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Benefits Business
Dental and vision benefits help employees stay healthy
Cutting ancillary benefits may lead to higher health care costs
By Len Strazewski
When times are tight and employers have shifted as much of the cost of their group health plans as they can without affecting recruitment and retention, ancillary benefits such as dental insurance and vision care become targets.
Should employers sacrifice ancillary benefits to balance the rising premiums for group health plans? The idea may be appealing, but cutting employer-paid vision and dental insurance benefits may create some big risks, according to recent research, and may actually increase health care costs over time.
This is an important message for agents to communicate to employers as they make their benefit plan decisions. There's more to ancillary benefits than meets the eye—or the teeth.
Lack of dental care can lead to periodontal disease, and recent medical research indicates that periodontal disease can be a precursor to two of the most expensive long-term medical costs: diabetes and heart disease.
The American Dental Association and the American Heart Association have long pointed out the link between oral infections and heart attack risk, recommending antibiotics before dental procedures for individuals with heart conditions and cardiac risk. New research makes the link even tighter.
A 2010 study led by the University of California, Berkeley, School of Public Health suggests that women who get regular dental care reduce their risk of heart attack, stroke and other cardiovascular problems by at least one-third.
The analysis, which used data from nearly 7,000 people ages 44 to 88 who were enrolled in the school's ongoing Health and Retirement Study, did not find a similar benefit for men, but researchers expect to find correlation in the future.
Published online September 29, 2010, in the journal Health Economics, the study compared people who went to the dentist during the previous two years with those who did not. The findings add to a growing body of research linking oral and cardiovascular health.
"Many studies have found associations between dental care and cardiovascular disease, but our study is the first to show that general dental care leads to fewer heart attacks, strokes, and other adverse cardiovascular outcomes in a causal way," noted study lead author Timothy Brown, assistant adjunct professor of health policy and management at UC Berkeley's School of Public Health. His remarks were part of a college publication on the study results.
Link to diabetes
Experts point to a similar link between dental health and diabetes. Dentist John Yamamoto, vice president of professional services for Delta Dental of California in Sacramento, says: "Research has shown a connection between periodontal disease and diabetes. People with diabetes are more likely to develop periodontal disease.
"In addition, recent studies have shown that periodontal disease may be associated with Type 2 diabetes. Periodontal disease may also makeit more difficult for diabetics to control their blood sugar, placing them at greater risk for diabetic complications."
Yamamoto also notes that regular dental exams can help screen for oral cancers and other serious health problems that manifest in mouth and jaw disorders.
The Institute of Medicine in Washington D.C., an independent nonprofit health research and policy organization, published research in April that confirms a broad link between dental care and overall health. The organization called for a new policy initiative by the U.S. Department of Health and Human Services to support funding for broad oral health programs.
In addition to diabetes and heart disease, the organization highlighted links between problem pregnancies and respiratory conditions.
Dental coverage largely determines access to oral health care and also predicts those who will seek it, but many people—older adults, for example—do not have dental coverage. Even when individuals have dental coverage, they frequently do not receive needed services because of, among other factors, transportation barriers or a lack of providers who accept public insurance, the study notes.
Insurers take action
Insurers are recognizing the need and are modifying dental plans to increase employer options. CIGNA, for example, is expanding its dental HMO plans with 24 new plan options designed to provide greater flexibility in benefit design and to help customers and employers meet their benefits budgets, the company says.
"As clinical studies continue to show the relationship between oral health and overall health, access to dental benefits will be a key differentiator among employers for both retaining and attracting employees," says Bebe Shuler-Mure, assistant vice president for CIGNA's dental products. "The new options will help employers control costs without sacrificing access to benefits and help them continue to promote a healthy, productive workforce."
VSP Vision Care in Rancho Cordova, California, has also identified valuable general health cost savings achieved with conscientious vision care. In April the company announced that a study conducted by Human Capital Management Services in Cheyenne, Wyoming, estimated that client employers saved $4.5 billion through early detection of chronic diseases with eye examinations.
The consulting group matched medical condition information for 200,000 participants with medical and pharmacy data obtained by employee health plans. The result was an estimated $1.27 of savings measured in treatment costs and productivity for every $1 spent on vision benefits.
The study indicated that employers who provided dental and vision benefits experienced 7% better productivity, 45% less turnover, and measurable savings in medical and workers compensation costs. Early detection of chronic diseases such as diabetes and hypertension also increased the likelihood that employees would be proactive in their health care and see a medical doctor to receive follow-up care.
"With health care costs spiraling out of control, these new findings…clearly demonstrate the importance of stand-alone eye care benefits. Preventive eye exams support overall wellness and are much more than a means to receive prescription eyewear," the study said.
New combo plans
Recognizing the value of providing ancillary benefits, insurers are also creating new combined vision and dental plan benefits. Ameritas Group in Lincoln, Nebraska, for example, recently announced its new FUSION program, which combines eye, dental and hearing care with an increased maximum of $5,000, up from the usual $1,000 to $2,000 dental benefits limit.
Regional BlueCross/BlueShield plans are also introducing dental and vision benefits to Medicare-eligible individuals. The Blues' Extras program offers the ancillary benefits in packages ranging from basic preventive dental and standard vision to full dental (including periodontal services, root canals and extractions).
In addition to these three packages, the dental portion of the premium package is offered on a stand-alone basis. This is important because only 22% of older persons are covered by private dental insurance, according to the Journal of the American Dental Association.
"We created packages for every need and budget, while providing as much access as possible through one of the nation's largest networks," says Steve Martenet, president and general manager of specialty lines for Anthem BC/BS. "By stressing convenience, we hope to eliminate any obstacles that exist between people getting the services they need, such as regular dental and vision care."
If employers insist that dental and vision benefits have become unaffordable, voluntary benefits may be an option their agents should present. The voluntary plans, paid by payroll deduction, can be chosen by employees to help them retain valuable benefits. Usually they are available at group rates and can continue to provide employees access to discounted benefit networks.
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