What Employers Should Know About Dental Benefits (Updated)

Did you know that about 4.15 million working days are lost yearly because of dental visits or sick days? Although dental health is significant for the quality of life, most adults don’t have coverage under Canada’s universal health care. Keep your office happy, productive, and smiling brightly by offering extended health and dental benefits.

Employee Dental Insurance 101

As an employer, you are in the perfect position to protect your employees’ oral wellness, and a comprehensive dental plan is a great place to start. There are a range of different options available to consider: 

• Basic coverage: includes teeth cleaning, regular checkups, gum care, and repairs such as fillings. The reimbursement percentage is usually between 70 - 100%, with 80% being the most common. Employees of all ages appreciate this type of coverage.

• Major coverage: combined with basic coverage, primary restorative care includes crowns and bridges. Reimbursement is usually limited to 50% of the cost based on the provincial fee guide of the employee’s residence. Employees more heavily use primary restorative care as they enter their forties.

• Orthodontic coverage: this coverage is also combined with basic and major coverage. It covers the cost of braces and other orthodontic appliances up to a lifetime maximum. Historically, these types of benefits have been primarily provided to children, but with the increased popularity of “Invisalign,” more and more adults are spending time in the orthodontist’s chair.

No matter which plan you choose, remember that prevention is critical. Employees can significantly reduce their risk of experiencing a health-related emergency by visiting the dentist for regular cleanings and scalings. With their oral health in check, they’ll also take fewer sick days and be more productive and focused at work.

Employers often have cost-related concerns when sponsoring an employee benefits plan. It is common to ask questions like "What will be the cost?", "Will the costs rise?" and "How will the funds be sourced?". We aim to clarify funding options and ways to avoid overpaying for dental benefits.

Funding of the employee dental coverage

Employers don't have to bear the full cost of funding health and dental benefits. Cost sharing between the employer and employees is common, with the employee's percentage adjusted based on business goals and budget. Cost-sharing arrangements like 80/20 and 70/30 are standard, but other configurations are possible too.

It's important to note that the premiums paid for employee benefits are tax-deductible for the employer.

For employees, even if they share the premium cost, they still gain access to group buying power that they otherwise wouldn't have had if they bought benefits on their own.

Note:

Recently, the Federal government has unveiled updated timelines for the expansion of its national dental program - Canadian Dental Benefit Program which caters to uninsured Canadians. Starting in January 2024, the program will extend coverage to seniors aged 77 to 86, followed by those aged 72 to 76 in February, and seniors aged 70 to 71 in March.

Seniors between the ages of 65 and 69 will have their application window open in May 2024, while individuals possessing a valid Disability Tax Credit certificate and children under 18 can apply online starting June 2024. Eligible Canadians are encouraged to submit their applications through the Service Canada website once their eligibility has been verified. Other Canadians will gain access to the application process in 2025.

Under the program, covered services will include preventative cleaning, examinations, x-rays, fillings, root canals, dentures, and extractions. Families with a net income below $70,000 will benefit from full coverage. For those with net incomes between $70,000 and $79,999, a 40 percent co-pay will be required, increasing to 60 percent for families with incomes ranging from $80,000 to $89,999.


Individuals who already have access to dental coverage will not be eligible for CDCP.

What does this mean to you?

Employers are now subject to a new tax reporting requirement mandated by the federal government. Starting with the 2023 tax reporting cycle, employers are now obliged to indicate on a tax slip whether an employee, former employee, or the spouse of a deceased employee was eligible on December 31 of the reporting tax year to access dental insurance or any form of dental coverage (such as a Health Spending Account), due to current or former employment.

For specific information regarding the completion of T4’s please see here

It is important to note that the appropriate code should be chosen based on whether Dental coverage was available to the employee – not whether the plan member has chosen to participate in the coverage. For example, if a plan member has waived coverage or has chosen not to participate in the plan, they would still have access to coverage.

What will help you control your dental premiums costs as an employer?

TLDR: Effective benefits communication.

1. Prevent benefits fraud, overcharging, and plan abuse 
2. Make sure employees understand their plans
3. Teach employees how to prevent dental emergencies

1. Prevent benefits fraud, overcharging, and plan abuse 

Employees who need help understanding their dental benefits may unexpectedly pay out of pocket for expenses. Worse, they may be vulnerable to fraudulent dental claims contributing to rising insurance premiums. However, more common than fraud are problems with overcharging or plan abuse. An example of this is when a dentist performs unnecessary treatments on a patient to maximize their earnings.

