Dental Spending Plans and Dental Insurance

A Simple, Flexible Dental Program That Works

Dental Spending (DS) Plans are based on the principles of self-funding and the direct connection of employer, employee, and dentist.  Self funding gives employers total control of costs because they tailor the contribution, funding, and benefit structures appropriate for their business.  Claims administration is streamlined and simplified due to the dollar-based plan design of Dental Spending Plans.

MDSIS-Spring eliminates the middleman, maximizes patient choices and benefit dollars, while allowing the employer to maintain control.  Dentists also embrace the approach because it doesn't interfere with the doctor-patient relationship.

The employee pays the dentist's full fee at treatment, submits a paid receipt or claim form to the employer or administrator, and is reimbursed for all or part of the fee, according to the plan design.  In addition, companies can have a dentist accept assignment of benefits, relieving the employee from paying fees up-front.  After treatment both dentist and patient file simplified claims forms.  The dentist is reimbursed according to plan design and collects from the patient for any remainder.

• The employer crafts the dental plan to fit their needs.  All forms, paperwork is provided by MDSIS.
• The employee chooses any licensed dentist anywhere. Together, they create a treatment plan.
• After a visit, the patient or dentist files a simple claim.
• Payment is swift: within a few days of submission.
• Unused benefit dollars remain in the fund (85% of employers with DS have a year end unused balance).
• Monthly claim reports are provided to the company.
  

FEATURES OF DENTAL SPENDING PLANS

• All benefits are determined by only two variables:  Co-insurance and plan maximum.
• There are NO UCR cutbacks with balance billing to the patient by the dentist.
• If a regular dental plan pays 50% on orthodontics up to a $1,000 maximum, this is only a 25% benefit, not 50%.  Orthodontic costs average $4,000+.  If the lifetime maximum is $1,500 then the plan pays only 37% not 50%. 
• Insurers can substitute the “least expensive alternate procedure” as the expense allowance instead of the fee for the actual procedure done.  This reduces the claim payment and increases the employee out of pocket cost.
• There are no frequency or age limits on any procedure with Dental Spending Plans (DSP).
• There are no excluded procedures other than cosmetic with DSP.
• There are no “missing tooth” exclusions in DSP.
• There are no pre determinations of benefits needed with DSP.  DSP pays based on the fees charged and services provided.
• Claim turnaround with DSP is one week including mail time of the check to the patient or dentist.  Traditional plans take 2 to 5 weeks and quite often the patient does not understand the EOB.

DSP pays what it says it will pay.  In fact, a traditional plan DOES NOT pay 100/80/50/50.  Analysis of hundreds of plans shows that the actual benefit percentages are 87/61/38/29.  Why?  Deductibles, UCR, exclusions, age limits, frequency limits and co-insurance all drive down payments until the average of all plans for all procedures is 55% in a traditional plan.  Brokers and employers are seldom aware of this.

DSP pays higher claim benefits than traditional plans but instead of 20% to 25% overhead, overhead with DSP is 8% to 12 %.  This frees up more of the premium to pay higher benefit levels.  The 100% of $150 and 50% of the balance design produces a reimbursement of 61% of charges rather than 55% of insurer plans.  This is a 10% increase, which is offset by a 10% lower administration fee.

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