If you're managing benefits for a company with 50-200 employees, dental insurance is probably on your radar: but it might be lower on your priority list than medical coverage. That's a mistake.
Here's the reality: dental benefits are one of the most used (and most appreciated) employee benefits you can offer. Employees actually see their dentist twice a year for cleanings, and when they need a filling or root canal, they're reminded exactly how much value that dental plan provides. At Total Benefit Solutions, we've seen firsthand how the right dental plan can boost retention, keep your team healthy, and avoid the nightmare scenario of someone calling out for a week because of an infected tooth.
2026 is bringing some changes to the group health plans requirements landscape, and dental is no exception. Let's break down what you need to know.
Why Dental Plans Matter More Than You Think
Most mid-sized employers think of dental as a "nice to have" benefit. We think that's backwards.
Dental insurance is preventive healthcare that your employees will actually use. Unlike medical insurance, where employees might avoid going to the doctor unless something's seriously wrong, dental benefits encourage regular checkups. Those cleanings catch cavities early, prevent gum disease, and even identify warning signs of diabetes, heart disease, and oral cancer.
From a business perspective, untreated dental problems lead to missed work days, emergency room visits (which cost 10x more than a dental visit), and decreased productivity. An employee dealing with tooth pain isn't focused on their job: they're searching for the nearest emergency dentist.
Plus, dental benefits are a retention tool. When employees are comparing job offers, seeing "dental included" matters. It's a visible, tangible benefit that shows you care about their overall well-being, not just checking a box for group health insurance for employers compliance.
The Three Main Types of Dental Plans
Not all dental plans are created equal, and if your broker is just handing you one option without explaining the differences, you're not getting the full picture. Here's what you need to know:
Dental HMO (DHMO)
DHMOs are the most budget-friendly option, with low monthly premiums and minimal (or zero) deductibles. The trade-off? Employees must choose a dentist from a network and typically need referrals for specialists.
Best for: Cost-conscious employers with employees who don't have established dentist relationships and are willing to choose from a network.
Dental PPO (Preferred Provider Organization)
PPOs offer the most flexibility. Employees can see any dentist they want, but they'll pay less if they stay in-network. PPO plans typically cover preventive care at 100%, basic procedures (fillings, extractions) at 80%, and major procedures (crowns, root canals) at 50%.
Best for: Mid-sized employers who want to offer flexibility and have employees who value choice. This is the most common plan type we recommend at Total Benefit Solutions.
Dental Indemnity Plans
These are the "traditional" plans where the insurance pays a percentage of the dentist's fee, regardless of network. Employees have total freedom to see any dentist, but premiums are higher and there's usually more paperwork involved.
Best for: Executive-level benefits or companies where employees have long-standing relationships with out-of-network dentists.
What Should Your Dental Plan Cover?
A solid dental plan should cover three categories of care, with different cost-sharing levels for each:
Preventive Care (100% coverage, no deductible):
- Routine cleanings (typically twice per year)
- Exams
- X-rays
- Fluoride treatments
- Sealants for children
Basic Procedures (80% coverage after deductible):
- Fillings
- Simple extractions
- Emergency care
- Non-surgical periodontal work
Major Procedures (50% coverage after deductible):
- Crowns
- Bridges
- Dentures
- Root canals
- Oral surgery
Most plans also include orthodontic coverage (braces), but it's often capped at a lifetime maximum (typically $1,000-$2,500 per child). If orthodontics matters to your workforce, make sure you're comparing the lifetime maximums across carriers: they vary significantly.
The Annual Maximum Problem (And How to Solve It)
Here's something most brokers won't tell you upfront: nearly every dental plan has an annual maximum: the most the plan will pay per person per year. In 2026, that max is typically between $1,500 and $2,000.
That might sound reasonable until your employee needs a crown ($1,200) and a root canal ($1,000) in the same year. Suddenly they're facing $700+ in out-of-pocket costs even with "good" dental insurance.
At Total Benefit Solutions, we push carriers to offer higher annual maximums when we can, and we make sure you understand exactly what that cap means for your team. If you're in an industry where employees are more likely to need major dental work (construction, manufacturing, hospitality), a plan with a $2,500 or even $3,000 annual max might be worth the slightly higher premium.
2026 Compliance Considerations
Dental plans are generally exempt from most ACA (Affordable Care Act) requirements if they're offered as a standalone benefit. But if you're bundling dental with your medical plan, or if your dental plan exceeds certain cost-sharing limits, you could trigger ACA compliance obligations.
Here's what you need to watch for:
If Your Dental Plan is "Excepted":
Most standalone dental plans qualify as "excepted benefits" under the ACA, meaning they're not subject to the ACA's essential health benefits requirements, out-of-pocket maximums, or preventive care mandates. To qualify, the dental plan must be offered separately from your medical plan, and employees must have the option to decline it.
If Your Dental Plan is "Integrated":
If you bundle dental with medical (one premium, one enrollment), the dental benefits count toward your medical plan's out-of-pocket maximum and must comply with full ACA rules. This is rare, but it happens: especially with smaller carriers.
ERISA Reporting:
If your dental plan is self-funded or if you have 100+ participants, you may need to file a Form 5500 annually. This is where employers get tripped up. Most fully insured dental plans don't require a separate 5500 filing, but if your plan is self-insured or if you're offering a flexible spending account (FSA) alongside it, you need to stay on top of reporting.
At Total Benefit Solutions, we audit your group health plans requirements annually to make sure you're not missing filings that could trigger DOL penalties. We've seen too many mid-sized employers get hit with $2,000/day fines because their previous broker didn't flag a Form 5500 requirement.
How Much Should You Expect to Pay?
For a mid-sized employer offering a dental PPO, you can expect to pay between $30-$50 per employee per month for employee-only coverage. Family coverage typically runs $80-$130/month.
If that sounds high, remember: employees are getting two cleanings a year (worth $200-$300 out-of-pocket) plus coverage for fillings and major work. The ROI is there, especially when you factor in reduced absenteeism and higher employee satisfaction.
DHMOs can be cheaper (as low as $15-$25/month for employee-only), but you're sacrificing network flexibility. For most mid-sized employers, the PPO is worth the extra cost.
The Total Benefit Solutions Difference
Here's where we're different from most brokers: we don't just hand you a dental plan and call it a day. We compare 4-6 carriers, negotiate annual maximums and waiting periods, and make sure your plan design actually matches your workforce's needs.
We've had carriers try to slip in 12-month waiting periods for major services or exclude coverage for pre-existing conditions (which is legal for dental plans, by the way). We push back. Hard. Because a dental plan that doesn't cover your employees when they actually need it isn't a benefit: it's a waste of payroll budget.
If you're a mid-sized employer looking to improve your group health insurance for employers package, or if you're frustrated with your current broker's lack of transparency, we're here to fight for you.
Ready to Upgrade Your Dental Benefits?
At Total Benefit Solutions, we specialize in helping mid-sized employers design benefits packages that actually work: not just check compliance boxes. Whether you're adding dental for the first time or your current plan isn't cutting it, we'll shop the market, negotiate on your behalf, and make sure you understand exactly what you're paying for.
Visit us at totalbenefits.net or call us at (203) 830-0951 to schedule a no-obligation benefits review.
Because you shouldn't have to accept "that's just how dental plans work" from a broker who isn't willing to fight for better.