Insurance industry dental loss ratios (DLRs) represent expenditures for patient services as a percentage of total premium dollars. A well-managed dental insurance plan allows maximal dollars toward patient care and the least amount toward administrative overhead.
Under the Affordable Care Act (ACA), medical insurance plans are required to minimally operate at an 85% medical loss ratio (MLR) for larger carriers and 80% MLR for smaller health insurance companies. Dental insurance is quite different than medical insurance in fundamental ways. Potential dental insurance company losses for payout of patient benefits are far more actuarially predictable. Most dental insurance companies impose yearly maximal payouts limited to only $1,000 to $1,500. Medical insurance may be on the hook for unlimited sums, in the event of catastrophic illness. In fact, few if any dental plans cover catastrophic events or major oral rehabilitation.
Dental insurance plans focus coverage on low-cost preventive care. The least percentage coverage is for more involved restorative treatments, like crowns and fixed bridge work. Further, many dental plans disallow payments for implant services altogether.
Note: While the data is for a company’s total (national) business, only those companies that report having health premiums in the state of Washington are included in this listing.