Self-Funded Dental & Vision Plans
Self-funded dental and vision plans are intended to provide dental and vision benefits for employees on a tax-free basis and on a tax deductible basis for the employer. By self-funding these programs, an employer is free to design the plan in any way they choose. Because dental and vision plans usually have an annual maximum benefit ($500-$2,000), an employer can design their plan with their maximum exposure in mind.
Self-funded dental and vision plans allow an employer to only pay for claims that are actually incurred. Under fully insured plans, an employer must pay premiums for a participating employee even if they do not use the plan.
These plans can implement claims being paid based on Usual, Customary and Reasonable fees. Under this scenario, the benefits paid will be restricted to a certain UCR percentile chosen by the employer. This protects an employer from paying claims to providers whose fees are higher than UCR.
A benefit of a self-funded plan is that you can allow the participants to use any dentist of their choice. A network is not necessary. However, employers can implement a PPO network to offer negotiated rates with providers that are members.
ASI can help you evaluate your current plan and help design a self-funded dental or vision plan. ASI prepares your Plan Documents, SPD and other necessary materials, including ID cards. We can also assist in implementing a PPO network to work in conjunction with your plan.
ASI can also assist in designing an HRA to fund your dental and vision needs. Similar to a medical HRA, a dental/vision HRA can be designed to reimburse your employees for dental and vision claims. This could also eliminate the need for a fully insured dental or vision plan.
- Illustrate Cost Comparison for Self-Funded Approach v. Traditional Fully Insured Plans
- Assist in Plan Design
- Draft Plan Documents, Including Plan Document, Summary Plan Description and Corporate Resolution
- Assist Broker in Plan Presentation
- Assist in Group Enrollment
- Provide Participant ID Cards and Plan Materials
- Provide Optional PPO Networks
- Enter and Process Claims
- Disburse Claims Payments
- Provide Standard Reports
- Provide Plan Review
- Provide COBRA Administration Services