Benefits administrator blog from Delta Dental

Category: Group dental benefits (Page 1 of 4)

Understand how dental coverage can help your organization. Take a peek at the ins and outs of group dental benefits.

Keeping dental insurance when budgets are tight

With today’s pandemic-related economic uncertainty and rising interest rates, you may find yourself with a benefits budget that’s stretched a bit thin. If you’ve considered dropping your group’s dental benefits to save money ― or don’t think you have the resources to add them ― we’ve got you covered.

DeltaCare® USA, Delta Dental’s DHMO-type product, offers comprehensive dental benefits for less than you might expect. These copay plans cover more than 400 procedures, so your employees won’t have to sacrifice quality care for affordability.

What it offers

Most DeltaCare USA plans include additional cleanings at reduced copayments, at-home teeth whitening, athletic mouthguards and porcelain crowns. And our orthodontic treatment in-progress provision allows new members to continue treatment with their current orthodontist, even if that orthodontist isn’t in our DeltaCare USA network.

Other advantages include: 

  • Tooth-colored fillings for any tooth
  • No lab fees or other hidden fees
  • No hidden charges for materials such as resins, metals or porcelain

What’s more, as a fixed copayment plan, DeltaCare USA offers your employees both convenience and simplicity:

  • No deductibles or maximums
  • No claim forms
  • Low or no copayments for diagnostic and preventive care

How it works

In most states, employees select a DeltaCare USA primary care dentist and pay their set copayment directly to the dentist. That’s it. Our primary care dentists even coordinate specialty care. An added bonus is that there’s no paperwork.

How it helps you

DeltaCare USA plans are easy to manage and offer predictable costs. Available resources include:

  • A comprehensive administrator support guide
  • A recently updated wellness library that includes a variety of helpful dental wellness content, including a risk assessment tool, wellness videos and dozens of articles

Remember, one of the biggest boosts to your budget is happy, healthy employees. Each year, over $45 billion is lost in productivity because of dental issues. When employees without coverage avoid going to the dentist or delay care, their dental issues often become more serious and may contribute to serious medical conditions, such as heart disease and diabetes.

So if you think budgetary woes mean dental coverage might not be in your future, consider DeltaCare USA. You’ll help your employees — and your budget — stay healthy.

Take the mystery out of dental expenses with the Cost Estimator

Your employees are busy enough, so trying to figure out how to budget their dental care shouldn’t become a second job. That’s why we created the Cost Estimator, a tool available for desktop and mobile that your employees can use to estimate quickly and easily what their next dental visit will cost.

What’s more, the Cost Estimator has just been refreshed with a new, accessible and mobile-optimized design.

How can the Cost Estimator can help my employees?

The Cost Estimator provides employees with a personalized estimate (based on the fee schedule from the last dentist from whom they received service) for an entire dental visit with a specific dentist. It calculates employees’ out-of-pocket costs based on their current benefits. Information is updated daily, so your employees can always count on getting an accurate cost estimate.

This versatile and easy-to-use tool offers employees a variety of useful features and information to help them make the most of their benefits and helps them become better informed consumers.

In the tool, employees can choose from a list of common dental procedures ― they can even specify which tooth needs treatment or what type of filling they’d prefer! After they select their procedure, the Cost Estimator calculates their estimated out-of-pocket cost. The tool subtracts both the network savings and the portion the plan pays.

Other tasks your employees can perform with the Cost Estimator include:

  • Adding procedures. If employees need to add services such as a cleaning or x‑rays to their visit, they can add them to their estimate to get the total cost of the visit.
  • Comparing dentists. Employees might be curious to see if they’d save by switching to another dentist. The Cost Estimator lets them compare up to five in-network dentists to find the best deal.
  • Selecting plan members. Employees can get cost estimates for anyone on their plan, such as spouses and children.
  • Reviewing benefits usage. Employees can access the benefits activity and history for everyone on their plan, and can also review their plan’s maximums, deductibles and out-of-pocket limits.

