Employers can design the plan to meet their needs and budget. A
typical plan may look like the following:
for a $1,000 annual maximum.
Direct Reimbursement is a win win situation for the employer,
employee and dentist!
A: With DR, benefits are based on the amount of dollars spent for
dental care rather than on type of treatment received. Because this is
how Direct Reimbursement works, it eliminates hassles about what is
covered and what isnít. Furthermore unlike some dental plans, DR
gives employees the freedom to choose any dentist for care, including
their own dentist. Finally, because Direct Reimbursement eliminates
the middleman, it is typically more cost-effective than other dental
Q: How do I design a DR plan?
A: Interactive Medical systems has a designated Direct Reimbursement
representative that will be happy to assist you and answer any
questions you may have.
Q: I own a small business, will Direct Reimbursement work for my
A: Yes. In fact, here in North Carolina our biggest market segment
are those employers with fewer than ten employees. Smaller employers
like DR because it is easy to understand and simple to administer.
Also, smaller employers like having the flexibility to design a plan
that will meet the needs of their employees and maintain their budget.
Furthermore, since there are no premiums, there are no renewals to
negotiate at the end of each year.
Q: Direct Reimbursement sounds so great, why isnít everyone using
A: Chances are employers who are ideally suited for a DR plan do
not use the concept because they have never heard of it before. In
general, people fear what they donít know. Since most employers have
not heard of Direct Reimbursement, they donít think it could work
for them. Most employers who have heard of DR first learned about it
from a colleague or dentist. Recently, the ADA has initiated a
national advertising campaign and that has helped supplement
advertising at the state level. It is hoped that this combination will
make Direct Reimbursement more of a household name.
Q: If a company designs a plan for 100 individuals with an annual
maximum of $1,500, will it actually spend $150,000?
A: This particular scenario is highly unlikely. While $150,000 is
the maximum amount of exposure, it is not close to the actual
experience of any Direct Reimbursement plan known to the ADA. Plans
typically do not reach this level of exposure because it is estimated
that only 60% of those with dental benefits actually use them in a
given year. Of those who do visit the dentist, the average claim cost
is less than $200 per year. Given those national averages, it is rare
that a company would experience the maximum liability.
Q: My employees live from paycheck to paycheck and cannot always
afford to pay for their dental treatment up front.
A: There are several ways to address this concern. Most dentists in
North Carolina now accept credit cards. An employee can pay for his or
her dental treatment with a credit card, turn in the receipt, and have
the reimbursement check to pay the credit card bill when it arrives.
If an employee needs major dental treatment, many dentists will spread
the payments over the course of a year. This way employees can submit
the monthly payments for reimbursement. Finally, in many instances
a dentist will accept an assignment of benefits option where
Interactive Medical Systems reimburses the dentist
directly rather than the patient.