Self-Funded Insurance Plans

Example # 1 – Self Funded vs. Delta comparison

  • Company pays 100% of $1,500/year
  • No restrictions, limitations, or exclusions
  • Cost was $63/employee/month
  • Delta charges more for a similar plan containing diluted coverage, exclusions and restrictions

Example # 2 – Benefit Rich Self Funded Plan

  • 90/10 Plan
  • $3,000 maximum
  • $9,000 family maximum
  • Employee pays $500 copay for braces
  • $85/month cost to the company

Direct Reimbursement

Simple

  • Employee simply visits the dentist of their choice, pays the bill, turns in proof of payment, and gets reimbursed by TPA.
  • Benefit payment may also be directly assigned to the dental office.

Sample Plans

Plan #1

  • 100% of the first $100 of dental expenses
  • 80% of next $1,750
    Total annual maximum benefit of $1,500 per individual*

Plan #2

  • 100% of the first $300 of dental expenses
  • 80% of the next $500
  • 50% of the next $1,600
    Total annual maximum benefit of $1,500 per individual*

Compare this with other plans available:

  • No restrictions and limitations
  • No non covered benefits except for cosmetic
  • No deductible
  • No network
  • No games or gimmicks

With Direct Reimbursement 90% of money goes to patient care. Compare that with traditional insurance where 60% goes to patient care. The savings can be reinvested by the company or used to increase benefits to its employees. The average per capita cost of Direct Reimbursement Plans is $400 per year.