The Michigan Dental Association and the American Dental Association are working in cooperation with dentists and dental societies, actively promoting dental benefits plans that stress fee-for-service, freedom-of-choice and quality of care. One of the most innovative models of dental benefits is the topic of this section, Direct Reimbursement, a simple concept that allows companies to self-fund dental benefits in a very cost-effective way.

Direct Reimbursement is a self-funded program that reimburses an individual based on a percentage of dollars spent for dental care, not on the type of treatment provided; it also allows patients to seek treatment from the dentists of their choice.

Direct Reimbursement is a straight-forward accounting process: Once a company has implemented a Direct Reimbursement plan, an employee visits the dentist of his or her choice, receives treatment, arranges for payment, and later presents a paid receipt or proof of treatment to the employer or administrator of the plan for reimbursement.

Reimbursement is based on a plan designed by the employer to meet both the company and employee needs. One company, for example, might reimburse 100 percent of the first $200 of dental expenses and 80 percent of the next $1,000, resulting in a total annual maximum benefit of $1,000 per individual. Another company might reimburse 75 percent of the first $1,000 of dental expenses, resulting in a total reimbursement of $750 per individual. Plan design varies widely among companies.

Unlike other forms of dental benefits, Direct Reimbursement allows patients to visit any dentist they choose. It frees patients to plan treatment with their dentists alone, with no third-party interference through exclusions or limitations on treatment. There are no predetermination or pre-authorization requirements, no Usual, Customary and Reasonable fees and typically no deductibles.

The following is a list of the resources available to you through the American Dental Association's Purchaser Information Service to promote Direct Reimbursement: 

• The brochure titled "Direct Reimbursement - The Dental Benefits Plan for Smart Companies" explains the concept of Direct Reimbursement and has an attached business reply card for those who need further information. In a concise, bulleted and easy-to-read format, this brochure is the first tool for learning about Direct Reimbursement.
• "Direct Reimbursement - The Dental Benefits Plan for Smart Companies" is a kit explaining the concept of Direct Reimbursement and contains sample Direct Reimbursement plans, commonly asked questions and answers, a sample Summary Plan Document, sample claim forms and a cost estimation data sheet.
• Telephone assistance is available for employers who would like to discuss Direct Reimbursement and other areas of dental benefits or simply request further information. The Michigan Dental Association does offer the information you need. Contact Caroline Ruddell, director of legislative and insurance advocacy, at (800) 589-2632, ext. 423.
• In 1996, the ADA News published a series of articles regarding Direct Reimbursement and the association's support and promotion of the concept. Reprints of these articles are available through the ADA's Purchaser Information Service office by calling (312) 440-2746.