Dental Emergency Benefits and Tips for Traveling Employees

Supporting the needs of your HR clients always includes looking for ways they can help employees with healthcare-related questions or concerns. Now that it’s time for summer vacations, the possibility of health-related emergencies may become a concern for employees who plan to travel.

If you are looking for new ways to be a hero to your HR clients, here is a sure-fire approach: help your clients alleviate employees’ concerns about emergency group health coverage (and, at the same time, tout the good news about your dental plans).

How? Simply suggest that your HR clients remind employees about tips and benefits for the group's employees when they travel.

Planning Tips

Before looking at benefits, let’s look at a few tips to help prevent dental emergencies.

• When planning to travel, group members should consider reading the brochure, “The Traveler’s Guide to Safe Dental Care,” produced by Organization for Safety, Asepsis and Prevention (OSAP). This brochure helps travelers understand how to choose an appropriate dental provider anywhere they may be for safe care.

• Prevention is the best approach. A dental check-up and dental hygiene visit are wise moves prior to traveling. Suggest that group members tell their providers about their travel plans and the need to take care of any dental-related concerns ahead of time.

• Make sure group members have their dental membership card at the ready to call their insurer. Why? Knowing the difference between regular dental care and what constitutes a dental "emergency" is key to the question of reimbursement for treatment while traveling.

• At least some coverage for genuine emergencies—as defined by the plan—is part of the benefits. For example, many plans offer an out-of-area emergency reimbursement. These may be limited to $100 per emergency subject to the plan’s limitations, exclusions and co-payments.

DHMO Emergency Benefits

Employees enrolled in a Dental HMO (DHMO)-type of plan typically receive treatment from a network of dental providers. DHMO patients need to obtain a referral from their primary care dentist for treatments outside their network.

Some contracts require that the employee contact their dental insurer prior to receiving any emergency dental palliative care or treatment when possible.

Types of emergencies typically covered by DHMOs include:

• Palliative treatment to ease severe pain;
• Treatment to eliminate acute infection or unexpected trauma; and
• Treatment to control excessive bleeding.

In most cases, the emergency would have to have taken place more than 50 miles from home.

Reimbursements:

Group members are required to pay out of pocket and then file a claim form when they return home, usually within 30 days. Employees should include the receipt or statement from the dentist who treated them along with their claim form. Reimbursement is offered at the in-network rate but may have a cap of $100 per treatment.

DPPO emergency benefits

Dental PPOs offer in-network and out-of-network coverage—so the group member will receive benefits in emergencies with no referrals from the regular provider.

Emergencies are likely to be defined similarly to that described with DHMOs. Note that DPPOs may have more benefits flexibility while the employee is traveling.

Reimbursements:

Here, too, a claim form and a receipt for services will need to be submitted when the vacation ends. Employees can check on what their plan’s emergency coverage is.

They will be responsible for paying the balance for treatment charges that are higher than their plan allows.

Supporting the Needs of your HR Clients

To help avoid reimbursement delays, be sure to supply your HR client with enough of the right forms for traveling employees.

Another way to show your interest in the HR client’s success is to gather the tips and benefits for group employees into a quick-read guide that is able to be distributed digitally.

Demonstrating your interest in your clients’ employees will ensure loyalty and repeat business for years to come.