Dental Insurance Brokers: A Houston Employer's Checklist

For your Houston business, start with the dentists your employees want to keep. Ask dental insurance brokers to explain dentist access, costs and plan limits.

Compare what employees may pay and how much each plan will cover. Also, ask about costs when a dentist is outside the plan's network. Start with these checks.

How to compare dental insurance brokers for your business

First, compare each broker's answers about plan costs, dentist access and yearly benefit limits. Ask for an explanation of these three points in every quote:

• Dentist access: Ask whether employees' preferred dentists belong to the quoted plan's network.
• Shared costs: Ask what employees pay for covered care, including visits outside the dentist network.
• Benefit limits: Ask how much the plan can pay toward covered care each year.

Next, use the Texas Department of Insurance (TDI) agent lookup resources. You can search by the agent's name or license number.

TDI also directs you to Sircon's Customer Inquiry form for types of insurance sold. That form lists companies the agent has worked for, too.

Finally, ask employees to confirm their preferred dentist is in-network. However, a dentist may belong to one plan's network but not another from the same insurer.

Define your employees' dental needs and budget

When you compare dental insurance brokers, start with a clear employee list. Decide how much you'll pay toward premiums, the price of coverage. Also, spell out which employee groups can enroll in your plan.

Small-business dental setup guidance recommends sharing an employee census with your broker or insurer. That means a list showing employee ages, locations and enrollment status. Ask the broker to walk through that list with you.

Next, review your rules for who can join the plan. Include which employee groups qualify and any waiting period for new hires. Ask: When would a new hire become eligible to enroll under our rules?

Then, set out what your business will pay toward each coverage type. The same guidance recommends deciding contributions for employee-only and dependent premiums. Put these two questions in your broker discussion:

• How much will we pay toward coverage for an employee alone?
• How much will we pay toward coverage for their dependents?

Finally, ask about your team's preferred dentists before you select a plan. The guide encourages employees to confirm their preferred dentist is in the network. Ask how the broker will help employees make that check.

Ask which group plans the broker can quote and how they are paid

Ask dental insurance brokers which employer plans they can quote for you. Also, request written details about fees and commissions before choosing one.

First, use TDI's agent search to look up an agent by name or license number. TDI also points to Sircon for insurance types and past company relationships. Then ask for written confirmation of current group dental quoting access.

Keep your questions specific:

• Which insurers and named group dental plans can you quote today?
• Which fees would we pay, and what pay would come from others?
• Will you share those details before we agree to work together?

For context, a December 2021 brief discusses disclosure rules for group health plans covered by ERISA, a federal benefits law. It addresses covered providers reasonably expecting at least $1,000 in direct or indirect pay for brokerage or consulting services. The brief excludes plans not covered by ERISA.

For covered arrangements, it calls for fee details before you enter, extend, or renew a contract. It gives December 27, 2021, as the start date.

Ask which rules apply to your dental plan now. Use this dated guidance to frame questions, not confirm current duties.

Check dentist access and compare employer and employee costs

Ask dental insurance brokers to check whether preferred dentists take part in each quoted plan. Then compare what employees pay for care, both inside and outside that network.

Check the exact plan, not just the insurance company's name. A dentist may accept some plans from an insurer yet remain out of network for others.

Request confirmation from both the dental office and the insurer's customer service team. Also, have employees confirm that their preferred dentist is in the plan's network.

Ask for written answers to these questions when comparing brokers:

• Which network does the quoted plan use?
• Did both the dental office and the insurer confirm each preferred dentist's status?
• What would employees pay if they chose a dentist outside that network?

Next, decide how much your business will pay for employee-only and dependent coverage. Ask each broker to show those two contributions clearly in the proposal. For each quote, request the full price of coverage alongside your employer contribution.

Then request a cost comparison that covers more than the price of coverage. Ask what employees must pay before the plan pays toward each type of care. Also, ask what share of covered bills employees must pay themselves.

Check the yearly cap on what the plan will pay for care. Include out-of-network costs in the written comparison, rather than treating dentist access separately.

Review coverage limits, waiting periods and exclusions

Ask dental insurance brokers for each proposed plan's full policy and benefit summary. Get written answers about what the plan covers and what it excludes.

For example, the East Texas Employee Benefits Cooperative's low-option summary lists a $1,200 yearly benefit cap. Preventive, basic and major services share that cap in this plan. These are terms from one Texas employer plan, not a PCIS quote.

Use that example to frame three questions for each plan you compare:

• Yearly caps: Which services share a limit on what the plan pays?
• Waiting periods: How long must employees wait for each type of care?
• Orthodontic care (teeth straightening): What age rules or other limits apply?

The same summary lists no waiting period for basic services. That does not establish waiting periods for other types of care.

For orthodontic care, that plan pays no benefits if the device was installed after age 19. Ask your broker to explain the age rules in each proposed policy.

Finally, the summary says its list of exclusions is not complete. It directs you to the policy for full details. Review your proposed policy before you describe benefits to your employees.

Compare written proposals and confirm ongoing support

Before you choose among dental insurance brokers, ask for a written proposal. Request the plan terms and a clear list of support tasks, too.

First, match each quote to the plan and dentist network it names. Use the same cost and dentist checks for every proposal you review.

Then ask for the full policy, not just a short plan summary. One Texas group dental summary says its list of coverage limits is not complete. It tells readers to check the policy for full details.

Check your own plan's terms rather than relying on this example. Next, ask each broker to put these support tasks in writing.

• Name the person who helps staff sign up and explains the plan.
• State who checks bills and helps staff with claim questions each year.
• Set a date to review the plan and costs before you renew.

Also, ask how soon you should expect a reply when you need help. Get a backup contact and a clear path for issues that stay open. Keep these written answers with the quote to compare each broker's scope of work.

Before you choose, ask each broker to fill any gaps in writing.

Contact PCIS about workplace dental benefits.