Nsurance Info
Advantages of Offering a Dental Benefits Plan to Employees (Part 3)
Kinds of Dental
Insurance Plans
Managed Care Dental
Plans
Preferred Provider
Organization (PPO)
plans are plans in which the patient has to select a
dentist from a list provided to him. These dentists have
agreed to discount their fee by contract with the
insurance company. Some PPO plans also allow patients
treated by dentists outside their list, where the patient
is penalized by excess co-payments and higher deductibles.
PPO’s are normally less expensive than indemnity plans in
their class.
Keep the following in mind while reviewing
a PPO Dental Insurance Plan.
What
is the percentage of the premium used for administration?
Will
the discount influence patients to change their regular
dentist? Will the amount of the discount the dentist ahs
to offer affect the number of treatment options for the
patient?
What
is the liability of the employer in the event of the plan
influencing dentist selection or treatment?
What
are the criteria of selection of dentists for the plan?
Does it have adequate number of dentists under contract?
What is the geographic distribution of dentists?
Does
the PPO dental insurance plan provide for specialist
referrals? If so, are the dentists limited to a specialist
on the “list” only?
How
does the plan provide for emergency treatment? If so then
how does the plan provide for emergencies outside the
geographical area?
Dental Health
Maintenance Organization (DHMO)
or Capitation plans
are designed in such a way that the patient does not have
any financial payout when he goes for treatment. These
plans pay the dentists on their “list” a fixed amount of
money monthly per enrolled family or individual,
regardless of visits.
In return, the dentists provides specific
types of treatment to the patients who visit him at no
charge, any other types of treatments require co-payment.
This way, the DHMO is rewarding dentists to keep patients
in good health, thereby keeping the costs low. This kind
of plan is one of the least expensive.
Factors to consider while reviewing a DHMO
plan.
What
is the percentage of the premium used for administration?
Does
the employer have access to enough information for him to
determine the level and amount of treatment rendered to
each of the employees?
What
is the utilization percentage for patients in this plan?
Average waiting period for an initial appointment and
average period between appointments has to be given due
consideration.
What
is the dentist/patient ratio for the DHMO plan? What is
the criterion of dentist selection in the program? What is
the geographic distribution of dentists?
What
percentage of dentists is selected for from those who
applied to participate? How
many dentists withdrew from the program in the recent
past?
What
is the rate of compensation for the dentists? Is it
sufficient compensation for the needs of the covered
patient population? What are the provisions made for
dentists in the event of unforeseen utilization?
What
are the benefits for patients needing a specialist's care?
How are specialists selected and compensated? Does the
plan have adequate specialists?
Does
the program provide for any emergency treatment? If so, is
it available outside the geographical area?
Fee-for-Service
Dental Plans
Direct
Reimbursement (DR)
plan is a self-funded dental insurance benefit plan which
reimburses patients on actual spent on dental care. It is
not based on the type of treatment received. The patient
has complete freedom in choosing the dentist. The
employers are liable to pay a percentage of actual
treatment cost, but they do not have to pay monthly
premiums for employees who do not need the benefit.
Moreover the employer is free of any responsibility to
take decisions on mode of treatment due to previous plan
selection or sponsorships. Direct Reimbursement Dental
Insurance Plan is American Dental Association’s preferred
method of dental coverage.
