A claims report provided by an insurance company that compares the total dollar amount paid out in benefits to the total dollar amount of premiums paid to the insurance company by the employer. Direct Reimbursement A method of providing benefits through which an employer reimburses employees directly for their dental care expenses instead of purchasing insurance coverage from a third party. A hybrid form of the PPO, the EPO is a plan in which the insurance company negotiates fees with a network of dentists in return for guaranteeing a specified volume of patients.
Patients receive no benefits if they seek treatment from a dentist outside the network.
An arrangement under which the dentist is paid for each service rendered according to a fee schedule established by the dentist. A limitation, found in most plans, which reduces benefits to the least expensive of all possible treatment options. A plan in which an insurance company negotiates fees with dentists and directs patients to those dental offices. An office model, often used by DHMOs, in which dentists are employees of the plan and are paid a fixed salary regardless of the amount of care they provide. A method used by insurance companies to determine what fees they will allow the dentist to charge.