Group Dental and Vision Benefits – Design, Trends, and Cost Control

Executive Summary

Dental and vision benefits are among the most frequently used components of any group benefits plan—and among the most emotionally resonant for employees.

Unlike disability or life insurance, these benefits are often used annually or even semi-annually, making them highly visible and strongly tied to satisfaction. But costs are rising quickly, especially for dental inflation, while plan sponsors wrestle with balancing budget constraints and employee expectations.

This article breaks down how to design, evaluate, and evolve your dental and vision offerings in a way that:

• Controls costs and usage

• Aligns with industry benchmarks

• Enhances the employee experience

• Integrates with flex plans and health spending accounts

• Leverages insurer tools and data to stay competitive

1. Why Dental and Vision Benefits Matter

• Most used benefits by employees under age 45

• Symbol of fairness and value—even for low earners

• Easy to understand (cleanings, glasses, checkups = peace of mind)

• Strong ROI in terms of satisfaction, even at modest cost

Yet many employers:

• Overpay for standard plans

• Don’t review coverage adequacy annually

• Fail to educate employees on what’s covered and how to claim

Employees don’t just want benefits—they want benefits that work.

2. Typical Plan Design Structures (Core, Enhanced, Flex)

Flexibility is growing, especially in mid-sized organizations (200+ lives).

3. What’s Covered—and What’s Not

Dental:

• Basic services: Exams, cleanings, X-rays, fillings, extractions

• Major services: Crowns, bridges, dentures

• Orthodontics: Braces, retainers (often for dependents only)

Vision:

• Eye exams (may also be covered by provincial plans for children/seniors)

• Glasses or contact lenses

• Laser eye surgery (sometimes eligible under HSA)

Limitations often apply:

• Frequency (e.g., 9-month recall for exams)

• Dollar caps (e.g., $1,000/year dental)

• Dental fee guide year (e.g., one year behind current guide)

4. Dental Fee Guides and Inflation Pressures

Dental inflation is real. Most provinces publish annual fee guides (e.g., Ontario Dental Association), which rise 3–7% annually.

Key issue: Many plans reimburse based on a previous year’s guide, saving money for the plan but creating employee frustration.

Employers must decide:

• Pay at current guide = happy employees, higher cost

• Pay at lagged guide = savings, but dissatisfaction

Pro tip: Consider a multi-year trend forecast with your consultant to project costs under different reimbursement approaches.

5. Preventive vs Major vs Orthodontics: Coverage Best Practices

High preventive coverage = lower major costs long term. Cleaning now saves crown later.

6. Cost Containment Tools Every Employer Should Know

• Dental fee guide lagging: 1-year delay to slow inflation

• Recall frequency limits: Every 9 months instead of 6

• Scaling/unit limits: Max number of cleanings per year

• Predeterminations: Required for major work >$300

• Per-service caps: Max reimbursement per procedure

• Co-insurance and deductibles: Shared cost structure

Combine these tools with employee education to avoid dissatisfaction.

7. Health Spending Accounts (HSAs) vs Traditional Coverage

HSAs allow employees to:

• Use tax-free dollars for dental/vision not covered under the plan

• Choose their own priorities (e.g., laser eye surgery, orthodontics)

Employers can:

• Control their budget (fixed cost)

• Avoid rising premiums and inflation pressure

• Increase perceived flexibility

Many organizations offer a core dental plan + HSA hybrid model.

8. Vision Care: How It’s Changing in Canada

Vision benefits are seeing renewed attention as:

• More Canadians work on screens full time

• Blue light, eye strain, and digital fatigue grow

• Provincial coverage gaps (especially for exams) widen

Vision trends:

• Increase in maximums ($200–$300 per 24 months)

• Expanded coverage to include prescription sunglasses

• Optional coverage tiers or WSA “wallets”

• Use of virtual eye exams and eyewear vendors (e.g., Clearly, Warby Parker)

9. Benchmarking Your Dental and Vision Plans

Benchmark regularly across:

• Industry

• Region

• Union vs non-union

• Retiree populations (if covered)

10. Voluntary and Optional Models for Enhanced Access

Employers can offer:

• Voluntary dental/vision plans (employee-paid upgrades)

• Optional top-ups through flex credits

• Buy-up plans for dependents or family coverage

• Portable individual plans at termination

This gives employees more control—and reduces employer liability.

11. Employee Communication to Reduce Frustration

Dental and vision benefits are emotionally sensitive. Employees get upset when:

• Claims are denied for “recall timing”

• Fee guide reimbursement is lower than actual fee

• Orthodontics is only for dependents

• Coverage is unclear at the time of procedure

Solutions:

• Clear employee-facing summaries (not just booklets)

• Annual benefits education campaigns

• “Top 10 claim mistakes to avoid” handouts

• Highlight HSA usage options for coverage gaps

The more frequently used a benefit is, the more critical it is to communicate it proactively.

Final Thoughts

Dental and vision benefits may seem “small” compared to LTD or drug coverage—but they’re the most visible to employees, and the most emotionally resonant.

Design them thoughtfully. Benchmark annually. Consider voluntary models or HSAs for flexibility. And don’t forget to communicate clearly.

If you need help reviewing your dental/vision structure or planning a more modern offering, we’re happy to guide you through the options.