Insurers put teeth into health care benefits

Earlier this year when Stamford, Conn.-based Pitney Bowes Inc. started encouraging its employees to floss once a day, it was at the forefront of a trend in dental care that is influencing dental benefit programs nationwide.

Pitney Bowes' daily flossing recommendation is part of its "Count Your Way to Health" program that incorporates numbers to make the various behavior changes easier to remember. The numbers run from zero to 100 and represent such activities as not smoking, zero; eating five fruits and vegetables a day; having a body mass index of 25 or less; participating in at least 30 minutes of activity each day; and using seat belts 100% of the time. Employees who follow these healthy lifestyle rules of thumb can earn up to $200 back a year on their health plan premium contributions.

The once-a-day-flossing activity was added to the program this year because "keeping healthy gums and teeth may impact heart health," explained Dr. Brent Pawlecki, Pitney Bowes' associate medical director.

Just as this discovery-derived from numerous studies by the medical, dental and insurance communities-has influenced Pitney Bowes' wellness program, it is beginning to alter dental plan designs.

Two dental plan providers-Kansas City, Mo.-based Assurant Employee Benefits and Aetna Dental, a unit of Hartford, Conn.-based Aetna Inc.-last month announced they were enhancing dental coverage to pay for additional periodontal care for pregnant women and plan members with heart disease and/or diabetes.

In January, Philadelphia-based CIGNA Corp. announced it was beefing up its dental plan benefits to provide additional periodontal care for pregnant women.

CIGNA's decision came in response to research that showed scaling and root planing-two components of periodontal disease care-resulted in an 87% reduction in low-birth-weight babies, said Rebekah Whitehouse, chief marketing officer for CIGNA Dental & Vision, Life, Accident and Disability.

"We offer that as a standard benefit for our medical and dental customers because a considerable number of stop-loss policies are triggered by premature births," she said.

In July, CIGNA enhanced periodontal benefits for plan participants with heart disease and/or diabetes after conducting an internal claims study that found a 5.8% decrease in medical costs for members with cardiovascular disease or diabetes when they are treated for periodontal disease vs. a 9.7% increase for those who were not.

Aetna's decision to enhance its dental benefits also followed an internal claims analysis that found plan members with cardiovascular disease and diabetes had reduced medical costs and improved health risk appraisal scores when they had regular periodontal treatment, said Dr. Mary Lee Conicella, Aetna Dental's national director of clinical operations based in Pittsburgh.

"Because of the research we did...we feel employers can save money down the line if patients have regular dental care and periodontal care if they need it. And if we encourage them to have this care," she said, "we can improve their overall health and then the employers get to reap the benefits of those cost savings."

Also in acknowledgement of the link between oral health and systemic health, Assurant's enhanced dental program, called "Lifetime of Smiles," will provide four cleanings per year in addition to several other services.

"It goes back to the fact if they have a healthier group of employees from an oral health perspective, then they are going to have healthier employees overall," explained Dr. Jim Gimarelli, vp of dental at Assurant.

Washington Dental Service, a member of the Delta Dental Plans Assn. located in Seattle, is developing a plan design that will be tailored to participants' individual needs, said Ron Inge, dental director and vp.

Under that plan design, a dentist will perform an initial risk assessment, and patients at high risk for certain conditions will be covered for the treatment of those conditions, said Dr. Inge.

Washington Dental Services' new offering is currently being tested in a pilot involving two self-insured employers-the insurer itself and another area employer that Dr. Inge declined to identify.

The cost of most of these dental coverage enhancements is being borne by the insurers themselves with two exceptions: Assurant's enhancements are available at no additional charge for new business, but renewing business will see a slight premium increase. Aetna's enhanced maternity dental benefits will be available at no additional cost to employers; however, there will be an additional charge for participants with heart disease and diabetes.

Assurant is offering the enhanced benefits at no additional charge because it stands to benefit in its role as a disability and life insurance provider, Dr. Gimarelli explained.

"There will be less work time missed for the significant health conditions like diabetes, preemie babies, heart attacks and strokes. The research has shown very clearly that about 80% of adults have some sort of periodontal disease. And, if they are more healthy from a periodontal perspective, then they are going to be in better shape to overcome other serious medical conditions. The dollars associated with all of these medical conditions are in the millions," according to Dr. Gimarelli.

CIGNA is so confident that enhancing dental benefits will lower medical costs that it is giving employers a 1% rebate on health care premiums if they also sign up for CIGNA Dental, according to Ms. Whitehouse. The insurer is also offering an incentive program, called "Wellness Plus," that increases the maximum annual coverage limits for employees who receive regular preventive dental care services.

"We call it evidence in action," Ms. Whitehouse said.

While employers with self-insured dental plans will shoulder the additional cost of providing these enhanced services, they will also benefit from any resulting savings on health care costs, dental plan executives point out.

"There will be an initial increase in utilization because of the assessment, but the downstream savings should offset that cost," said Dr. Inge.

"Certainly the employer has a lot at stake if they have a healthier employee population that has better oral health. That is going to lead to better experience on their medical," echoed Dr. Gimarelli.

Indeed, many employers are interested in expanding dental plan coverage in recognition of the link between oral and overall health, said Cathye Smithwick, a principal at Mercer Health & Benefits in San Jose, Calif.

"As employers get ready to look at benefits, what is coming up more and more in that discussion is 'let's have a detailed discussion about plan design' and whether it's competitive, and the clinical aspects of the plan and whether they support wellness and medical management on the medical side," she said. "The generic term of it is medical-dental integration."

Integration doesn't mean consolidating providers, but rather recognizes that "oral health, especially periodontal health," is linked to overall health, Ms. Smithwick said. "After all, the mouth is a part of the body."