Since the mid 1970s both the American Dental Association and its constituents have supported self-funded, dollar-based dental plans as the best method of providing a quality dental benefit to employees and their dependents. These types of plans include Direct Assignment (“DA”) and Direct Reimbursement (“DR”) models which are based on freedom-of-choice of dentist and fee-for-service.
Florida is one of the most active states in the promotion of these types of dental plans. Since 1997, the Florida Dental Association has funded a statewide campaign to promote these plans to both mid and large group employers.
In 2004, the FDA branded DA/DR into Pelican Dental Concepts. Both DA and DR are dollar-based rather than procedure-driven. There is no pre-determination of benefits, pre-authorization, submission of radiographs, alternate treatment or LEAT clauses. Additionally, there are very few restrictions, limitations or exclusions. Most plans include orthodontics or include a separate orthodontic rider.
Direct Assignment plans are the most used. Under DA, the covered individual selects any licensed dentist and obtains treatment. The dentist is paid by the plan administrator based on a dollar-tiered design. Any portion of the dentist’s bill that is not reimbursed by the plan will be balanced billed to the patient.
Another version of DA is Direct Assignment Plus or Dental Decisions. Under this type of Pelican plan, the patient and the dentist share a co-pay per office visit that covers the cost of plan administration. The dentist is paid directly by the administrator less the dentists portion of the co-pay. Most dentists have agreed to participate in this type of payment plan to help support the association’s promotion of Pelican type plans.
The original version of self-funded dental plans developed in the 70's is Direct Reimbursement. A person with a DR plan selects any licensed dentist, pays for the dental treatment and submits a receipt or claims form to the administrator and receives reimbursement up to plan limits.
Regardless of plan type, everyone wins with Pelican Dental Concepts--the employer, the patient and the dentist. Many employers learn about the benefits of Pelican Dental Concepts through information provided at their dentist's office such as a benefits fact sheet, or a referral card.
Employers can also be directly referred using our online Referral Form. Dental offices refer patients that are influential and/or decision-makers for employers. We then contact these referrals and present information pertaining to the benefits of DA/DR. These patients may be the CEO, COO, CFO, employee benefits, risk manager, or HR Director of the business.
When you complete the
you'll receive a stuffed Percy Pelican as a free gift for your referral, along with our thanks for spreading the good word.
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