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Subcommittee finds dental utilization largely preventive, recommends education not benefit cuts
Summary
EBC told the Insurance Subcommittee that about 80% of dental claims are preventative/diagnostic and only about 20 people per year exceed the $1,000 maximum. The committee recommended no changes to plan maximums or orthodontic eligibility and asked for more staff education on network use and FSAs.
During the Jan. 9 meeting, Nancy Bellosa of EBC summarized dental plan enrollment and utilization for District 69. She said there are 134 Employee Only participants and 52 Family participants, which the materials state "result[ed] in 325 individuals who are covered by Dental." Bellosa reported that roughly 50% of members used in-network providers (below the industry benchmark of 67%), that about 80% of claims are for preventive and diagnostic care, and that very few claims (under 2%) are for implants or prosthodontics.
Bellosa explained that increasing the annual maximum benefit from $1,000 to $1,500 or $2,000 would raise premiums by 7%–10%, and that adding adult orthodontics would also increase rates. Given utilization patterns and low incidence of hitting the maximum, the committee agreed no plan changes were justified and recommended targeted education for staff on in-network provider use and on Flex Spending Accounts to help pay for services.
