Analysis: Dental cover - cost confusion

“Some people, when having NHS treatment, are not being told by the dentist that some of the treatment they are having is private treatment,” adds Kirsty Jagielko, head of product management at benefit provider CIGNA HealthCare. “A lot of people are used to going for a scale and polish and check-up so they are not used to an unexpected bill.”

Researching the market

Variations in pricing create challenges for both insurers and employers seeking to ensure that benefit levels remain competitive. Intermediaries report that they rely on insurers to a large extent to monitor pricing levels in the private sector.

CIGNA uses its own claims data in order to assess pricing trends, gathering lots of information about the bills charged by dentists.

“There is nowhere to go as a consumer so it is difficult to get a sense of what is typical,” says Jagielko. “We spend a lot of time analysing our data and we also review our satisfaction survey to see where people are most concerned.”

CIGNA reviews benefit levels annually and adjusts reimbursement levels for specific treatments, rather than across the board. Although the OFT reports that the costs of private dental treatment in England are among the highest in Europe, Jagielko does not believe rate rises are “unreasonable” but does note that there is variation across practices.

“There are some established well-known clinics developing a name for themselves that can use that as a bit of leverage,” she reports. “Prices are higher in London, lower in major towns and lowest in provincial areas.”

Simplyhealth, another provider, conducts “extensive” research every two years, involving both consumers and dentists, in order to review benefit levels. 

“When setting benefit levels we look at a wide number of factors including NHS and private pricing past and present, new treatments available and our own claims data to determine the types of claims made and the average cost,” says Bernie Hurn, research and development manager. “We also look at how best to segregate benefits and also market and competitor changes and reviews.”

Benefit levels

Simplyhealth’s 2011 annual dental survey found that 40% of 10,000 consumers said they were deterred from going to the dentist by the cost.

However, intermediaries do not, by and large, believe that dental benefits should cover the cost of care completely.

PMI Health Group’s Blake argues that, with most schemes arranged on a voluntary basis, it is the employee’s responsibility to choose between lower premiums or more extensive coverage.

“I suspect there is a little bit more self choice involved with dental than most health insurances,” he says.

Enrich’s Williams agrees.

“From experience of our own clients and their employees, it is not widely expected that dental treatment will be covered in full and most dental benefit schemes will be implemented on the basis of a standard level of cover being available for employees depending on the location of the employer,” she says. “Therefore, an employer in London is more likely to opt for a higher level of cover in order to ensure an adequate level of benefit is in place. Many consumers are more concerned with having annual check-ups and hygiene visits covered rather than full restorative and major treatment covered.”

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