Dental The years of managers ranting and raving at employees to work are over, today’s managers are leading with a smiles. To take care of those teeth, we have provided a choice of a few plans to tailor to your families and your perilly whites. Most Americans who have dental insurance through their employer (and many who are self-insured) are enrolled in some type of a managed dental plan - either a DMO or PPO. (Bihari, MD, 2010) There are two available plans for your families and yourself. The most common types of managed care plans are dental maintenance organizations (DMOs) and preferred provider organizations (PPOs). DMO’s and PPO’s, how do I choose and which will work best for my needs?
Dental Maintenance Organizations (DMOs)
A dental maintenance organization (DMO) is a dental organization was designed to lower dental costs for you and your employer. (Adler, 2009) By joining a DMO, you get quality coverage at half the cost, it is much less than if you went to the dentist and paid for it yourself. Employees and employers tend to favor DMO’s because they are generally a lot cheaper than PPO’s.
Preferred Provider Organizations
A preferred provider organization (PPO) insurance plans pay for each individual treatment that is covered. According to Keh (n.d.), “What is covered varies based on plan and price, but when a service is covered, anywhere from 50 percent 100 percent of the cost is covered. Utilizing preferred dentists contracted with PPO ensures full payment of the indicated percentage.” (para. 1) These plans usually run higher because the employee’s are still responsible for remaining percentile not covered but you are able to go to any provider.
Plans
Now that we have given you some background on available plans, let’s take a look closer at the presented plans. As with any documentation you should evaluate the credibility of the source of the reference material. (Cascio, p. 243, 2010) DMO
The DMO Plan is similar to a medical HMO. When you enroll in the DMO Plan, you select a DeltaCare network primary care dentist (PCD). To receive benefits, you must see your PCD, or your PCD must refer you to another dentist/specialist in the network.
Plan Features:
• There is a $10 in office visit copay.
• There are no deductibles or annual dental plan maximums. (Loan Depot, 2012)
• There may be copay associated with specific covered dental services.
PPO
According to Loan Depot (2012), “The Delta Dental Plan offers you the flexibility to choose any dentist and receive benefits. However, if you go to a Delta Dental PPO network dentist, you’ll pay less because Delta Dental’s PPO dentists have agreed to charge lower, negotiated rates.” (PPO para. 2)
Plan Features:
• You pay the first $75 in eligible expenses per person ($150 maximum per family) each year before the plan pays benefits.
• In-network preventive services are covered at 100% and aren’t subject to the $50 deductible.
• In-network basic services are covered at 80% and major services are covered at 50%, after you’ve met the deductible. (Loan Depot, 2012)
• If you receive services from a dentist outside of the Delta Premier Dentist PPO plan, your claim will be paid based on the out-of-network coinsurance levels. (Loan Depot, 2012) Employee is responsible for your coinsurance and any remaining deductible.
• The Delta Dental PPO Plan covers up to $2,000 of eligible dental expenses per covered family member each calendar year.
• The Delta Dental’s PPO Plan has a lifetime maximum of $2,000 per covered family member for orthodontia services.
VISION
Managers need to oversee the production of their company and the day to day operations. At Loan Depot we want you to know seeing is believing, your vision is not only valuable to you but also to our company. With Loan Depot the vision plan, provided by Anthem Blue Cross, provides a benefit for an exam and materials on a yearly basis. According to Loan Depot(2012), “You can choose from any vision provider you choose, but the plan generally pays richer benefits when you receive care from doctors who participate in the Anthem Blue View Vision network. If you decide to go to an out-of-network provider, you’ll be reimbursed for exams and eyewear according to a schedule of benefits.” (Vision para.1)
References
Adler, A. (2009). HMOs Explained. Retrieved from http://www.cbsnews.com/2100-201_162-288749.html
Cascio, W. F. (2010). Managing Human Resources: Productivity, Quality of Life, Profits (8th ed.). Retrieved from The University of Phoenix eBook Collection database.
Loan Depot. (2012). [Brochure of LDEcrow-Your Benefits 2012] Retrieved from https://classroom.phoenix.edu/afm211/secure/view-attachment.jspa?ID=23709411&messageID=151487926&name=benefits%20loan%20depot.pdf&view=inline
Keh, G. (n.d.). PPO Vs. DMO for Dental. Retrieved from http://www.ehow.com/facts_5752764_ppo-vs_-dmo-dental.html
401khelpcenter.com. (2010). Retrieved from http://www.401khelpcenter.com/benchmarking.html
Pfau, B.N., & Kay, I.T. (2001). The human capital edge: 21 people management practices your company must implement (or avoid) to maximize shareholder value . New York, NY: McGraw-Hill.
Bihari, MD, M. (2010). HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs?. Retrieved from http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm 