Dental Benefits Flashcards
1
Q
Dental Benefits
ACA Impact
A
Enhanced # of people with access to dental insurance
- Pediatric oral care = essential health benefit
- Expanded income for Medicaid eligibility
2
Q
Dental Benefits
Advantages of ER-Sponsored Dental Plans
A
- Pre-Tax EE contributions
- Stable budget for dental costs
- Dental HMOs and PPOs give network and services at discounted cost and ensure quality of care
- Better oral health = indication of better overall health
3
Q
Dental Benefits
Benefit Classes
A
- Class I = Preventive/Diagnostic: Exams, Cleanings
- Class II = Basic: Fillings, Root Canals
- Class III = Major: Crowns, Dentures
- Class IV = Orthodontia
4
Q
Dental Benefits
Plan Design Provisions
A
- Deductible
- Coinsurance (Tiered by Class)
- Annual maximum
5
Q
Dental Benefits
Provisions to Limit Cost and Antiselection
A
- Exclusions (Cosmetic, Experimental)
- Preexisting conditions limitations
- Frequency limitations
- LEAT
- Waiting periods
6
Q
Dental Benefits
Underwriting Parameters (List)
A
- Group Size
- Minimum participation requirements
- New business
- ER contributions
- Geography
- Demographics
- Waiting Periods
- Incentive coinsurance
- Transferred business
- Other coverages (packaged)
7
Q
Dental Benefits
Reimbursement Models
A
- Indemnity Plans (FFS, UCR)
- PPOs (Managed Indemnity, EPO, POS)
- DHMOs (IPA, Staff Model)
- Discount Dental Plans
8
Q
Dental Benefits
Claim Practices
A
- Predetermination of Benefits
- LEAT
- Coordination of benefits
- Dental review of complex claims
- Maximum Allowable Charge or UCR Limit
