Pelican Defined: What are the Pelican Dental Concepts?

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Pelican Dental Concepts is the brand name for self-funded, dollar-based dental programs endorsed by the Florida Dental Association. These plans include Direct Assignment, Direct Assignment Plus and Direct Reimbursement. Pelican type plans were the original consumer-driven benefit model and have been in the national dental marketplace for over 30 years with more than 100 groups and 55,000 Florida employees and dependents currently covered.

As a self-funded dental plan, the employer, not a third party, has complete control over the plan design and costs. Pelican plans cover most non-cosmetic dental procedures, therefore there are few restrictions, limitations or exclusions like those found in the majority of traditional insurance and managed care dental plans. Also, Pelican plans are based on " freedom of choice", thus the enrollee is not limited in the selection of their preferred dentist.

Because Pelican plans are based on fee-for-service, the enrollee knows exactly how much the plan will cover for each procedure. Plan designs are based on a percentage of dollars rather than by procedures; a sample plan might cover 100% of the first $200, 80% of the next $500 and 50% up to an annual maximum of $1,000.

Depending on the type of plan selected by the employer, the patient may simply pay the dentists fee and submit a claim to the plan administrator for reimbursement up to tier level maximums. Or, the administrator may pay the dentist directly and the enrollee or dependent would pay any difference not covered under the plan. Under Direct Assignment Plus (Dental Decisions), there is also a co-pay shared by the patient and dentist per office visit which covers all administrative costs. These plans can either be self-administered, or a licensed Third Party Administrator can be retained to manage the plan for the employer.

Special Note to Employers: Employers receive tax benefits when they offer a Pelican dental benefit as part of a Section 125 cafeteria plan.
This allows enrollees to pay for monthly dental coverage with pre-tax dollars and if a flexible spending account is also offered these funds can be used to pay dental co-pays and for additional treatment services.