Dental plans are often seen as a way to increase your sales in addition to offering major medical plans and voluntary benefits. Yet, in most cases, especially with the employer market, dental has been offered as an employee-paid add-on. With the advent of PPACA, dental is being stripped out as a separate product, and will be offered to employees for an extra premium separate from health insurance.
However, there still seems to be confusion about the applicability of the new PPACA amendments to dental and vision plans and when these plans may be exempt. The new amendment requirements under PPACA (age 26 rule, preventive care, annual limits restrictions, etc.) apply to a "group health plan," which is an employee welfare benefit plan that provides medical care. PPACA uses the definitions that were already existing in the HIPAA portability rules, which define "medical care" very broadly. However, the HIPAA portability rules do contain an exception for "limited scope" dental and vision coverage.
HIPAA regulations say that a dental or vision plan will meet this exception if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan. The regulations go on to say that benefits will be considered "not an integral part of the plan" only if: (1) participants have the right to elect not to receive coverage for the benefits, and (2) if a participant elects coverage, the participant must pay an additional premium or contribution for that coverage. If the dental and vision benefits are under separate insurance policies, they likely would fall under the exception. However, if they are self-funded (or insured, but not under a separate policy), the regulation requires that the participant must be able to separately elect to receive coverage, with corresponding difference in premiums or contributions.
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If you examine the way most dental insurance plans are set up, you will see that the greatest portion of the benefits that an individual receives from their dental coverage differs from those types of benefits provided by most other types of insurance. The primary goal of the typical dental plan is to ensure that the covered individual receives regular preventive dental care (checkups, dental cleanings, x-rays, dental sealants, fluoride). This is because dental insurers realize that most of the dental treatment an individual will require throughout their lifetime is not caused by unpredictable events (such as an accident), but instead dental treatment costs are increased by situations where minor problems were not detected and dealt within an appropriate time frame. Companies selling dental insurance plans know that if they can encourage a covered member to seek regular preventive dental care, then that person's potential for needing extensive dental treatment during their lifetime will be greatly reduced. Thus, the insurance company's cost for providing dental care for that individual will be reduced. This means more profit for the insurance company.
As a broker, your interest in selling dental plans should rank toward the top of your laundry list of available voluntary benefits you offer to clients. Dental insurance pays decent commissions, and discount dental pays well if you sell a decent plan and do that in multiples. Since your audience is about half the American population, you have a huge audience to sell to and make additional revenues from those sales.
Group dental differs somewhat from individual dental plans, and both markets are definitely going to heat up as PPACA gets implemented over time. Your clients will smile because their preventive dental procedures will keep them in good oral health. And you can be smiling all the way to the bank with more money in your pocket from dental plan sales.
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