Assignment 6 Flashcards
What organizations provide dental care coverages?
- insurance companies
- BC and BS associations
- others (including state dental plans –> Delta)
3 types of dental plans (resembling medical)
- fee for service indemnity approach
- preferred provider
- dental HMO approach
The 10 dental treatment categories
- diagnostic
- preventive
- restorative
- endodontics
- periodontics (gums)
- oral surgery
- prosthodontics
- orthodontics
- pedodontics
- implantology
These pay a fixed allowance for each dental procedure
scheduled dental plans
Advantages of schedule plans
- cost control
- uniform payments
- ease of understanding the plan
- employee appreciation of the plan
disdvantages of schedule plans
- benefit level must be examined and potentially changed periodically to maintain reimbursment objectives
- plan reimbursement levels will vary by location
- if scheduled benefits are set near maximum of the reasonable customary range - dentists who charge less than prevailing rates may be unfluenced to adjust their charges upward
by far the most common plan offering, these cover some percentage of the reasonable and customary charges, or the most commonlu made by the dentists (will cover 75%-90% of the claims submitted in that geographic area)
nonscheduled plans
Advantages of nonschedule plans
- percent of total cost reimbursed by the plan is uniform
- there is a built in automatic adjustment for inflation and also for variations in the relative value of specific procedures
disadvantages of nonschedule plans
- cost control
- opportunities for modest benefit improvements are limited
- rarely clear wha the specific payment of a particular service will be either to the patient or the dentist
3 factors that affect the cost of a dental plan
- design of the plan
- characteristics of the covered group
- the employers approach to plan implementation
Issues to be addressed in designing a dental plan (7)
- type of plan
- deductibles
- coinsurance
- plan maximums
- treatment of preexisting conditions
- whether services should be limited
- questions concerning orthodontic coverage
disadvantages of lifetime deductibles (dental)
- promotes early overutilization by those anxious to take advantage of the plan
- once satisfied, deductibles are of no further value for the presently covered group
- introduces emplyee turnover as an important costs consideration of the plan
- im impacting costs, it could result in adverse employee reaction
The major concern about how to treay preesxisting conditions in a dental plan is:_____.
And this is handle in 3 ways:
the replacement of teeth extracted prior to the date of coverage.
- excluded
- treated as any other condition
- covered on a limited basis
Sensitivity of costs to dental plan design (what impacts costs, (4))
- deductibles
- maximums (minor)
- coinsurance
- inclusion of orthodonticd
Characterisitc of a dental plans covered group that should be considered in the cost of the plan
- age of participants
- gender distribution
- location of group
- incomes of participants
- occupations of participants
