Tools for Employers: Choosing a Dental Benefits Plan for Employees

Why should my company offer employee dental benefit plans?

Keeping your employees’ smiles healthy keeps workers productive and can even lower medical care costs. This means finding a high-quality dental plan that pays dividends to both employees and employers.

Successful management of the dental benefit request for proposal (RFP) and choosing a dental plan requires receiving and evaluating a variety of information to make the best business decision for your company and its employees. Understanding your employees’ oral health needs before investing in a plan can help in identifying the best benefit for your employees. A group policy is one size fits all and needs to reasonably accommodate employees with greater dental needs at an affordable cost for all.

To help employers choose the best plans for their organizations, the American Dental Association (ADA) Council on Dental Benefit Programs (CDBP) has developed a set of tools to help evaluate employees’ needs and plan proposals.

Tools in this toolkit

Prior experience metrics to seek with any proposal - Include this tool in your RFP, requesting the bidder to submit metrics to objectively gauge prior performance of the plan.

Assessing the final proposals - Use this survey to make sure the plan will meet your employees’ needs.

The more you know about dental benefits, the better equipped you will be to ask the appropriate questions. The American Dental Association can be a resource in helping you support your employee’s oral health through a dental benefit plan.

To speak with someone about selecting a dental benefit plan, call the ADA’s Center for Dental Benefits, Coding and Quality at 312-440-2500.

Looking to buy an individual dental benefits plan for yourself and your family? Learn more about your options on MouthHealthy.org.

ADA Guidelines for an Appropriate Dental Benefit Plan
The following are the ADA’s guidelines for recommended features of a comprehensive dental benefits plan. Use these as a guide when looking for a quality dental benefit plan for employees.
  1. At a minimum, dental benefit plans should include coverage for the following preventive services:
    • Topical fluoride applications for children and all at-risk populations
    • Prophylaxis (cleaning)
    • Application of pit and fissure sealants as warranted for all ages
    • Space maintainers
    • Oral health risk assessments
    • Screening and education for oral cancer and other dental/medical-related conditions
    • Oral hygiene instruction
    • Dietary consultation
    • Preventive resin restorations
    • Fixed and removable appliances to straighten teeth
    • Athletic mouth guards
    • In-office patient education, i.e., tobacco cessation counseling
  2. Diagnostic and preventive services should have first dollar coverage, i.e., the plan should cover these services regardless of whether the patient has met the plan’s deductible.
  3. Dental benefit plan administrators should help employers communicate with employees regarding the importance of at-home routine oral care and regular dental visits to monitor and prevent dental disease.
  4. Plans that restrict patients’ choice of dentists (e.g., an exclusive provider organization or EPO) should not be the only plans offered to subscribers. In all instances where this type of plan is offered, patients should have the annual option to choose a plan that affords unrestricted choice of dentist, with comparable benefits and equal employer-contributed premium dollars.
  5. In order for the employer to understand the plan prior to purchase, the extent of any benefits available under the plan should be clearly defined, limitations or exclusions described and the application of deductibles, copayments and coinsurance factors explained by the dental benefit plan. While a plan with comprehensive coverage costs more, a clear understanding of the richness (or lack thereof) of the plan prior to purchase is essential.
  6. Employers should try to understand the overall satisfaction of dentists in the plan’s network to ensure that employees receive care within a network that values the doctor-patient relationship.

Did you find this toolkit helpful? The Council appreciates your feedback and wants to make sure these resources are as relevant and up-to-date as possible. Please send comments and suggestions to dentalbenefits@ada.org.