Let’s take a closer look at how you can help your employees understand dental costs and terms when it comes to dental insurance coverage.
Dental Fee Guides: The Basis of Dental Insurance Coverage
Every province and territory has a provincial dental association that is responsible to set its own dental fee guide for practitioners in the province. The fee guide acts as a sort of baseline for what the dental rates should be. This is what insurance carriers usually refer to for reimbursement coverage in an employee benefits plan.
The catch is that it isn’t mandatory for dentists to follow the provincial dental fee guide, meaning that they can charge more, which then creates a discrepancy between what an employee pays and what their dental plan covers. Moreover, dental specialists (for example: orthodontists) follow a Specialist Fee Guide, which tends to be higher than the General Practitioner Fee Guide.
Each provincial dental association releases its dental fee guide on an annual basis. With inflation and increased costs for personal protective equipment (PPE) and other items, we’ve seen higher than normal increases to fee guides across Canada over the last three years. In BC, the fee guide increase for 2024 is 4.73%. In 2023, the fee guide increase was 5.99% and a whopping 7.35% increase in 2022.
Dental Scaling Units
Scaling units are another key term that is useful for people to understand when they see a dentist. Scaling units refer to a unit of time (usually 15 minutes) spent cleaning the plaque from someone’s teeth. The average number of scaling units in a benefit plan is typically 10-12 units annually.
Dental Coverage Predeterminations
Predeterminations are pre-treatment estimates that can be sent over to your insurance carrier prior to moving forward with specific dental work. Predeterminations are recommended for higher dental expenses such as, for example, major dental services (example: crowns, dentures, or bridges), or orthodontics.
Do you have questions about your dental coverage and terms? Get in touch with us and let’s chat!