How can the Cost Estimator help my bottom line?

The Cost Estimator provides members with transparency about their out-of-pocket costs. More cost transparency can mean fewer questions and less confusion about the value of visiting an in-network dentist. By showing the substantial cost differences between in-network and out-of-network dentist visits, the tool encourages in-network utilization — which can help members save and may help lower your group’s dental plan costs.

Is the Cost Estimator available to my group?

Yes! All Delta Dental PPO™ and Delta Dental Premier® groups are eligible to sign up for the Cost Estimator. Talk to your Sales contact to find out how to add this service to your plan.

DeltaCare® USA members receive a plan booklet with their copayments for covered services, so this tool isn’t necessary for DeltaCare USA plans.

To access the Cost Estimator, employees simply click Plan ahead for a visit from the member portal. PPO and Premier members can also access a more limited version of the Cost Estimator through the Delta Dental mobile app, which features in- and out-of-network fees.


With the Cost Estimator, your employees can be confident not only about staying within their budgets, but also that they’re getting the best deal for themselves and their families. Be sure your employees don’t miss out on this valuable resource.

Twice as nice: dual coverage

Are your employees aware of dual coverage and how it works? If not, they could be missing out on substantial savings on their dental care.

Dual coverage (or coordination of benefits), as the name implies, is when a person is covered under two dental plans. This doesn’t mean double coverage, however. Both plans won’t fully cover each approved procedure. In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.

Why would my employees have dual coverage?

There are several scenarios in which an employee may have dual coverage:

  • An employee and his or her spouse both have employer-sponsored coverage
  • An employee has two benefits-eligible jobs

That’s good to know! How do my employees know which is their primary carrier?

Your employees and their dependent children may be eligible for dual coverage. Which insurance carrier is the primary depends on several factors.

For employees, the primary carrier depends on whether the employee also has dental coverage through a spouse or domestic partner:

  • If the employee does, the primary carrier is the one provided by his or her employer.
  • If the employee doesn’t, but currently has two jobs that provide dental coverage, the primary carrier comes from whichever employer has provided coverage for the longest time. If the employee has coverage through a current and former employer, the current employer’s plan is primary.

For dependent children, the primary carrier depends on whether the child’s parents are married and live together.

  • If they are (or have joint custody), the primary carrier is through the parent whose birthday falls earlier in the year. (If both parents have the same birthday, the primary carrier is the one that’s provided coverage for the longest time.)
  • If they aren’t and don’t have joint custody, the primary carrier is though the parent who has legal custody of the child.

Is there anything else my employees should know about dual coverage?

Yes. For starters, dual coverage applies only to group plans, not individual plans. Group plans can coordinate benefits only with another group plan.

If one of the plans covering the claim is an individual dental plan, that plan will always pay coverage as primary. Individual plans can’t coordinate benefits with other individual plans, either. In that situation, all plans will pay as primary.

Also, if employees have dual coverage, they must inform their dental office of both plans before they receive treatment. (Failure to do so could be considered insurance fraud!) Once they do, we’ll coordinate the cost sharing with the employee’s other plan.

An important caveat is whether the employee’s secondary policy has a non-duplication of benefits clause. While this clause won’t negate their dual coverage, it means the coverage will provide less benefit than standard dual coverage would.

For example, if an employee has dual coverage in which the primary carrier covers 50% of a procedure and the secondary carrier covers 80%, then 100% of the cost of the procedure would be covered. However, if the secondary carrier has a non-duplication clause, then only that carrier’s 80% would be covered.

Employees should also be aware that they’re still responsible for amounts that exceed maximums, charges above the allowed amount if using an out-of-network provider and charges for non-covered services.

Finally, dual coverage involving an HMO-type plan such as DeltaCare® USA can be complicated. Employees can contact Delta Dental Customer Service for details if they have dual coverage involving two HMO-type plans or a PPO and HMO-type plan.

Does Delta Dental have dual coverage resources for my employees?

