Preferred Provider Organization (PPO)
PPO plans provide the member with the option to receive care from any dentist or to select a dentist from the Premier Access PPO network. The dentists in our network have agreed to charge a reduced fee for Premier Access members, thereby lowering out-of-pocket costs for these members. PPO plans have a Calendar Year Maximum (CYM), which is the total amount that will be paid (after the yearly deductible is met) for dental care during the year (except for orthodontia which, if covered, is handled as a Lifetime Maximum). Payment for services is made through a claims submission process.
Premier Access offers one of the largest selections of PPO plan designs in the industry – and it will customize plans to meet group requirements. Aspects of PPO plans that can easily be customized include: CYMs; services by Class level (Class I Basic, etc.); deductibles; and discount levels.
Dental Health Maintenance Organization (DHMO)
DHMO plans (also known as capitated or prepaid plans) provide care through a network of contracted dentists. Each covered procedure has a specific co-payment (co-pay) that the member pays at the time of service; these co-pays are generally lower than the member would pay if receiving care without the DHMO plan negotiated discount. The member receives a Schedule of Benefits which lists all covered services and the co-pay for each, thereby allowing the member to plan in advance for out-of-pocket costs. There are no Calendar Year Maximums, Deductibles or claims with a DHMO plan. Specialty care is provided through a referral system.
Premier Access has an extensive network of DHMO providers and an excellent Quality Management Program to ensure a high level of care and service.
The PPO and DHMO plans each have a distinct advantage: with DHMO, out-of-pocket costs are lower and the PPO offers more choice in where the member may receive care. Premier Access has developed the Premier Advantage plan to offer members the opportunity to access care through both DHMO and PPO programs in order to take advantage of both of these benefits. Each month, members can assess their upcoming dental care needs and select the plan that will have the best coverage at the most cost-effective price to accommodate the services required. All the employee has to do to change plans is let us know by the 25th of the month to be effective the following month.
Plus Plans (MAC)
These plans work much like a PPO plan however the in-network and out-of-network maximums are set at a negotiated network fee that is lower than the PPO fees. This is the Maximum Allowable Charge (MAC). The in-network dentists have agreed to accept this negotiated fee as payment in full; the out-of-network dentists may charge more and the member will be balanced billed for the amount that remains. The monthly premiums for these plans are lower but the member can experience slightly higher costs when receiving care he 25th of the month to be effective the following month.
A Dual Option dental plan allows employers to offer members a choice of a high or low plan. At Premier Access, Dual Option plan designs can come in many different formats. For example, we offer high/low PPO plans in which the high PPO has richer benefits (i.e. less out-of-pocket costs for members) than the low PPO. The low PPO, however, costs less monthly can often be a better ‘fit’ for certain members than the high PPO.
In addition to a High/Low PPO Dual Option, Premier Access offers the following Dual Options plan designs: DHMO/PPO; DHMO/Plus (Mac); and High/Low Plus (Mac).
Many of the Premier Access plans are available on a voluntary basis, i.e. the employer organization deducts the cost of the plan from the enrolled employees’ paychecks each month. This allows the employer to provide excellent benefits at no direct cost to the company other than the administration costs involved. It is an effective solution to the employees’ desire for dental benefits, allowing them a group rate rather than having to purchase an individual plan.