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It’s obvious that people battling cancer or other serious medical conditions need to visit a physician more frequently than those without those health problems. But people may be surprised to learn that those with certain high-risk health conditions should be visiting their dentists more often as well.

As the connections between dental health and overall health become clearer, dental insurers are responding by providing enhanced benefits to encourage people with certain medical conditions to take better care of their oral health, to lower both dental and health-care costs.

At the same time, insurers are more closely tailoring plan designs for employers, who are increasingly looking for ways to hold the line on dental benefit costs that on average have increased 5 to 7 percent per year. Principal Financial Group Inc., for instance, just announced a new preferred provider organization (PPO) product that offers a 25 percent discount to covered members who use dentists within a specified network.

Employer-sponsored plans are the primary route through which Americans access dental coverage; more than 100 million people are covered by dental PPOs. The vast majority of those, 97 percent, are insured through their employer under group plans, according to the National Association of Dental Plans.

Beginning in 2010, Delta Dental of Iowa will add several more medical conditions to its Enhanced Benefits Program, a dental benefit package that currently offers additional dental treatments such as cleanings and fluoride applications to pregnant women and diabetics. The new medical conditions include high-risk cardiac conditions, suppressed immune systems, kidney failure and people undergoing chemotherapy or radiation treatments for cancer.

“A whole change started to take place in dentistry five years ago,” said Donn Hutchins, president and CEO of Delta Dental of Iowa and board chairman of Delta Dental Plans Association. “I would say it’s an emerging direction; it’s really trying to get the right personalized care to each member.”

Based in Ankeny, Delta Dental of Iowa provides coverage for approximately 750,000 members in the state in about 3,200 employer groups. The not-for-profit organization is a member of the Delta Dental Plans Association, which provides coverage to more than 51 million people across the country.

In-network discounts

Principal last week announced the rollout of Network Select, a new PPO option for its dental plan members. The plan offers covered employees a 25 percent discount for using dentists within its network who have agreed to charge discounted fees.

Those discounts translate to lower out-of-pocket costs for the employee and a lower rate for the employer, said Theresa McConeghey, Principal’s assistant vice president of dental benefits. Principal’s network encompasses more than 120,000 dentists nationwide.

“Encouraging our members to utilize dentists in the Principal network enables us to pass on savings to employers, which is why we’re lowering costs across the board on our plans that emphasize network providers,” she said.

The plan design is one of a number of customized options that employers can choose from, McConeghey said. “The focus here was coming up with plan designs and price points that are attractive to employers.”

Dr. Robert Dahlberg, a Des Moines dentist who has practiced for 29 years, said he doesn’t sign up for every PPO plan that’s offered.

“If a patient asks me if I’ll sign up, the first thing I look at is (the insurer’s) reimbursement schedule,” he said.

“If their reimbursement schedule is consistent with the cost of care, I’m happy to sign up. If that’s not the case, it would be good for the patient, but it wouldn’t be good for the provider. And over the long run, it may not be good for the delivery of care.”

According to the Principal Financial Well-Being Index, a quarterly survey conducted for Principal by Harris Interactive, employees rank dental insurance near the top of their list of important benefits. Having access to a dental plan ranks third, after health insurance and defined contribution retirement plans, according to the survey.

“So we know dental is a very important thing to a consumer,” McConeghey said. “So we tried to step back and look at some of the trends.”

Among those trends: The number of people who are visiting the dentist has been increasing, particularly over the past year. Principal experienced a 3 to 4 percent increase in the number of its members that receive dental services in 2009, McConeghey said.

“Personally, I think it’s a very good thing,” McConeghey said. “I think it means people are becoming more aware of their dental needs and dental benefits. There is such a connection between oral health and overall health that it’s going to increase people’s health at the end of the day.”

Growth expected

Delta Dental of Iowa introduced its Enhanced Benefits Program in 2007, initially offering added benefits for pregnant women and diabetics. Studies have shown that diabetics may achieve better control over their blood sugar levels by reducing the plaque in their mouth. Researchers have also found links between periodontal disease and low birth weights; pregnant women with periodontal disease are 7.5 times more likely to have a premature baby because of the increased bacterial burden.

In a study involving 10,000 employees, providing additional dental cleanings for diabetic patients among those employees generated more than $71,000 in medical cost savings, noted Dr. Ed Schooley, Delta Dental of Iowa’s dental director. And with an average cost of $250,000 for hospitalizing each premature baby, avoiding that complication has a very quick return on investment, he said.

The enhanced coverage provides for up to four cleanings per year rather than two, as well as fluoride treatments.

About 15 percent of Delta Dental of Iowa members currently have the enhanced coverage for eligible medical conditions within the small group plans for companies with 50 or fewer employees, Hutchins said. Now, it will be offered as an optional coverage to large groups upon renewal for 2010 as well.

“There is interest, so we are expecting it to grow,” he said. The cost for the added coverage is up to 1 percent increase in premiums, “but the cost savings far outweigh that,” Hutchins said.

As research advances, it’s likely that other high-risk groups will be added, Schooley said.

For example, researchers are now studying the potential benefit of additional dental cleanings for patients receiving prosthetic joint replacements.

“Our plans are structured to cover preventive visits at no cost,” Hutchins added. “This is really a natural extension of that, leading to accurate health information to reduce disease and cost. That’s a good thing.