The following information is provided to determine if DR is the right dental plan for you and your employees: 

v      DR plans are self-funded because dental benefits are entirely predictable.  The average person incurs less than $250 per year in dental care expenses. 

v      Dental Reimbursement pays the patient a percentage of total charges spent rather than tracking individual procedures and fees. 

v      There are no excluded procedures except those restricted by federal tax laws or employer design. 

v      Usual, Customary and Reasonable fee limits (UCR) and Coordination of Benefits (COB) provisions are not required in Direct Reimbursement dental benefits.  UCR fees are set amounts paid by a carrier for benefits, and COB is a plan policy provision designed to eliminate duplicate payments and provide the sequence in which coverage will apply (primary and secondary) when a person is insured under two contracts.  The costs of these administrative controls are equal to or exceed any dollars saved.   

v      Claims are processed quickly (usually within 2 or 3 days). 

v      Checks are written on an account funded by the employer with employer and employee (pre-tax) contributions used to set the plan’s budget. 

v      Because of low administrative costs, 93% to 95% of budgeted dollars are allocated to benefits. 

v      Orthodontics can be included and is treated the same as any other dental condition.  There are usually no lifetime maximums on orthodontia. 

v      The typical indemnity dental plan averages 54% reimbursement of submitted charges.  DR reimburses at a higher average because there are no exclusions, waiting periods, fee reductions, or deductibles.   

v      All necessary administration, forms, systems, and ERISA compliance materials to ensure quick implementation and successful operations are readily available. Administrative costs are low and some employers choose to self administer these plans. 

v      Aggregate stop loss coverage, while available, is not generally needed with dental benefits. 

v      It is not unusual for employers to end the year with a positive balance in their dental benefits account.  Employers can often go 3 to 4 years without an adjustment in funding factors. 

v      The greatest concern expressed by employers about DR is the apparent lack of cost controls.  Under DR the cost of dental care is controlled by the patient.  There is no better control than a cash paying consumer. 

v      People do not overuse dental benefits and are capable of purchasing dental care the same way they buy other services.  Understanding and information is the key. 

v      The patient is responsible for paying the dentist, either at the time of service or subsequently, after getting reimbursed. Credit cards are widely accepted by dentists. 

v      Periodic reports are easily generated and show budgeted expenses, actual plan costs, number of claims processed, percentage of incurred claims that are reimbursed and year-to-date loss ratio. 

v      Claim funding factors can be calculated from actual claims experience, if available, or are based on average costs for the type of industry, geographic location and plan design quoted.