Direct Reimbursement FAQs
- Who do we call to obtain a preauthorization?
- Where do we send our bill?
- How are "major services" covered?
- What is not covered?
- What is the benefit design?
- What is a typical DR plan like?
- Do Dentists sell DR?
Who do we call to obtain a preauthorization?
With DR there is no preauthorization required for any service.
Where do we send our bill?
With most DR plans the charges are the responsibility of the employee. The employees are then reimbursed by their employer or Third Party Administrator upon evidence of payment.
How are "major services" covered?
DR reimburses each employee based on a percentage of the total dental bill incurred, not by the type of service.
What is not covered?
Purely cosmetic dental expenses, such as teeth bleaching are not covered by a DR plan (these expenses are not tax deductible). Dental expenses covered by the employee's medical plan are also not covered.
What is the benefit design?
With DR, the plan design will vary with each employer. Ask each employee for a copy of their dental care plan.
What is a typical DR plan like?
Some typical plan designs are:
- PLAN 1: 100% of the first $100 dental expenses; 80% of the next $500; 50% of the next $1,000. Total annual maximum benefit of $1,000 per individual.
- PLAN 2: 70% of the first $1,000 dental expenses. Total annual maximum benefit of $750 per individual.
- PLAN 3: 100% of the first $100 dental expenses; 80% of the next $1,750. Total annual maximum benefit of $1,500 per individual.
Do Dentists sell DR?
We are asking dentists and their office staff to be informed about DR so they can refer interested employers to the ODS Marketing Department. Dentists and their office staff can play an important role in helping their patients understand the benefits of direct reimbursement. If you have any questions, contact ODS.