FDA Dental Plans Offer Affordable Coverage

Dec. 14, 2001
Low administrative overhead make DR/DA an attractive option.

The Florida Dental Association (FDA) announces its endorsement of the most common self-funded dental plans, Direct Reimbursement and Direct Assignment. These self-funded dental plan concepts

give employers options that other forms of dental prepayment do not.

DR (Direct Reimbursement) and DA (Direct Assignment) are the most basic forms of self-funding. The employer has direct control over the plan administration, design and cost. With both models, reimbursement is based on a dollar-tiered structure, rather than on the procedure performed. Under these plans, the employee and the dentist determine the best course of treatment.

DR and DA both have low administrative overhead; the average cost to manage these types of dental plans is less than 12 percent, depending how the claims are processed.

Implementing a basic DR or DA plan is simple. Working with a qualified consultant, employers choose a plan design best suited for their business. In Florida, there are several third-party administrations (TPA's) offering variations in both DR and DA plans. Once the DR or DA plan is operational, the employer then gets a summary plan document and the employee gets a certificate explaining the plan's features. The employee then goes to any licensed dentist

for treatment. The plan may be administered by the TPA or self-administered using mainly available software programs.

In a DA plan, the dentist can receive an assignment of benefits. The

dentist is then reimbursed based on the dollar-tiered structure and, after receiving payment "balance bill" the patient for the remaining fee.

Several Florida employers self-fund their dental plans by incorporating the Direct Assignment or Direct Reimbursement model. DA or DR covers more than 170,000 Florida employees and dependants. With the aid of a licensed third- party administrator, businesses can process claims efficiently.

Providing a dental benefits plan makes good business sense. Promoting and sustaining oral health as well as wellness keeps more efficient employees. In fact, many job seekers are more interested in working for businesses that offer a range of full benefits packages that includes a dental plan. Today, offering a comparable benefits package can be affordable as well as efficient.

To show its support of this type of self-funded dental insurance plan, the FDA is embarking on an education and awareness campaign within the South Florida area. Ads will be running in both the Miami Herald and El Nuevo Herald as well as the Daily Business Review. The message can also be heard on WLRN, WAMR and WAQI AM.

With a membership of almost 6,500 licensed dentists, the FDA represents about 75 percent of all Florida-licensed dentists. The FDA's mission is to improve the public's health through professional and patient education and maintaining high practice standards.