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Dental Fee Changes 2021

As Dental costs continued to rise in February of 2020, Group Insurance Managers made the decision to freeze the reimbursement rates under the Dental insurance program at the 2020 Dental Fee Guide rates. This reduced the premium increase for members by 4.5% (from 6.5% to 2%). In February of 2021, to avoid a 4% increase in Dental premiums for members, Managers decided to continue to apply the 2020 fee guide rates. Holding reimbursement rates to the 2020 Dental Fee Guide allowed the Dental premiums to remain at 2020 rates, resulting in no increase in premiums for all members, which could have amounted to an extra $1.58 (s) or $3.19 (f) each month.  However, this does result in members paying more for certain procedures, when required. Surplus in Dental premiums which came about as a result of COVID-19 related shutdowns of dental offices was used to provide all members with a premium holiday for the month of June. As of January 2022, Dental reimbursements will follow the 2021 Dental Fee Guide, with this matter to be reviewed in February 2022. This fall, all NLTA Group Insurance programs will undergo a review as part of the regular five-year program market study. Input from members will be sought at that time.

To better inform members of the dental costs associated with insurance premiums, the following chart provides four examples, for illustration purposes, of our most common Dental procedure claims:

Calendar Year

PROCEDURE 2018 2019 2020 2021
Basic Preventative (total cost) $102.98 $105.98 $110.11 $112.46
Insurance claim $82.38 $84.78 $88.09 $88.09
Member pays $20.60 $21.20 $22.02 $24.37
Periodontic (total cost) $81.39 $84.56 $86.03 $88.87
Insurance claim $65.11 $67.65 $68.82 $68.82
Member pays $16.28 $16.91 $17.21 $20.05
Polishing (total cost) $20.11 $21.48 $22.23 $24.05
Insurance claim $16.09 $17.18 $17.78 $17.78
Member pays $4.02 $4.30 $4.45 $6.27
Recall Exam (total cost) $28.17 $29.80 $32.29 $32.57
Insurance claim $22.54 $23.84 $25.83 $25.83
Member pays $5.63 $5.96 $6.46 $6.74
Sample Major Restorative Procedure* $902.50 $950.00 $1,000.00 $1,050.00
Insurance claim $722.00 $760.00 $800.00 $800.00
Member pays $180.50 $190.00 $200.00 $250.00

 

Basic Preventive services often include scaling/teeth cleaning.

Periodontic services include treatment of gums and surrounding tissue of a tooth.

Polishing services are actual polishing of teeth/fluoride treatments.

Recall Exams are annual visits to the dentist based on schedule within your plan documents for a full oral exam.

*Example of member cost for a more expensive Dental procedure.

 

 

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