SUMMARY.
Get the security, coverage, and predictability of a fixed premium dental plan and the potential savings usually only available to self-funded plans with BeneCare’s Premium Credit Program. This innovative plan design ensures qualified[1] groups that the large majority[2] of their premium dollars are used to pay for dental care services. If not, the group receives a premium credit for the difference in the subsequent year of coverage.
HOW IT WORKS.
One of the factors used to calculate a group’s premium is “utilization rate,” which is the quantity and types of services the group’s membership is expected to use over a coverage year. This helps project the group’s “care expense,” a factor used to calculate a rate that presupposes a large majority of the paid premium will be used to pay for dental care expenses.[3]
If the actual care expense is less than projected, the group will receive a premium credit for the difference in its subsequent year of coverage. However, if the care expense is higher than projected, the group owes nothing additional above its paid premium. Literally, you can have your cake and eat it too. It’s better than level-funding.
RECONCILIATION AND CREDIT COMPUTATION[i]
At 18 months and again at 30 months following the group’s effective date, BeneCare will conduct a review of the group’s total care expense over the previous plan year to determine what percentage of the premium was allocated to care expense.[4]
If the care expense is less than projected, the group will receive a credit against their premium in months 19 through 24 and 31 through 36, respectively.[5] Better yet, if the care expense meets or exceeds the projection, the group owes no additional money above the premium it has already paid.
| Month | Activity | Description |
| 1 — 12 | Fixed premium | Group pays quoted monthly premium. |
| 18 | Reconciliation | Total care expense is calculated against premium paid in plan year 1. |
| 19 — 24 | Credit | Credit against premium if care expense is less than projected for year 1. |
| 30 | Reconciliation | Total care expense is calculated against premium paid in plan year 2. |
| 31 — 36 | Credit | Credit against premium if care expense is less than projected for year 2. |
NEED MORE INFORMATION?
Plan sponsors should contact their benefit consultant for additional details and a quote. Or you may contact BeneCare Dental Plans directly using an online request or by calling 800.445.6665. Benefit Consultants may also call 800.445.6665 or submit an online request.
[1] The Premium Credit product is available at BeneCare’s discretion and subject to group size and other relevant factors.
[2] Each group’s exact percentage is based on actuarial and other factors and is fixed in accordance with the terms of their group contract.
[3] The projected care expense percentage and associated premium are evaluated on a group-by-group basis and defined by the terms of the applicable group coverage contract.
[4] Reviews are retrospective and occur at least six months after the end of the plan year being reviewed. Care expense calculation will be in accordance to the terms of the group contract and related policy documents, and may include a reasonable estimate of incurred — but not reported — claims. Refer to your plan documents for more details.
[5] Exact timing of, calculation of, and mechanism for premium credits will be in accordance with the terms of the applicable group contract and supporting documents.
