DentaLink USA's

Preference Dental Network

Product Description

Overview Preference Dental Network Selecting Participating Providers Appropriate Fees for Quality Care Enrollment Administrative Support and Customer Service An Important Point for Employees

Overview

Preference Dental has been designed to help associations contain dental benefit costs while meeting their members' needs for affordable coverage and quality dental care.

By utilizing a network of Pre-Paid Dental Plans, we are able to offer one of the nation's largest number of participating pre-paid dental providers that is available through a single source. These providers have entered into contractual agreements to;

• reduce fees.
• abide by quality assurance procedures.
• have periodic reviews of patient records.

Members benefit further because these plans offer:

• coverage for a wide range of dental services.
• no waiting periods before benefits begin.
• no deductibles.
• no annual maximum benefit.
• no claim forms.
• toll-free telephone lines for information and service.

Associations can be confident that our Preference Dental Plan will offer affordable coverage and quality dental care.

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Pre-Paid Dental plans are offered by companies that have established contractual arrangements with general practice dentists to provide specific dental benefits to plan participants for scheduled co-payment amounts. The dentists receive monthly payments for each subscriber that selects their office. This monthly capitation, plus the scheduled co-payments, becomes their total compensation for the services provided.

Preference Dental offers coverage through a national network of Pre-Paid Dental plans that have been combined to offer a comprehensive member benefit.

Key Advantages include:

• one of the largest number of participating dentists in a pre-paid dental network.
• premiums as much as 50% lower than voluntary indemnity plans.
• a wide range of covered services that have no out-of-pocket cost include:
• preventive care - including X-rays
• cleanings every six months
• sealants for children through age 17
• fluoride treatments for children
• a network of dentists selected for their proven cost effectiveness and commitment to quality care.
• no deductibles or annual maximums.
• fixed co-payments for certain types of care.
• coverage for emergency services everywhere.
• no claim forms for care received within the network of dentists.
• toll-free customer service and information lines.

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In the Managed Care networks, dentists are selected that have demonstrated a commitment to prevention oriented, quality care. The basic premise is that quality assurance begins with provider screening. A multi-part screening process is used that thoroughly examines each potential participant.

First, introductory material is typically sent to identified groups of dentists to determine their interest in joining the network. Many dentists first express an interest in these plans as a result of a referral from either a patient or another dentist.

Second, respondents are sent an information packet that describes how pre-paid dental plans operate, the specific details of the plans being offered in their area, and copies of the provider contracts. Whenever possible, this information is delivered during a visit by a Provider Services specialists while gathering information about treatment philosophy and methods, staffing profiles, and office hours.

Third, a thorough on-site assessment is made during a meeting with the dentist and the office staff. Most evaluations are about five pages long and cover items such as:

• education and training
• the treatment, x-ray, and sterilization areas
• the malpractice and liability insurance
• emergency coverage procedures
• which procedures are performed and which are referred out.

Every effort is made to have dental offices located close to the population centers that they will serve and to have a sufficient number of dentists available to provide for the subscribers.

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Two Factors are key to successful pre-paid dental plans:

• negotiated fees that are fair to both the dentists and to the patient
• a rigorous Quality Assurance Program.

If the negotiated fees are not fair to the dentist, the plan may experience a high turnover of participating dentists. And, if the plan is unfair to the patients, they will not continue to subscribe to the plan. These key factors are monitored through:

• Treatment Protocols - to encourage necessary and appropriate care, dentists follow three treatment levels.
• Level 1 is intended to bring the patient's mouth to a healthy state. It provides for x-rays, comprehensive examinations, cleanings, basic restorations and other routine services.
• Level 2 provides for on going dental health maintenance.
• Level 3 provides for any major treatments, in conjunction with Levels 1 and 2, to help assure the ultimate success of the more expensive Level 3 services.
• Utilization Guidelines - to provide uniform and fair practice standards and to define expectations of benefit. The basis is the American Dental Association's list of procedure codes. Actual procedures are then monitored by Provider Service specialists.
• Quality Assurance - to maintain our commitment to excellence. Each of the companies we use conducts periodic on-site audits of dental patient records, member surveys, staff training, and has strategic plans for responding to client and provider needs.

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Association members who wish to participate may enroll in the Preference Dental Network during the initial enrollment period or at any future date.

Under our Preference Dental Network:

• Members are asked to select a dental office location for themselves and their eligible dependents.
• All family members will use the same dentist.
• Each month each network dentists is sent an eligibility listing of members and dependents who have selected that office. When a member calls for an appointment, the dentist uses this list to verify eligibility.
• Members are issued ID cards but they do not need them to schedule appointments and use the plan.
• And, since these are prepaid dental plans, there is no need to file claims forms except in the event of an emergency outside the network area.

We ask that association members complete the enrollment process and return all enrollment forms to us by the tenth of the month prior to their effective date. This provides the necessary time to:

• process the enrollment information.
• set up membership records for the account.
• establish the monthly bank draft account.
• add the participant to the list bill for the appropriate pre-paid plan and send the application to the plan.
• reconcile the list bills with our participant records and make payments on their behalf.
• have the dental plan update the dentist's list of participants selecting that office.

Premiums can be paid either on an annual basis or by an automatic bank draft that occurs on the first Friday of each month. We help the association member establish the payment procedure they wish to use.

Members may enroll or make a change at any time during the year. When they join, they agree to stay in the plan for twelve months. We must receive changes by the fifteenth of the month in order for the change to become effective at the beginning of the following month.

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DentaLink's Preference Dental offers efficient, accurate administrative support. For any assistance needed, whether a premium statement or a member coverage question, service is available by local or toll-free telephone.

Claim Processing

• Members do not submit claim forms
• Pre-paid dental plans pay the dental office a per-capita amount each month
• Subscribers are only responsible for the scheduled co-payment when visiting their participating general dentist.

Information for Members

• DentaLink and our national network of dental plans can help, at enrollment time and throughout the plan year
• Toll free phone numbers are available to help educate and inform members about the advantages of our Preference Dental Network.
• DentaLink and network personnel will work to design communication methods to provide enrollment information and answer members' questions.
• Standard enrollment materials include:
• an informational brochure that includes local and toll-free numbers for subscriber questions and service.
• a provider directory listing general practice dentists and giving their address and phone number.
• a Summary of Benefits and Copayments.
• an enrollment form.

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Under the Preference Dental Plan, members receive information explaining their co-payments. These are the amounts (if any) that subscribers will have to pay to their participating general dentist. If the services of a specialist are needed, the general dentist will refer the patient to the nearest participating specialist that will provide the dental service for a fee that is, generally, 25% lower than their usual charge.

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DentaLink USA
E-mail: mail@dentalinkusa.com

P.O. Box 12016
Newport News, VA 23612
757 873-0737
800 296-5289

Copyright © 2000, DentaLink USA, All Rights Reserved.