strictly voluntary. Ultimately, this means that Alberta dentists still charge varying prices for dental services.

How does this affect plan sponsors?

Many benefit providers, including Alberta Blue Cross, have adopted the ADA&C guide as the basis of payment for at least some of their dental claims. When this is the case, there is the potential to experience plan savings based on a reduction in claims costs for many common dental procedures. However, it is important to note that the direct impact of the reduction will vary based on plan design, usage and plan member and dental provider behaviour.

How does this impact your employees?

The impact to your employees will depend in part on whether or not dentists reduce their fees to align with the ADA&C fee guide. If they do, then your employees could find themselves paying less out of pocket for most dental procedures.

If dentists do not charge the ADA&C fee guide fees, the reality is that your members may actually pay slightly more out of pocket as their plan's level of coverage may have lowered to match the ADA&C guide. The best way to help your employees avoid or offset a potential increase in dental expenses is to ensure that they take advantage of opportunities to coordinate their benefits or use spending accounts if available. In addition, it is important that employees become informed dental consumers who are aware of the potential savings that can be generated by shopping around and comparing various dental services.

Helping your employees be informed consumers

Because different dentists can charge varying rates for dental services, it’s important to be as informed as possible before getting dental work done. Here are some actions we recommend you suggest your employees take to get the most out of their dental benefits:

Step one: identify their coverage

  • Suggest your employees
    • talk to you or their benefit provider to find out the details about their coverage; and
    • ask for information about their coverage that they can take with them to the dentist.

Step two: find out what their dentist will charge

  • Recommend your employees
    • inform their dental office about their benefit provider;
    • ask their dental office if they charge according to the "Alberta Dental Association and College fee guide." If they do, then your employees could find themselves paying less out of pocket as the fees in that guide are, on average, lower;
    • show their dental office their dental plan’s rates, if they are able to, and ask how their fees compare to the fees their plan pays; and
    • ask their dental office to submit a predetermination prior to receiving treatment.

Step three: stay or shop

  • By now your employees should have some idea of what their plan will cover and what they will be paying out of pocket.
  • Remind them to use another plan or a spending account if they have them.
  • If they are not satisfied with the amount they will be paying out of pocket, suggest they shop around. Because dentists charge differing rates, this can result in significant savings.

Contact your benefit provider

Contact your benefit provider to learn more about your dental benefits. Most benefit providers can provide you with additional information regarding your plan and can provide you with educational materials for your employees.