People are going back to the dentist in full force to regain control of their oral health. Open Season is the best time to reexamine the dental plans available to federal employees and TRICARE retirees, as plans and premiums may be changing.
One change of note is from a popular mid-Atlantic dental plan that is making some significant enhancements that will generate some buzz among feds. Dominion National, which has offered the only Dental HMO (DHMO) plan available to FEDVIP participants since 2014, is upgrading its offering to an Exclusive Provider Organization EPO plan.
What is a Dental EPO and what does this change mean?
“Our dental EPO plans include predictable, pre-determined fees and are designed for transparency for members and dentists in that there are specific copayments listed for each covered service. If you know what dental procedures you need to have completed, you will know how much you will pay for your dental care before you even go to the dentist,” said Mike Davis, Dominion National president. “Dominion’s EPO also provides immediate access to care, meaning no waiting periods, no annual maximum limits and overall just the peace of mind that you don’t have to worry about unexpected costs.”
When looking at dental options, it’s important to look at price, coverage and dental network access. While Dominion’s EPO plans are competitively priced and cover preventive, basic and major restorative care, dental network access has dramatically increased and has more than doubled the number of participating dentist listings. Additionally, enrollees may now receive services from any in-network dentist without having to select a primary care dentist.
Contrast that with a PPO, which covers a percentage, or coinsurance, of the total cost. But the total cost could vary depending on where the procedure is performed. For example, the average cost of a crown in the Washington, D.C. area is about $1,500. An enrollee using a PPO would have to contact his or her dental office to discover that price; the PPO only reveals the percentage it pays. The EPO, on the other hand, ensures participants get the same fixed price as participating Dominion dentists agree to the same contracted fee, and that cost is revealed upfront.
An EPO does require participants to stay in network, which is how it can offer those prices while keeping premiums lower. A PPO offers more flexibility to go outside the network. That element of choice is attractive to some participants – particularly if they have a relationship with their dentist and want to ensure they can continue receiving care from their dentist. It is important to consider if you will need to go outside the network in your dental plan evaluation. PPOs might make sense for someone who travels a lot, which could make it hard to stay in network. However, if your dentist participates in an EPO network and you plan to receive dental treatment locally, an EPO might make sense if you are looking to pay a lower premium.
Why reevaluate your options?
Your dental needs may change each year. Some years may be focused on preventive care like cleanings and exams, which are offered with the standard option plans. However, others may need more restorative care such as crowns, root canals or implants, which are likely covered at a higher level with high-option plans.
In addition, dental health has been linked to overall health in a number of studies, which have linked gum disease to oral cancer, heart disease, diabetes, respiratory ailments, preterm birth, skin diseases, thyroid problems and leukemia.
“We conducted a study with Capital BlueCross and Geneia, LLC, which associates receiving recommended preventive dental care with reduced emergency room visits, hospitalizations and medical claims costs for people with chronic medical conditions,” Davis said. “Minimizing emergency room visits and in-patient hospital stays can be associated with significant savings on medical expenses. Dental can help play a role.”
That’s why Dominion National created an incentive plan to help encourage participants to get regular dental checkups.
“Each family member enrolled with Dominion who receives two cleanings during the plan year will be reimbursed for their $10 office visit copayments made to the dentist at the time of service – a total reimbursement of $20 per family member. We submit a check for the reimbursement to the primary subscriber,” Davis said. “This has been very well-received and can move the dial on member satisfaction and retention.”
Also, when choosing your dental plan don’t forget to look at other value-added services and discounts that may be available with your plan. For example, Dominion National now offers discounts on Invisalign, SmileDirectClub’s clear aligner program and teeth whitening procedures. Due to increasing consumer demand from the pandemic, Dominion also covers teledentistry services.
When and where to enroll
This year’s Federal Employees Dental and Vision Insurance Program (FEDVIP) open enrollment season for choosing a dental plan runs from Nov. 8, 2021, through midnight EST Dec. 13, 2021, for coverage effective Jan. 1, 2022. FEDVIP is available to Federal employees, retirees, TRICARE retirees and their families.
For more information on Dominion National’s EPO, visit FederalDentalPlans.com. There you can review plan information, find a dentist, view an enrollment video and see a list of FAQ’s. To enroll, go to BENEFEDS.com.