Page 29 - Revolution Health Plans Brochure 2024

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Self-Funded Dental Plan Options
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Dental Plans & Self-Funding
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Benefits PPO 25 PPO 50 PPO 100
Dental plans have long been a profitable staple for the insurance companies. Considering Deductible $25 Individual $50 Individual $100 Individual
Waived for Preventive & Diagnostic Services
$75 Family
$150 Family
$300 Family
the vast promotional efforts and the numerous players in the market, it stands to
reason that the margins are high enough to justify self insuring this type of benefit. Annual Maximum $1,200 Per Individual $1,000 Per Individual $800 Per Individual
Preventive & Diagnostic/Basic/Major Services
Dental coverage already has low plan maximums, excellent preventive care initiatives,
reasonable cost sharing, and utilization controls. Given these limits, the prospect Orthodontic Lifetime Maximum $1,200 Per Individual $1,000 Per Individual $800 Per Individual
of paying less for administration and actual claims than you pay for insured dental
coverage is excellent, albeit not without some level of exposure for high utilization or Services Cost Sharing**
claims cost in any given year.
Preventive & Diagnostic Services
By aligning with Benefit Indemnity, you gain access to a dental care PPO to provide Oral exams
the appropriate negotiated fees, and Benefit Indemnity to arrange the administration Prophylaxis
Bitewing x-rays
and claims management for the plan. With this help you can fund your own dental Radiographs 100% of Allowed Benefit
plan without the insurance company overhead, profits or premium taxes! Fluoride treatments
Sealants on permanent molars
The dental plans on the next page are typical of what you see in the market. If you have Space maintainers
Palliative emergency treatment
had dental coverage for your group for a number of years, then select whatever you

feel best fits your needs. If you’ve never had dental coverage before, we recommend Basic Services
Restoration fillings using approved materials
that you start with the PPO 100 plan and work your way toward stronger benefits over Periodontal scaling and root planing 80% of Allowed Benefit

time. First-time dental plans frequently experience a rush to compensate for neglectful Endodontics (treatment as required involving the root and pulp of the tooth, such as root canal therapy)
care prior to having coverage and can result in higher costs than you might expect. Simple extractions
Major Surgical Services
Surgical restoration periodontic services
ADMINISTRATIVE COSTS & CLAIMS FUNDING (including osseous surgery, mucogingival surgery and occlusal adjustments) 50% of Allowed Benefit
Administration costs include the cost of the leasing of the dental PPO, the handling of Oral surgery
General anesthesia rendered for a covered dental service
claims and documents, customer service, and communication for any of the standard
plans displayed on the next page. Major Restorative Services
Full and/or partial dentures
Fixed bridges, crowns, inlays and onlays
Claims funding will typically be drafted from the employer's designated account on a Denture adjustments and relining 50% of Allowed Benefit
weekly basis as required to cover the cost of incurred dental benefits. Recementation of crowns, inlays and/or bridges

Repair of prosthetic appliances as required

Orthodontic Services
* BIC also provides access to more traditional dental coverage. Benefits for orthodontic services may be available for covered members under age 19 who meet 50% of Allowed Benefit

Ask your representative for more information. treatment criteria. Covered services limited to 36 consecutive months of covered services.

** Payments are based on the allowed benefit. ParticiPating dentists accePt 100% of the allowed benefit as Payment in full for covered services. non-ParticiPating dentists may bill the
member for the difference between the allowed benefit and their charges. Please refer to your summary Plan descriPtion (sPd) for details. the sPd is the final determination of benefits.

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