As employees, we all can do our part to ensure sustainability of benefit programs and achieve more value. Specifically regarding the health and dental benefits, there are voluntary actions employees can do which can result in savings both individually and collectively to all employees of the same program. Generally speaking, how health/dental rates are priced is quite straight forward:
As claims make up the majority of the rate, the lower your claims are as a company, the lower your health/dental rates will be.
Pressures such as health/dental inflation, increasing costs and availability of specialty/biologic drugs, and an aging workforce, add to the complexity of having a sustainable benefit program that meets the needs of employees. To follow are voluntary steps employees can take to get more savings from their program.
Prescription Drug Dispensing Fees:
Each prescription consists of two parts: Ingredient costs & dispensing fee
The dispensing fee will vary depending on the pharmacy.
The majority of pharmacies in Alberta are charging between $12-$13 per prescription. The main exception is Costco’s dispensing fee which is between $4-$6 per prescription.
When purchasing maintenance drugs (i.e. high blood pressure), purchase a 90 day supply and eliminate two dispensing fees.
Rather than refill 100% of a prescription for a condition nearly healed, consider refilling a lesser amount – i.e 25%.
For 20 years, Alberta dentists operated without a fee guide, meaning they had free range on what they could charge. A 2016 review found Alberta’s dental fees to be the highest in the country. The provincial government announced in December 2016 that a new dental fee guide, similar to what other provinces had in place, would be created to rein in costs. The new dental fee guide, introduced January 1, 2018, is not regulated which means dentists are still free to set their own rates. That said, on average the fees originally set out in the fee guide were approximately 8.5% lower than 2016 fees.
What Can You Do?
Avoid surprises. Ask for rates and pricing (use your booklet and insurer to confirm what is coverage before the work is done.
Shop around; get estimates when possible. This is very important for claims in excess of $500.
Bitewing x-rays should not be required every visit. Ask, “when were they last done?”. “Are they really necessary?”. Generally bitewing x-rays are needed every 24-36 months for adults with low risk of cavities and 12-18 months for high risk.
Replace fillings only when there is evidence that this is required. Replacement signs include:
o Fillings feeling rough to the tongue
o Temperature sensitive
o Pressure sensitive
o Sweet sensitive
Get a detailed explanation of all charges before you leave.
Never sign a blank form.
Review the form in detail to ensure that the charges reflect the work you had done.
Use your dentist’s professional expertise to provide, what you feel are, the best dental solutions for you and your family.
Use your plan to help pay for the solutions you wish to purchase.
Use your power as a consumer to maximize the value you receive
For more information regarding steps employees and employers can take to maximize savings in your benefit program contact Benefit Consultants Inc. at firstname.lastname@example.org or call 1.800.667.2973