We offer several resources to help your employees navigate their dual coverage. Your benefits resources page offers materials that explain dual coverage, how it works, who’s covered and offers helpful contact information for questions. Employees can also refer to the dual coverage information available on the Delta Dental member site.

Dual coverage at first may seem confusing, but with some guidance and our resources, your employees can enjoy maximum saving with minimum hassle.


Note: This post was updated to specify that dual coverage applies only to group plans and doesn’t apply to individual plans.

How gum disease is connected to overall health

When your employees want to improve their health, chances are they’ll start by improving their diet, beginning an exercise program or quitting bad habits like smoking.

These are all fantastic ways to get healthier, but your employees may not realize that their gums are also crucial to their overall well-being. This February for Gum Disease Awareness Month, remind employees of the often-overlooked connection between gum health and overall health.

The connection between gum disease and overall health

Gum disease, or periodontal disease, is a common bacterial infection that causes a chronic inflammation of the gums and surrounding tissue. It’s the major cause of adult tooth loss, and it affects nearly half of people over 30, according to the Centers for Disease Control and Prevention.

The effects of gum disease extend well beyond the mouth. Gum disease has been linked to a number of serious health conditions, including:

  • Heart disease, heart attack and stroke. Inflammation from bacteria in the gums may eventually lead to narrowing of arteries and heart trouble.
  • Dementia. Chronic gum inflammation can be a risk factor for Alzheimer’s disease later in life.
  • Glaucoma. Tooth loss and gum disease may increase the risk of this disease of the optic nerve.
  • Rheumatoid arthritis. The bacterium that causes periodontal disease may increase the severity of rheumatoid arthritis, lead to an earlier onset of the disease and cause symptoms to progress more quickly.
  • Diabetes. People with diabetes are at increased risk of developing gum disease. In turn, having gum disease can make your blood glucose harder to control.
  • Premature birth and low birth weight. Pregnant women are at increased risk of gum disease due to hormonal changes and increased blood flow. Gum disease is associated with an increased risk of preterm birth, as well as low birth weight and other pregnancy complications.

Early treatment of gum disease can effectively lower health costs in the long term. The devastating effects of the condition in its developed stages are largely preventable when employees stay informed and take action.

Ways to keep your employees informed

Your employees may be unaware of the connection between gum disease and overall health. What’s more, many of them may not realize they have gum disease. The condition isn’t usually painful, and many people don’t know they have gum disease until it progresses to more serious conditions, such as tooth loss.

Delta Dental has a wealth of resources you can use to educate your employees during Gum Disease Awareness Month and beyond. You can:

How your Delta Dental coverage can support employees’ gum health

Routine dental checkups and cleanings, covered by all Delta Dental plan as diagnostic and preventive services, can help prevent and monitor gum disease.

Treatments for gum disease, such as scaling and root planing, are typically covered under most dental plans under periodontic services.

When non-surgical treatment is inadequate, Delta Dental’s standard plans offer several surgical treatments to slow down or prevent the progression of the disease. Common procedures include:

  • Gingivectomy. Diseased gum tissue is removed and reshaped to get rid of pockets between the teeth and gums.
  • Gingival flap surgery. Gum tissue is separated from surrounding teeth and deflected back to allow a dental surgeon access to the jawbone and the root of the tooth for deep scaling and root planning.
  • Osseous Surgery. Also called pocket reduction surgery, this procedure eliminates the bacteria populating the pockets by cutting the gums to remove the bacteria and repair the damaged bone.
  • Bone grafting. This procedure increases the amount of bone in a part of the jaw where bone has been lost or where additional support is needed. Bone may be taken from elsewhere in the body and surgically fused to existing bone in the jaw.

Employees with chronic conditions may be at a higher risk for gum disease. SmileWay® Wellness Benefits offers additional coverage for gum treatment for those diagnosed with diabetes, heart disease, HIV/AIDS, rheumatoid arthritis or stroke.

Looking to improve your support for employees with or at risk of gum disease? Talk to your Account Manager about how your dental plan can improve employee health and reduce long-term costs.

