An employee says their dentist is out-of-network. What can they do?
Three options. (1) Switch dentists — use the carrier's online directory to find an in-network provider. (2) Use the OON benefit — DPPO plans typically still cover OON care at a lower percentage (e.g., 50% instead of 80% for basic services), with the employee paying the difference. (3) Stay with the dentist as a private-pay arrangement — paying out of pocket and submitting receipts may yield partial reimbursement at the OON rate. Some highly-recommended dentists are willing to accept the in-network reimbursement amount even though they're technically OON; it's worth asking. We help employees navigate network questions when they arise.
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- Employee Benefits
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- Employee Benefits
Related FAQs
Can I use a Professional Employer Organization (PEO) or association plan instead?
Sometimes. **PEOs** (TriNet, Justworks, Insperity, Sequoia, etc.) bundle health, retirement, and HR services for small businesses — they pool employees across many client businesses to access large-group pricing and richer plan options. For some NY small employers (especially those with younger/healthier workforces), PEO pricing beats community-rated small-group. But PEO arrangements have implications for tax, payroll, ERISA compliance, and unwinding can be complicated. **Association Health Plans** (AHPs) are restricted in NY — DFS regulates them tightly and they're far less common…
Read answerDo I have to offer health insurance to my employees?
Federal law (ACA employer mandate) requires "applicable large employers" — generally those with **50+ full-time equivalent (FTE) employees** — to offer affordable, minimum-value health coverage to full-time employees, or pay a penalty. Below 50 FTEs, federal law does not require coverage. NY does not impose its own coverage mandate beyond federal rules. That said, most healthcare practices and professional services firms offer coverage as a recruiting and retention necessity — the labor market makes it functionally non-optional even when legally…
Read answerDo voluntary benefits coordinate with major medical?
No — and this is the main feature, not a bug. Voluntary benefits pay cash directly to the employee, regardless of what major medical paid. There's no coordination of benefits, no offset, no reimbursement claim. The cash can be used for anything: deductibles, copays, lost wages, transportation, childcare, household expenses. This is why voluntary benefits are so frequently paired with HDHP medical plans — they fill the high-deductible gap with non-coordinated cash.
Read answerDo voluntary benefits cost the employer anything?
Generally no — premiums are 100% employee-paid through payroll deduction. Some employers pick up a portion of premium as a richer benefit (especially for groups looking to differentiate). The administrative cost of offering voluntary benefits is real but small: enrollment communications, payroll integration, claims questions handling. Most carriers in this space provide turnkey enrollment platforms and call center support to make administration light.
Read answerDPPO vs. DHMO — what's the difference?
**Dental Preferred Provider Organization (DPPO)** plans operate like a medical PPO: members can see any dentist but pay less in-network. There's typically an annual deductible ($50–$100), an annual maximum benefit ($1,000–$2,500), waiting periods on major services (6–12 months for crowns, 12–24 months for orthodontia), and coinsurance percentages by service tier (preventive 100%, basic 80%, major 50%). Strongest coverage breadth. **Dental Health Maintenance Organization (DHMO)** plans require employees to pick an in-network primary dentist, who refers to specialists. Typically: no annual…
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