We are seeing more and more local companies make the switch from conventional insurance plans to a self-funded, or direct reimbursement plan. The wonderful thing about a direct reimbursement dental plan is the fact that it is predictable. Unlike medical insurance, dental policies have a maximum dollar amount of benefits that can be paid out per person per benefit year, no matter what happens.
Self-funded plans provide benefits to all three parties involved: the employer, the employee, and the dental office. Employers save money when the funds set aside for reimbursement are not completely used. Very few people use their maximum yearly benefit. This remaining capital can be used to fund benefits in future years, or even offer improved benefits. When a conventional insurance company is used to administer these benefits, that remaining capital stays with them. If your employees aren’t using their benefits to their fullest, you might be paying them way too much to administer your plan.
Employees benefit from direct reimbursements plans because they don’t have to worry about their dentist being in network, or jumping through hoops to get their claims covered. It’s simple, they choose their dentist and can either pay for treatment themselves, and submit their receipt for reimbursement, or the dental office can submit a claim for them. You can choose the way you want your plan to function.
As far as the dental office is concerned, we receive payment much faster without claim issues, or denials that we regularly receive from insurance carriers. This allows patients easier access to treatment. The last thing we want is for confusing insurance rules and regulations to discourage patients from getting treatment.
There are several ways to structure your self-funded plan, you can choose which ever benefits or limitations you want to include. It’s all up to you!
For more information, check out the American Dental Association website: http://www.ada.org/en/public-programs/dental-benefit-information-for-employers/direct-reimbursement-plan/how-direct-reimbursement-works.