Using a 'self-funding' approach to your employer sponsored dental and vision plans, you need someone to administer the plans you design. RPA, Inc. is that company.
Why should you, as an employer, self-fund or self-insure your dental and vision plans with Direct Reimbursement?
- Better Benefits
- Lower Costs
- No Waiting Periods
- No Provider Lists
- No exclusions (except cosmetic services)
- You only pay for the claims that are incurred and get to hold on to your cash until a claim is paid
- You design your plan
- Low administrative cost
Save Money!
With a ‘traditional’ insurance carrier, employers pay a monthly premium for each employee and their dependents regardless of whether the employee uses the benefit. Studies have shown that 50% of the employee population (in any given company) actually access and receive dental care and fewer access vision care services.
With a self-funded Direct Reimbursement Dental or Vision Plan, you pay a small monthly administration fee, and pay claims when services are received and claims are incurred.
Why would you let an insurance company profit with your money?
Dental and vision benefits are usually finite in measure in the way that they are designed. Your exposure is always "fixed". You design a dental plan with an annual maximum benefit of $1,000, $1,500, or other maximum benefit and you know that what your maximum exposure is.
You hold onto your money until a claim needs to be paid. If no claims are paid, it's still your money.
How are benefits determined?
You, the employer may design the plan or we can help you. Benefits are based upon dollars spent versus services received. For example, most dental plans will pay 100% of preventive and diagnostic services, 80% for routine dental care and 50% for major services up to a defined annual maximum benefit. These traditional types of plans also stipulate how often one would be able to get their preventive work done and will pay benefits based upon “usual and customary” charges.
Direct Reimbursement (DR) Plans do not limit the number or frequency of preventive care nor do they pay at specific percentiles.
A typical DR plan would look like this:
100% of the first $300.00 of submitted dental expense = $300.00 Benefit
80% of the next $1000.00 of submitted dental expense = $800.00 Benefit
50% of the next $1800.00 of submitted dental expense = $900.00 Benefit
Total Annual Benefit $2000.00
Some plans cover Orthodontia at 50% up to a separate lifetime maximum.
Typical charges or services excluded from coverage would be personal hygiene items such as toothbrushes and cosmetic services such as bleaching or whitening agents and supplies.
