What is DENTALExpress+^©?

DentalExpress+^© is an innovative self-funded employee benefit plan that combines the simplicity of the Direct Reimbursement plan design with additional employee-friendly reimbursement options.  The plan design bases benefits on a percentage of dental expenses incurred unlike traditional dental plans which calculate benefits based on the type of treatment received. 

With DentalExpress+^© participants choose their own dentist and elect one of  two options for claim submission.  Participants can submit a simple claim form for reimbursement of expenses; or the dentist can bill Flores and payment can be made directly to the dentist.  Even though the plan is a limited benefit (by maximum annual dollars available), there is high-perceived value since there are no UCR cutbacks, waiting periods or pre-certification review requirements.  

Costs of the plans are easily controlled.   Employers are able to select plan design parameters that best suit the financial commitment they wish to make.  There are no hidden costs, and the simple plan design results in low administrative costs.  Most importantly, employers keep any unused funds since they pay only for claims actually incurred.

How Does DentalExpress+^©  Work?

1. Participants visit their provider of choice and present their ID card.
2. Participants receive the necessary treatment.
3. Participant may either:  (A) pay the provider and submit their detailed receipt to Flores, or (B) the provider can bill Flores direct via fax or mail.
4. Flores adjudicates claims daily. Benefits are based on a percentage of expenses incurred instead of type of treatment. Exclusions and limitations on treatment are few, if any.
5. Flores generates a weekly check register and transmits to Employer. Employer funds the amount of the check register through Flores’ automated process.
6. Flores mails or direct-deposits reimbursements within the designated time frame established by the employer.

 

What Does The Employee Get?

The employee can preserve their provider/patient relationship; there is no limitation on provider selected and both the provider and the participant receive payment quickly. There are typically no waiting periods or exclusions (except cosmetic), no UCR reductions, no deductibles, and no precertification requirements.  The process to file a claim is simplified and payment is guaranteed within the designated time frame established by the employer.   The employee can manage the entire process on-line and can elect to receive e-mail notifications throughout the claim process.

As an added bonus, any unpaid balance can be automatically directed to the participant’s Flores FSA (Flex Account) – no need to file a separate claim.

 

What Is The Employer's Role?

With Flores assistance,

1.         Determine eligibility;

2.         Establish plan design and/or co-payment provisions;

3.         Determine annual benefit maximums.

The bottom line is that employers can customize the plan based on the amount they want to spend.

 

Statistics from the ADA (American Dental Association) indicate that:
- less than 60% of employees with dental benefits seek dental care
- the average participant spends less than $160 for dental care per year .

 

Since the employee's share of the expense increases as more benefits are used, overuse is inherently discouraged and prudent buying of services by the employee is encouraged.  Remember, the employer can hold and invest the reserve funds to generate additional income to offset costs.

 

Why FLORES?

• EXPERTISE
• INNOVATION
• SUPERIOR QUALITY SERVICE
• PRIVACY
• ACCURACY & ACCOUNTABILITY

Combining leading edge technology with superior service has propelled us to the forefront of reimbursement plan administration nationally. Mirroring our Flexible Spending Account (FSA) service, we have instituted innovative features in the administration of benefit plans that will ensure complete satisfaction for employers and their employees:

Some of these features include:

• Assistance with plan design and employee communications;
• Dedicated account management;
• Easy enrollment – including on-line capabilities;
• Electronic file transfer capabilities for eligibility and claim funding;
• Ability for participants to fax in claims over our toll free fax line;
• Guaranteed claims turnaround time;
• E-mail notifications to participants throughout the claim process;
• Claim cost controls such as screening for duplicate services or cosmetic procedures;
• Participant account summaries and claim forms available on our internet site;
• On-line and On-Demand detailed account reporting for employers;
• Automatic continuation to the participant’s FSA (Flex Account) at the participant’s option;
• HIPAA privacy requirements exceeded.