Choosing the benefits for your employees or members is a very tough assignment. There are many Dental Plan options out there, but which one will be the right option for your group?
One option that you have is between a Self-Funded or a Fully Insured Dental Plan. Each provides advantages, so let’s compare.
What is a Fully Insured Dental Plan?
A fully insured Dental Plan is managed fully by an insurance carrier. The group generally chooses from a set of coverage parameters and a few PPO (provider) options. The insurance carrier has a set premium that is assigned for each individual, two person or family. Once your group is enrolled, the carrier takes full responsibility for paying the dental claims incurred by your group. All of the costs are rolled up into the monthly insurance premium as determined by the carrier and any risk of increased claim activity is assumed by the insurance carrier.
The Fully Insured Dental Plans tend not to be very customizable and they may come with restrictions that could be somewhat problematic for your employees or members. However, these plans are fixed cost and are fairly simple to manage as the group will just need to update eligibility and pay the monthly invoice.
What is a Self-Funded Dental Plan?
Self-funded plans allow the group to save on costs that may be associated with a Fully Insured Dental Plan. Cost savings and benefits from a self-funded include:
- Full control of the plan design
- Plan designs that will provide cost savings
- Eliminating insurance underwriting costs
- Eliminating premium tax
- Low administrative fee each month
- Lowering the group operation costs
Self-funded dental plans also work very well with other wellness programs that will in turn encourage lower utilization and reduced claim costs.
Just because you have a self-funded dental plan does not mean that you cannot have a full PPO network! We offer several PPO options that can work with both local and nationwide providers. Our current available networks are DentaMax, Aetna and Anthem, but you can also allow us to help you with creating and managing your own local PPO network at no additional cost to the plan.
We provide ongoing account maintenance and reports, help you customize your dental plan and provide live phone support to your employees or members.
Comparing Fully Insured vs Self-Funded
| Fully Insured | Self-Funded | |
| Plan Design | Some options, but regulated by the carrier | Fully customizable |
| PPO | Some PPO options, nationwide providers | Can be paired with a negotiated PPO nationwide network, smaller local provider set or simple reimburse per service option |
| Total Cost | Fixed premium rate set at the beginning of each plan year | Generally, has a savings over the Fully Insured Plan as operating costs are lower |
| Participation Requirements | May have a minimum participation requirement | No minimum participation requirement |
| Financial Risk | Insurance carrier assumes full risk for increased claim usage | Group must pay the full cost of the claims when they are incurred, however the claims are controlled by your plan design |
| Support | Provided by carrier | Provided by your Third-Party Administrator |
We can help you compare what kind of plan would work for your group. Please call us at (800) 573-7474 and we can help you choose the best Dental Plan for you and your group.