A growing number of group dental plans are rewarding members who receive regular preventive care with an extra allowance they can use to help cover big expenses such as bridges or implants.

The maximum-limit rollover programs, which work a lot like cellphone plans that let customers roll over unused minutes, started a few years ago at Ameritas Life Insurance and Guardian Life Insurance Co. of America.

Today, this design has spread to some plans at insurers including UnitedHealth Group, Cigna and Starmount Life Insurance. Principal Financial Group is set to start its program effective Oct. 1 for plans sold after July 1. All plans aren’t available in all states.

Here’s how the rollover plans generally work:

A patient who sees his dentist at least once a year for an exam and cleaning, but whose care costs less than a certain amount, say $500, can roll over a portion of his maximum remaining allowance to the following year.

The portion depends on the insurer and the employer’s plan.

So, a patient with a $1,500 annual maximum might roll over $250 to the following year for an increased maximum of $1,750. Some plans cap the number of years that balances can be rolled over to three or four.

Most also cap the maximum dollar amount that can be rolled over. At UnitedHealth, for example, which introduced its Consumer MaxMultiplier on Jan. 1, the maximum dollar limit that could be accumulated under its most generous plan is $3,200, or $1,200 in addition to the basic annual limit of $2,000.

Promoting Regular Care

Insurers say the programs encourage members to get regular checkups, including cleanings, which help reduce the incidence and severity of gum disease and tooth decay. Gum disease increasingly has been linked to other health problems including heart disease and diabetes. So improving members’ oral health should help keep overall medical costs down for employers and patients, insurers with rollover plans say.

The rewards for good behavior also help keep low-risk patients from dropping their plans as health-care premiums and co-payments rise, they say. Dental-plan premiums rose 2.7% last year, far below the 7.7% for medical plans, according to the National Association of Dental Plans.

But some other dental insurers criticize rollover plans as gimmicky retention tools. “We suggest that employers interested in promoting needed services can just as easily raise the annual maximum for all,” says Gary D. Radine, chief executive of Delta Dental Plan of California, Pennsylvania and affiliates, one of the largest independent dental plans.

Jacquie Hill, a spokeswoman for Assurant Employee Benefits, another major dental provider, says at most 6% of dental-plan members ever hit their annual limit.

Dollars for Implants

Still, with the rollover plans, the higher annual limits in following years can be used to provide a cushion for extraordinary expenses such as tooth replacements, insurers with such coverage say. Since 2005, all dental plans offered by Guardian, for example, have been covering dental implants, which can cost as much as $3,000 each, and UnitedHealth expects to begin covering them later this year or early next. Cigna offers riders for implants for employers who want to add coverage for them to group plans.

Preventive care and diagnostic screenings are covered at 100% under many dental plans; bridges, implants and other restorative work are usually covered at 50%.

As part of the prevention and wellness trend, more insurers also are covering new screening exams for oral cancer — including ViziLite, an early screening for precancerous oral lesions that uses a chemical light, and Oral CDx, a brush biopsy used in the dentist’s office to examine suspicious mouth lesions for cancer. Guardian began covering ViziLite in March. Cigna is covering the brush biopsy in all plan designs and ViziLite in some.

source 

Tags: