This example is a company in northern Indiana and has been a SERCO client since July of 1996. Average enrollment in the Plan is about 115 employees per month with approximately 50 being single and 65 family. Schedule of Benefits is as follows:
For a group this size an insurance premium of $102,360.00 would have been paid for the year (based on a conservative premium of $40.00 single and $100.00 family per month). Obviously they didn't pay a premium because they had a DRP instead, therefore the total that was paid for the DRP (claims and administration fees) in 2005 came to $60,941.32 for a savings of 43%.
1. Direct Reimbursement Plans are an innovative approach to self-funding dental benefits.
2. Available to any small or large group.
3. DRPs are flexible and designed to you and the Employer's needs.
4. You see the dentist of your choice.
5. The employee is reimbursed to the benefit levels that you determine as the employer.
Overall Benefits and Maximums
You may receive treatment from any properly licensed person who is a dentist and who is rendering services and treatment within the scope of his/her licensure and training.
State Licensed In Illinois, Indiana & Michigan
Recommended by the ADA (1986)
Valparaiso School Corp. and Jay County School Corp.
Mobil Oil and Marriott Corp. (1996)
Eastman-Kodak and Olan Mills Studios (1998)
Type I
These benefits include Preventive and Diagnostic Procedures such as: Oral Exams, Cleanings and X-rays.
Benefits are usually paid at 100% without a deductible.
Type II
These benefits include Minor Restorative Procedures such as: Fillings, Anesthesia, Oral Surgery and Extraction's.
Benefits are usually paid at 80% with a deductible.
Type III
These benefits include Major Restorative Procedures such as: Crowns, Bridges, Dentures, Root Canals, Periodontal and Endodontic.
Benefits are usually paid at 50% with a deductible.
Type IV
These benefits include Orthodontic Procedures.
Benefits are usually paid at 50% with a deductible.
Overall Benefits and Maximums
Maximum benefits are usually $1,000.00 annually.
Orthodontic Procedures usually have a lifetime maximum of $1,000.00 and it's own lifetime deductible.
Deductibles are usually $50.00 annually per person.
Dependent children (if elected) are eligible until age 19 or age 23 if a full time student.
Premiums
$45.00-$50.00 for single coverage
$80.00-$90.00 for employee and one dependent coverage
$120.00-$150.00 for full family coverage
About 50% is paid out in claims by the insurance company