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Good oral health is an essential part of health care and overall wellbeing.2
According to the National Association of Dental Plans (NADP), Americans with access to affordable dental insurance benefits are more likely to go to dentists, take their children for dental care, and experience better overall health. Why? Dental coverage can help eliminate the #1 reason for skipping dental care visits – perceived cost – because services like checkups and cleanings are free with most dental insurance plans. And dental checkups can uncover a lot more than just cavities: more than 90% of all common diseases have oral symptoms.3 Studies also show that good oral health can help adults avoid or better manage serious health-related issues.2 Thinking of offering dental benefits to your workers? They'll appreciate it. In fact, 68% of employees sign up for dental insurance when employers offer it.4After all, like regular health insurance, dental insurance can help keep them healthier.
|Dental PPO: More Dentist Choice||Dental HMO: Less Dentist choice|
|Like PPO health insurance, these dental insurance plans typically have extensive provider networks and let enrollees see other dentists. But when enrollees stay in-network, they pay less and don't need to submit claims. Want to see if a dental provider is with Guardian? Find out here.||These dental plans tend to offer lower premiums, but there's also less flexibility with a limited number of providers. Like HMO health insurance plans, enrollees choose a Primary Dentist and have to go through them for all care, including specialist referrals. Many DHMO dental plans have no deductibles or caps – and while there are flat-rate copayments for most non-preventive treatments, overall costs for enrollees will likely be lower.
(Available in select markets. DHMO not available on Guardian Direct)
Affordability is important, and one way for an insurance company to control premium costs is by offering a variety of plans with different levels of benefits. Guardian Direct provides several levels of individual dental insurance: Explorer, Core, Achiever and Diamond plans. Generally speaking, a basic dental insurance plan covers preventive care services such as checkups, cleanings, and a few essential treatments, like cavity fillings, with little or no reimbursement for major treatments. Full coverage plans cover many more services – and often at a lower out-of-pocket cost to enrollees. For example, they may cover a broader range of preventive procedures such as fluoride treatments and sealants – either in full or small co-pay. A quality full-coverage plan may also cover many types of major procedures.
|Preventive care||Checkups, cleanings, routine x-rays, and sometimes, fluoride treatments|
|Basic restorative care||Fillings, extractions, and other simple services|
|Major restorative care||More complex treatments such as root canals, as well as dental devices like bridges and dentures|
|Orthodontic treatment||Braces and other types of teeth aligners|
Over 7 million people have Guardian Dental.7
Guardian has one of the largest provider networks.8 It makes a difference.
When people find dentists they like, they tend to stay loyal: Over 60% of working Americans have been going to the same dentist for at least three years, and 32% have been with the same provider for ten years5 Guardian has one of America's largest networks8, with more than 120,000+ dental benefit providers at more than 420,000 locations, including thousands of specialists, such as periodontists, pediatric dentists, and orthodontists. We're continuing to make our network stronger, adding more dentists in more locations every year. That means if you already have a provider you love, there's an excellent chance they're in one of our plans. How can you be sure? See for yourself: Guardian also makes it easy to find a provider.
|120,000+ dentists8||420,000+ locations8||Up 42% 5-year network growth9||Close to 40% discount average member savings9|
When enrollees see in-network dentists, they pay less for services than other patients because the insurance company negotiates discounted fees on your behalf – and members get that discount even if they haven't met the deductible yet. Guardian's average discounted fee is 36%9 – one of the strongest rates in the industry.
When people don't have dental insurance, they have to pay for dental care out of their pocket. How much? A study from the American Dental Association estimated they spend between $492 and $785 per year. Dental insurance can help by paying for part or all of the cost of covered services. Most dental plans share the following features:
- Free preventive care – The most common dental treatments – preventive checkups and cleanings – are usually covered without any out-of-pocket charge.
- A provider network – Some plans only cover "in-network" treatment; other plans let enrollees go out of network, but they save more by using network dentists.
- A deductible – Like most health care plans, there's a certain amount enrollees pay out of pocket before the insurer starts paying – typically around $50 for an individual and $150 for a family.
- Co-pays or co-insurance – Enrollees pay for a portion of many treatments. Co-pays are flat fees; co-insurance is when enrollees pay a percentage of the dentist's charge.
The preventive/basic/major coverage formula
A lot of insurance companies use this formula to provide a high-level overview of what they cover. If you see a dental plan described as 100/75/50, here's what that means:
- Preventive care, including services such as dentist checkups and cleanings – is covered 100% (you usually don't even pay a deductible).
- Basic procedures – like fillings and extractions – are covered at 75%.
- Major procedures like crowns, bridges, and root canals are covered 50% – and there will typically be a waiting period before the plan will pay for major care.
Some services may be considered "basic" by one insurance company and "major" by another. But whatever the benefit formula, there's typically a cap on the total amount dental insurance companies will pay for care in a given year – usually between $1,000 and $2,000 per plan member. Any dental expenses over the insurance plan cap are your responsibility.
When your company is with Guardian, enrollees can easily find dentists or access their ID cards from smartphones or tablets with our mobile app. Employees and family members can also manage their benefits online at Guardian Anytime, which lets them:
- Find a dentist
- Submit and check customer claims
- Download forms
- Learn about oral health
- Get estimates of dental care costs
Is there a dental plan that covers everything?
As with regular health insurance, we are not aware of any policy from any dental insurance company that pays 100% of care costs, for every customer, with all dentists.
How much does dental insurance cost employers?
As with health care coverage benefits, the average cost of premiums varies widely depending on company size, location, plan type, and coverage levels. Even so, the cost of quality, company-paid coverage is much lower than a health plan, commonly in the range of $20 to $50 per person per month.4 Plus, companies may qualify for a tax credit.6 It's also important to note that dental insurance can be offered as part of their voluntary (i.e., employee-paid) benefits, with minimal costs to the company. Enrollees still come out ahead because employer groups get affordable rates and may enjoy more features than a comparable plan for an individual customer.