Many people do not ask questions of their dentist because they respect that they are a professional delivering a professional service. However, dentists must explain to patients what is being done and what is being charged to them or their plan.

Employees must review their invoices and assess the charges due to the potential for overcharging.

Recent statistics show that insurance companies pay at least $7 billion annually for Canadians' dental care. Therefore, employers are interested in helping their staff become better dental consumers.

The employer is responsible for providing employees with expert advice (e.g. via benefits advisor), so they can fully understand their plan maximums and coverage limitations. 

Moreover, employers can encourage employees to be better consumers by seeking service at a better price, as dentists can charge more than the local fee guide, resulting in out-of-pocket costs. 

2. Make sure employees understand their plans

Refer them to expert resources

Employers can help their employees become better dental consumers by directing them to plan booklets that outline coverage and reimbursement levels. It is helpful to inform employees of basic codes, such as recall exams and X-rays, to help them assess invoices. Small businesses may need more consultant support, while larger companies may have the human resources infrastructure to implement sophisticated educational strategies.

Boost engagement

When making plans or carrier changes, it's essential to communicate with employees. Conducting focus groups to determine which benefits employees want most can get them involved and invested in the new plan. Providing clear information through brochures, education sessions, and online meetings can also help employees understand the changes and become champions of the plan.

Employers can encourage employees to educate themselves about their benefits through plan design. Co-pays and employee contributions can motivate employees to review their invoices and question their providers, leading to a better understanding and utilization of their benefits.

Clarify employee responsibilities

Employees should submit requests for predetermination if they are still determining whether their dental plan covers a procedure. Employers should advise employees to refrain from signing blank forms for their healthcare providers, which may result in added charges. Plan members can report plan abuse or other problems by contacting the hotline of the Canadian Life and Health Insurance Association.

3. Teach employees how to prevent dental emergencies

Another way to help your team is by minimizing lifestyle factors leading to poor oral well-being. Get started by introducing an employee wellness program or by addressing these key areas:

Stress Less to Protect Teeth and Enamel

Helping staff manage stress is critical to protecting their dental health. Stress can lead to teeth grinding and jaw clenching, which damages teeth and enamel. And because these behaviours often occur during sleep, people may not even know they are doing them! 

Stress also decreases immune system function, increasing the chance of an oral infection. Keep staff happy and healthy by checking in regularly about their stress levels and removing excess tasks from their plates if needed. 

Consider sharing some of the benefits of mindfulness meditation with your team or talking to an employee benefits advisor about bringing in a stress reduction program.

Sleep More to Reduce the Risk of Periodontal Disease

It might come as a surprise, but a strong connection exists between lack of sleep and poor oral health. In fact, in one well-known Japanese study from Osaka University, lack of sleep was the second highest risk factor for periodontal disease! According to the study, people who received 7 to 8 hours of sleep per night showed less gum disease than those who had less than 6 hours. 

As an employer, encourage your team to maintain a good work-life balance and ensure they have enough downtime. Remember that stress and sleep are firmly linked, and consider what else you can do to help them stay calm on the job. 

Snack Smarter by Reducing Sugar Consumption

As many know, a “sweet tooth” can be devastating for oral health. Encourage staff to limit or avoid alcohol, sugary drinks and snacks, and highly processed foods.

Tip: provide healthy office snacks so that they aren’t tempted to munch on sugar at work. 

Lower Gum Disease Risk by Quitting Smoking 

In addition to causing almost 75% of gum disease, smoking can lead to tooth loss and various cancers. You can help employees kick this deadly habit with solid education and support programs. Before introducing a program, speak with an employee benefits advisor to find the right fit for your team. 

Conclusion

Oral wellness is much more important than you think. Not only can poor dental health increase employees’ financial and emotional stress, but it can also reduce overall quality of life. If staff cannot focus or come to work because of oral health issues, the consequences for your company can be expensive.

Ensure you provide a solid dental benefits plan and educate your team on making positive lifestyle choices. With some simple changes, you’ll see bright, healthy smiles soon!