Funding gap

The problems in accessing NHS dentists are receding, but employees are still facing challenges paying for it finds Sam Barrett

Access to NHS dentistry is on the up, with 1.4 million more people receiving treatment in the last 24 months than in the same period ending March 2006. But, according to a recent market study by the Office of Fair Trading (OFT), employees are still facing financial pain when it comes to paying for treatment.

The market study, which was published in May, found that patients had insufficient information to make informed decisions about their choice of dentist and the dental treatments they receive. Possibly more concerning, it found that around 500,000 patients a year were given inaccurate information by their dentists regarding their entitlement to NHS treatment. In many cases this led to them paying more to have the treatment carried out privately.

To address these concerns, among its recommendations the OFT has called for more proactive enforcement of the rules surrounding the provision of clear and accurate information about prices and available dental treatment.

The OFT’s findings came as no surprise to Michelle Rae, dental product manager at Cigna. “We conducted a survey into the dental market – ’Dental Consumer Survey 2012: A guide to understanding attitudes towards dental care’ – and found that a third of those surveyed had difficulty understanding treatments and costs, with nearly three-quarters of these people concerned by their confusion,” she explains. “It’s good that the OFT is calling for better information for patients.”

Benefit pressure

While the OFT’s call for more proactive enforcement might help to bring the cost of dental treatment down, evidence of an increase in the cost of treatment could put pressure on the amount of dental benefit included on cash plans.

On a £1 a week plan, dental benefit is around £50 a year. For example, Simplyhealth offers £60 of dental benefit, Medicash, £55; Health Shield, £50 plus a further £165 for dental accident on its 75p per week Essentials plan; and Westfield Health £55 plus a further £110 for dental trauma.

Paul Shires, sales and marketing director at Westfield Health, believes this is sufficient on these entry level products. “We don’t really come under any pressure to increase the benefit,” he says. “Employees like the breadth of appeal of a cash plan and, as they can claim for other health costs, regard them as offering good value for money.”

There isn’t sufficient dental cover on a cash plan unless you only want to cover routine maintenance or solely NHS care

But, although the providers haven’t had demands from employees to increase dental cover, some advisers believe that increasing it would be a positive move. “There isn’t sufficient dental cover on a cash plan unless you only want to cover routine maintenance or solely NHS care,” says Colin Boxall, director of the Advo Group. “Although improving one benefit can distort the balance of cover on a cash plan, I do think, if demand is out there, providers could offer a wider restorative benefit to complement existing coverage.”

To illustrate the potential shortcomings of existing cover, although a cash plan will cover two NHS check-ups a year, at a total cost of £35, the cost of any additional NHS work will far exceed the dental benefit.

Band two treatment, which includes fillings, root canal work and the removal of teeth, costs £48. So, even if no work is required in the other six monthly appointment, the annual spend would be £65.50. And, if treatment takes an employee into band three at £209, the cash plan’s benefit can seem very meagre.

Private treatment, which the OFT found was being advertised as the only option by some dentists, will drain benefit even faster. A routine check-up costs around £35 to £40 with a scale and polish adding a further £30 to £40. Without additional work, an employee could be looking at an annual cost of £130 plus to see a private dentist.

Flexible cover

Some of the cash plan providers are addressing the low levels of dental benefit. Sue Weir, chief executive at Medicash, explains: “On our Proactive plan we offer unlimited NHS cover on two highest levels, costing £3.50 and £5.00 a week. We also find that when someone goes to the dentist regularly, bills tend to be at a lower level as a result of the preventative work.”

Bespoking benefits also helps to overcome the issue of limited cover. For instance, on Westfield’s Mosaic it is possible to increase the dental cover to £250 and strip out all but one of the other benefits.

Engage Mutual also offers the option to have a higher level of dental benefit on its One Fund. With this the member chooses how they use their overall allowance rather than it being ascribed to individual benefits. Although an excess of £40 is charged for each benefit, this approach does mean that, for £10 a month, an employee could claim up to £720 of dental benefit a year.

But while there is some flexibility around the level of dental benefit on a cash plan, Boxall says that where a client wants more comprehensive dental cover they tend to prefer a specific dental policy rather than a cash plan. “Without the benefit of hindsight, employees do prefer the spread of cover provided by a cash plan as, over a year, it is far easier to access a wide range of benefits. But, if they need more expensive restorative dental care they may regret having a cash plan over standalone dental cover,” he says.

Dental plans

Dental plans, such as those offered by Denplan, Cigna and Bupa, can certainly offer more generous cover limits. As an example, Cigna’s plans offer between £1,200 and £3,000 of cover and Denplan’s Wellbeing range offers up to £2,200 of cover a year, while its scheduled plan Lucent will give up to £5,500 of cover.

Colin Perry, corporate channel manager at Denplan, says there has been healthy interest in dental plans as an employee benefit. “There’s been a steady increase in sales and they remain a popular benefit with employees,” he says. “Cover can be flexible too, with employers able to put a base level of cover in place and allow employees to increase this to match their dentist’s charges.”

His views are echoed by Cigna’s Rae. Her research has shown a growing interest in dental plans as an employee benefit. “There is a lot of interest in employers introducing dental schemes,” she says. “Employees value them and employers also benefit as they can help reduce absence by preventing dental health problems.”

But this additional cover does come at a higher price. While an employer can spend £1 or less on a cash plan, a 100-employee company looking to introduce Denplan’s Elementary, which is designed to pick up the cost of NHS treatment, as a company-paid benefit will pay £7.30 a month per employee.

Ultimately the decision of whether to go for a cash plan or a dental plan comes down to what the employer is trying to achieve. As Howard Hughes, head of employer marketing at Simplyhealth, observes: “If an employer specifically wants to look after employee’s dental health, a dental plan is ideal, but if they want to help them with everyday health costs, a cash plan provides a breadth of cover that can appeal to all employees.”

Optical Benefits

Optical benefits are one of the three most common claims on cash plans, with many employees using them to pay for regular eye tests, glasses and contact lenses. Benefit levels tend to be fairly generous. At £1 a week, Simplyhealth gives £60 of annual cover; Westfield £55; and Health Shield £50 (for a premium of 75p a week).

As well as benefiting employees, the optical benefit is often sold as supporting an employer’s duty of care requirements. Under the Health and Safety (Display Screen Equipment) Regulations 1992, employers are required to provide VDU users with eye and eyesight tests on request and special spectacles if needed.

Further, EU legislation being introduced next year will require employees who drive on company business to have regular sight tests. For commercial licence holders, tests will be required every five years while private licence holders will need to have a test every 10 to 15 years. Although employers won’t be responsible for the cost of these, it will be in their interest to ensure employees comply with the regulations.

But while cash plans are often sold as a means to cover off these requirements, Brian Hall, sales and marketing director at BHSF, says it is not always a valid approach.

“We’re seeing the wheels come off the claim that optical benefit addresses display screen equipment (DSE) obligations for employers. Picture the employee who uses up their cash plan optical benefit paying for contact lenses and then submits a claim to the employer for DSE eye test and glasses,” he says.

To counter this, BHSF offers a voucher through its optical benefit, giving employees access to an eye test for driving or DSE and a range of glasses if required. Employees can then pay for any upgrades on their glasses, such as opting for designer frames, or, if they have enhanced optical benefit on their scheme, use this to pay for them.