DHMO vs DPPO
A DHMO assigns members to an in-network dentist with set copays and usually no annual maximum. A DPPO allows any dentist, with deductibles, coinsurance, and an annual benefit maximum.
All coverage
Coverage
Group Dental
Preventive, basic, and major dental coverage to round out your employee benefits package.
Who it's for
Dental is one of the most-used benefits and an inexpensive way to make a package more complete.
- Employers adding to an existing medical plan
- Teams with families who want orthodontia coverage for kids
- Businesses that want to offer a benefit at no cost through a voluntary, employee-paid plan
What it covers
Typical coverage includes
- Preventive care such as cleanings, exams, and X-rays, often at 100%
- Basic services such as fillings, extractions, and root canals
- Major services such as crowns, bridges, and dentures
- Orthodontia for children, and on some plans adults
How it works
How group dental insurance works
Choose a plan type and funding
You pick a DHMO, a DPPO, or both, and decide whether the business pays for it or employees pay through voluntary payroll deductions.
Employees enroll
Employees enroll themselves and their dependents when the plan starts or when they're hired. Voluntary plans may need a minimum number of enrollees.
Employees get care
DHMO members see their assigned dentist and pay set copays. DPPO members can see any dentist; the plan pays a percentage after the deductible, up to the annual maximum.
Renew
Dental rates are often guaranteed for more than one year. At renewal we compare the market and adjust benefits if needed.
Before you decide
Common considerations
Annual maximums
PPO plans cap what they pay each year per person. A higher maximum costs more but matters for employees who need major work.
Waiting periods
Some plans, especially voluntary ones, delay coverage for major services and orthodontia. Carriers will often waive waiting periods for groups switching from prior coverage.
Employer-paid or voluntary
Employer-paid plans generally have richer benefits and fewer restrictions. Voluntary plans cost the employer nothing but may need a minimum number of enrollees.
FAQ
Frequently asked questions
Can I offer dental insurance without a medical plan?
Yes. Group dental is usually sold as a standalone plan, so you can offer it with or without group health coverage.
What is a typical annual maximum on a dental PPO?
Many plans cap benefits between $1,000 and $2,000 per person per year, and some offer higher maximums for a higher premium.
Does group dental cover orthodontia for adults?
Most plans limit orthodontia to children, often up to age 19. Some plans offer adult orthodontia as an option.
How much does voluntary dental cost the employer?
Nothing in premium. Employees pay the full cost through payroll deduction, and the business handles the deductions.
Can employees keep dental coverage after leaving?
Federal COBRA applies to dental plans for employers with 20 or more employees. We can explain continuation options for smaller groups.
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