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	Frequently Asked Questions

Who manages the costs of dental care if there is no insurance company involved?

First, do dental costs even need management by an insurance company when the average dental plan claim cost per person per year is only $150? Second, the patient is typically responsible for a portion of the dental services provided, which encourages them to become good consumers for dental services like any other commodity or service.

If Direct Assignment works so well, why haven't we heard of it?

Direct Assignment is a plan concept, not an insurance product, and is typically administered by a Third Party Administrator. There is no national sales force or insurance company promotion. Also, Direct Assignment allocates more plan dollars to dental care and less plan dollars to administration & compensation than any other dental plan. While brokers may be less inclined to introduce the plan to employers, Direct Assignment is widely recommended by benefit consultants. There are approximately 4,000 employers nationwide using dollar based plan designs.

Isn't it true that Direct Assignment patients must first pay the dentist, and wait to be reimbursed?

No. Direct Assignment has an assignment of benefits feature that allows dentists to file claims on behalf of the patient. Ninety-five percent of all claim checks are written directly to the dentist.

If an employer already has a self-funded dental plan, why would they move to Direct Assignment?

Many Direct Assignment clients were self-funded before moving to Direct Assignment. Their motivation was two-fold:

Value. No monthly administrative fees charged under Direct Assignment.
Simplicity: Easy to understand dollar-based plan designs. No deductibles, UCR provisions, pre-determination, frequency of care limitations, etc.

How much savings can be realized with Direct Assignment over traditional fully insured plans?

Actually, claim costs can be comparable to the typical fully insured indemnity plan design (100/80/50/50). However, fully insured plans normally pay 52-54% of total submitted charges and retain 30-40% of premium dollars, whereas Direct Assignment plans pay an average 60-65% of total submitted charges (pre-tax) and retain approximately 10% of paid claims via the office visit withhold from each claim check (participant co-pay and $5 DDS withhold). Any funds remaining in the reserve fund at year-end belong to the employer.

Won't our claims cost increase as more services are covered under Direct Assignment?

It's true that more procedures are covered. Plan design can be designed to produce specific claim cost outcomes. Also, because retention costs are paid via the office visit withhold per claim, the plan can afford to pay a higher percentage of submitted charges.

Who are some employers utilizing dollar based plan designs? *

Mayo Clinic, US	32,000	Escambia Schools, FL	6,500
Mohawk Carpet, GA	32,000	St. Petersburg Times	2,500
Eli Lilly, IN	23,000	Villages Lake Sumter, FL	2,500
Wachovia Bank, NC	16,000	City Wilmington, DE	1,200
White Castle, OH	11,000	The Times-Picayune, LA	1,100
Gwinnett Schools, TX	11,000	City Melbourne, FL	1,000
Pinellas County, FL	7,000	City West Palm Beach, FL	800
Lubbock Schools, TX	7,000	City Ft. Walton Beach, FL	800
Baylor University, TX	6,000	University of Florida	800
City Colorado Springs	2,000	Tampa Port Authority	300
Littleton Schools, CO	1,500	Poynter Institute	100

*Additionally, many employers in the 50-100 employees range currently utilize DA

We have PPO "discounts" now and don't want to give them up.

We maintain that premium retention (30-40%) associated with most PPO type plans far outweigh the 8% savings (average) realized via utilization of PPO networks. Also, Direct Assignment plans can be offered alongside managed care plans, usually as a buy up option.

What makes Direct Assignment a better value than other self-insured dental plans?

Simple dollar-based plan designs versus complicated procedure-driven plan designs. Also, most importantly, administrative costs are paid at point of service, via the patient receiving treatment (office visit with co-payment withhold) and the dentist providing the treatment ($5 per claim withhold). This fee per claim alleviates the need for monthly administrative fees that can run anywhere from $3-$6 per employee per month (PEPM).

To what do you attribute such high client retention?

Freedom of choice regarding dentist & treatment makes the plan very attractive to employees. Simplicity of dollar-based plan design makes plan easy to understand and use. Value realized when higher percentage of total claims is paid via plan using pre-tax dollars. Fully staffed customer service department, toll free 800 number, and 24 hour web access to personal claims data, allows employer and employees to access and monitor claims information from any location at any time.

Frequently Asked Questions