|How it Works
The following is an overview of why
direct reimbursement is
the most cost effective method to provide your employees with the highest quality of
health care. With direct reimbursement, your company only pays only for the benefit it
receives, and the cost to cover the expenses to organize and administer the plan. Here is
how it works to save you money, and give your employees what they desire in a dental plan:
Direct Reimbursement Dental,
Medical (HRA), Health Savings Account (HSA), and Vision Plans.
- Employers can design the plan any way they want...customized
and not off-the-shelf. The employer retains control.
- Your employees have freedom of choice -- direct
reimbursement, has the best network of dentists and
physicians because it includes all dentists and all
- You have a better dental and
medical plan at less cost. This includes a
rich benefit for the employee along with lower overhead for the employer.
- Can include any dental,
medical and vision care
- Benefits are based on a percentage of a specified dollar
amount up to an annual maximum.
- HSA’s are a tax saving for both employee and employer.
- User Friendly
- No exclusions or limitations
- No UCR
- No predetermination
- No claim forms
- Employer receives the credit for providing the benefit; not
some insurance company.
Direct Reimbursement Employee - Process.
- Employee choose own dentist or
- Employee and health care
provider determine treatment.
- Employee incurs expense.
- For medical HRA, employee
submits medical insurance EOB. Dentist submits claim form as proof of treatment to DRAS,
- Employee is reimbursed by DRAS Ltd., from employers dental
- Employee is responsible for paying
dentist or physician.
Direct Reimbursement Employer - Process.
- Claims are processed by DRAS,
- A check register is emailed to
company and funds are mailed or wired to cover claims.
- Checks are written and mailed
Why Self-Funded Plans?
- Dental costs are predictable, unlike medical costs.
- No need to insure/manage costs that are non-catastrophic.
- No need to insure/manage costs that are low-risk and low
- HRA when used with a high
deductible medical insurance, are also predictable and
- Indemnity/Insured 15% - 30%
- HMO/DHMO 30% - 40%
- Traditional/self-funded 9% - 13%
- Direct Reimbursement 4% - 8%
What Employees want in a dental
and medical plan.
- Freedom of choice - to go to
provider of choice, quality
provider, ability to stay with family dentist.
- User friendly - simply, no confusing handbooks, no
UCR/limitations and complications.
- Treatment decision between patient and provider.
- Quick reimbursement/simplicity.
- Assistance from employer in meeting dental
and medical costs.
- All dental procedures covered.
- No exclusions for pre-existing conditions.
- No long waiting for appointment for a network
Why Employers offer dental
and medical benefits.
- Requested by employees.
- Popular benefit.
- Encourages employees to seek routine dental
and medical care.
- Reduces absenteeism.
- Increases employee loyalty.
Direct Reimbursement, Adm., Services, Ltd.
P.O. Box 292455
Kettering, OH 45429