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Containing Dental Costs

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Unique and flexible “managed fee for service” programs that are proven cost effective alternatives to traditional dental insurance.

• Dental PPO networks
  • Passive PPO. Patients may visit any dentist and plan benefits are the same in and out of network. Likely to generate costs savings of approximately 10%.
  • Active Incentivized PPO. Patients may visit any dentist but benefits are richer in network to give patients an incentive to use more cost effective PPO dentists.
    Likely to generate cost savings of approximately 25%.
    

    	PASSIVE PPO			ACTIVE INCENTIVIZED PPO
    Plan Benefits	PPO Dentist	Non-PPO Dentist		PPO Dentist	Non-PPO Dentist
    Preventive services - % Covered By Plan	100%	100%		100%	80%
    Basic services - % Covered By Plan	80%	80%		90%	70%
    Major services - % Covered By Plan	50%	50%		60%	50%
    Deductible	Waived	Waived		Waived	$50/calendar year/person
    Annual maximum	$1,000	$1,000		$1,500	$1,000

• Maximum Allowable Charge (MAC) for Out of Network Services
  • MAC = 80th Percentile of the National Dental Advisory Survey.
    PESC Administrators uses the 80th percentile of the National Dental Advisory Survey as the MAC for services provided by non-PPO dentists. If non-PPO dentists charge more than the MAC, patients are responsible for paying the difference between the amount billed and the MAC amount paid by the plan.
  • MAC = PPO Fees. PPO dentist fees can be used as the MAC for services provided by non-PPO dentists. This maximizes the employers’ savings and gives employees a major incentive to use PPO dentists.
    

    	80th Percentile MAC			PPO Fees MAC
    	PPO Dentist	Non-PPO Dentist		PPO Dentist	Non-PPO Dentist
    Dentist charge for a crown	$547.00	$700.00		$547.00	$700.00
    50%covered by plan	$273.50	$350.00		$273.50	$273.50
    Employee copayment	$273.50	$350.00		$273.50	$426.50
    PLAN SAVES					$76.50

 

 

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