Pay and Benefits Watch: Dental benefits full of cavities

Over the past year, Congress and the Clinton administration have required health insurance companies participating in the Federal Employees Health Benefits Program (FEHBP) to provide federal employees with coverage of contraceptives and mental health aid, and to comply with the President's Patients' Bill of Rights.

But federal employees want better dental care coverage more than any other benefit, according to the Blue Cross/Blue Shield Association, which surveys and holds focus groups with the four million FEHBP beneficiaries it covers-45 percent of the federal market.

Dental coverage is not a part of the basic health insurance package offered to federal employees. Employees can get supplemental dental coverage from some insurance plans, but they typically require additional premiums. Blue Cross/Blue Shield's Federal Dental Blue program, for example, requires an additional premium and is only available in five areas around the country.

A federal employee enrolled in Blue Cross/Blue Shield said "current coverage for federal employees is deplorable. There hasn't been significant improvement in dental coverage for services such as orthodontics, bridges and other costly services that older federal employees are now experiencing."

The employee described having to pay $5,000 for two bridges and four teeth cappings.

"This is outrageous," the employee said. "There are private firms whose dental insurance would cover 50 percent or more of those costs."

According to the 1995 Employee Benefits Survey by the Bureau of Labor Statistics, 57 percent of private sector employees had dental coverage. Their plans typically covered 100 percent of the costs of routine examinations and X-rays, 80 percent of the costs of fillings and minor surgery, and 50 percent of expensive procedures like crowns and orthodontics.

Focus groups have told the Office of Personnel Management, which runs the FEHBP, that they want better dental coverage. In a recent letter to health insurance companies, OPM encouraged them to offer federal employees non-FEHBP supplemental dental insurance, which requires additional premiums, and to "list such coverage prominently on the non-FEHB page of your plan brochure."

If dental coverage is in such high demand, why hasn't it been made part of the FEHBP?

"We had a lot of things this past year to consider-mental health, Patients' Bill of Rights, long-term care," an OPM spokesperson said. "Basically we had to prioritize. Dental health was not one of the top three or four priorities. In the future, dental benefits will be one of our focuses."

As for Blue Cross/Blue Shield, spokesman Bill Pierce said the insurance company wants to offer federal employees better dental coverage, but is restricted by OPM rules and mandates for other types of coverage.

"OPM hasn't allowed us to expand dental coverage," Pierce said.

Ned Lynch, senior research director at the House Government Reform Civil Service Subcommittee, said dental coverage should not be mandated, but OPM should give insurance companies more freedom to decide what benefits to include in their FEHBP packages.

"OPM's increase in mandates on FEHBP and its standardization of benefits package is robbing employees of the choices they might want," Lynch said. "If FEHBP had a true cafeteria-style menu of health care choices, an employee who wanted to would be able to choose a plan that provides better dental coverage over one that provides better mental benefits."

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
Close [ x ] More from GovExec