5 ways to build a dental benefits package that employees will love

In the midst of the Great Resignation, benefits are more important than ever for attracting and retaining employees. About 37% of employees would rather receive more substantial benefits than additional salaries or bonuses. To create a dental benefits package that stands out and gets your company amazing applicants, consider these five plan enhancements.

1. Lower your plan’s deductible for individuals and families

Lower deductibles are appealing to employees for a variety of reasons. They’re easier for employees to hit, meaning they’re more likely to have their plan pay for their dental treatments, and employees who frequently reach their deductibles are more likely to save. The same is true for family deductibles.

Delta Dental PPO™ plans generally do have deductibles or maximums, but they can be adjusted depending on the wants and needs of your organization. Another option is DeltaCare® USA plans, which are particularly appealing for this reason — they don’t have deductibles or maximums.

2. Add a D&P waiver

With Delta Dental’s D&P Maximum Waiver® feature, the costs of covered diagnostic and preventive services (D&P) don’t accrue against a plan’s yearly maximum. Covered services typically include regular exams, x‑rays and cleanings.

Employees can then spend their coverage dollars on other needed dental services. D&P waivers are effective immediately, renew automatically and don’t require extra work from the employee or group to track remaining dollar amounts.

For more information, check out this flyer (PDF) or contact us.

3. Provide orthodontic coverage for all ages

The number of adults seeing orthodontists is at an all-time high, according to the American Association of Orthodontists, and that means the pool of prospective orthodontic patients is wider than it’s ever been.

Without coverage, prospective orthodontic patients can expect to pay between $3,000 and 6,000 dollars depending on their age. Delta Dental plans can help cut these costs in half. Orthodontic coverage is available under all DeltaCare USA group plans and can be optionally included in any Delta Dental PPO plan. Instead of limiting orthodontic benefits to dependents under 19, consider offering orthodontic benefits to children and adults.

4. Add implant coverage

The majority of adults ages 35 to 44 have lost at least one permanent tooth, and by age 74 more than a quarter of adults have lost all their permanent teeth.

One treatment for a lost tooth is an implant. Implants are an appealing option because they closely resemble real teeth, they’re permanent and comfortable, and they slow down the bone loss caused by losing a tooth. However, they can be expensive for patients without coverage. A single implant can cost up to $3,000 to $5,000.

Delta Dental offers several different options for implant coverage for groups. Implant coverage is available under Delta Dental PPO and some DeltaCare USA group plans.

5. Offer expanded coverage to employees with chronic conditions

Serious health issues like heart disease, diabetes and HIV/AIDS effect millions of Americans each year and people with these conditions are more likely to have oral health related problems as a result. With SmileWay® Wellness Benefits, you can add expanded coverage for your employees with chronic illnesses and make your plan more attractive.

If your company chooses to make this benefit available, your employees who have been diagnosed with diabetes, heart disease, HIV/AIDS, rheumatoid arthritis or stroke can receive 100% coverage for additional cleanings and gum treatment.

This optional benefit is only available for Delta Dental PPO plans, and your eligible employees must opt in to receive the additional coverage. These benefits can help keep your employees smiling and healthy, and healthy workers are a win-win for your company!


Having a competitive benefits package is key to recruiting and retaining valuable employees in a labor market that is replete with resignations. When you’re evaluating your benefits package, consider enhancing your company’s offerings. An appealing benefits package can be the edge you need to attract prospective employees.

Maximize your dental benefits before the end of the year

The end of the year is on the horizon, and with it comes the beginning of a new benefits year for most plans! In most cases, benefits from 2021 won’t roll over to plans that start on January 1, 2022, so it’s a good idea to remind your employees to take advantage of their remaining annual maximums.

By having their final cleaning or getting a toothache checked out, your employees are maximizing their plans. Your employees can also take advantage of programs like BrushSmart, which gives Delta Dental members exclusive discounts to help them transform their oral health.

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