Pelican Defined: Sample Dental Plan Designs

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Sample Plan Designs

Each employer designs the DA or DR benefit level according to company need. DA/DR plans are based on a dollar-tiered structure. Plans can employ varying levels of shared expenses and, for example, encourage employees to seek preventive care.

Sample Plan #1
100% of the first $200
80% of the next $1,000
annual maximum benefit: $1,000 per enrollee

Sample Plan #2
100% of the first $100
80% of the next $500
50% of the next $2,000
annual maximum benefit: $1,500 per enrollee

Sample Plan #3
100% of the first $200
80% of the next $300
50% of the next $1,120
annual maximum benefit: $1,000 per enrollee

Sample Plan #4
75% of $1,000
annual maximum benefit: $750 per enrollee

Sample Plan #5
100% of the first $100
50% of the next $800
annual maximum benefit: $500 per enrollee

In developing costs for the various plan designs the following underwriting issues are analyzed:

  1. Scope of covered services
  2. Claims payment rules
  3. Plan's benefit formula
  4. Effective date of the plan
  5. Employee eligibility rules
  6. Participation levels
  7. Location
  8. Size of the group
  9. Dental benefits history of expected plan participants
  10. Turnover rate for employees
  11. Occupational status of employees
  12. Male/female distribution

To obtain a cost estimation for your business, please click on the link below to complete and submit the estimation form. A representative will contact you once your information has been reviewed.