General Service Questions SureCircle Services
General Service Questions What is an Employer Self-Funded Plan?
An employer self-funded (self-insured) plan is one in which an organization directly funds the benefit rather than going through an insurer. Under this type of plan, there are no monthly premiums. Instead, the employer sets money aside for the benefit until it is needed for the funding of claims. More on self-funding Are Self-funded dental plans related to Direct Reimbursement plans or Direct Assignment plans?
Yes, both direct reimbursement and direct assignment plans are types of self-funded plans. Why are dental benefits good candidates for self-funding?
Dental benefits pose relatively low financial risk for the self-funding organization when compared to medical benefit self-funding. One reason for the low risk is the relatively low cost of dental care (the national average dental plan payout is around $168 per year per individual and $300 per year per individual + dependents). Moreover, dental benefits tend to be underutilized. Statistics show that 40% of all employees with a dental benefit will not visit the dentist in a plan year; of the 60% who do utilize their dental benefits, only 5% hit their annual maximum benefit amount. Can a self-funded plan work for companies of any size?
No, self-funded plans are advisable for employers with 50 or more members. Having at least 50 members on a plan lowers the financial risk for the self-funding organization. If a dental plan for 50 individuals has an annual maximum of $1,000, will the plan spend the full $50,000?
Most plans will never reach their maximums, this is because approximately 40% of members with dental benefits do not receive any dental treatment in a given plan year, of those who do, only 5% will actually hit their yearly maximum limit amount. Our plan includes employee contributions; how are these calculated?
An annual cost estimate is provided to the employer during their plan set-up. It is up to the employer to decide on the employee contribution. Any residual money in the employer fund collected as an employee contribution remains in the fund until it is paid out. What are the cost savings with self-funding?
While employers could potentially save up to 40% on the cost of their dental benefit, there are never any guarantees of cost savings with a self-funded plan. What is the difference between a dollar-based, and procedural-based plan?
Most dental insurance plans are procedure-based, this means that coverage is determined by the type of treatment (preventative, diagnostic etc.) However, a dollar-based plan is one in which coverage is determined by the overall treatment cost, regardless of the class of treatment it falls under. SureCircle offers both types of plans. SureCircle Services What are the advantages of SureCircle's third party administration services?
Self-funding can be complex, especially with all of the laws governing HIPAA and ERISA programs. Administering an employer self-funded plan with SureCircle frees HR personnel from day-to-day administrative issues and lets us do what we do best. We are HIPAA and ERISA compliant and our system is completely automated for efficient and accurate administration. Moreover, SureCircle's has a user friendly online system that keeps employers and members informed about their plan with real-time data 24 hours a day, 7 days a week. Can governments, schools, unions or other types of organizations interested in a self-funded plan have a SureCircle plan?
Yes, SureCircle plans are not just for employers, we can administer plans for any self-funding organization. How can I estimate how much a plan will cost?
The cost of your plan depends on multiple factors that determine the plan utilization. SureCircle utilizes a third party actuarial system to provide employers with their plan's cost estimate. We also provide an easy-to-use web-based interface where employers can get a customized online estimate. Does a self-funded dental plan from SureCircle mean increased staff time?
No, on the contrary, SureCircle handles all claims processing, payments, support inquiries, reporting, and enrollment functions. So managing a SureCircle dental plan should have little impact on an employer's staff time. Our professional claims review procedures ensure effective fraud control and accurate claims processing. And, since employees can login to their member accounts and self-enroll, add dependents, edit their profile, monitor their utilization and view their benefit plan summaries, SureCircle can help employer's HR staff focus on more strategic issues while we handle the day-to-day plan administration. How can I get a quote?
You can get a quote online or by calling our toll free number (877) 388-1200. How quickly can I get started with my self-funded plan from SureCircle?
Establishing a self-funded benefit plan with SureCircle is simple and convenient. In fact, the entire set-up and enrollment process can be done online. Our friendly and prompt sales and customer service staff will be happy to assist you at every step of the way. The following steps outline our set-up and enrollment process:
- Register, sign-up and accept the SureCircle Employer Service Agreement
- Select and configure a self-funded benefit plan (Automatically creates the Plan and Summary Plan Document [SPD])
- Add and invite employees to enroll (Invitations can be sent via email)
- Employees enroll and add dependents (SureCircle provides benefits ID cards)
- Establish the employer benefit bank account for funding purposes
How are claims paid?
When a claim is received by SureCircle, it is processed based on the plan. SureCircle makes payments to beneficiaries on behalf of the employer. Who manages claims and monitors the quality of care in a self-funded plan?
SureCircle manages claims filed on behalf of the plan members and monitors the quality of care. Many procedures require documentation from the dentist to assure treatment was complete, dentally necessary, and to rule out any procedures done for cosmetic reasons. Do employers need an insurance broker to buy a SureCircle plan?
SureCircle will be happy to work with clients either directly or through a broker. If a member has other dental coverage, who coordinates the benefits?
Because the SureCircle plan is a self-funded plan, any other insurance coverage is considered primary to this plan. So, if a member has any other dental coverage as a subscriber or a dependent, claims should be processed by the other coverage first and then submitted to SureCircle with a copy of the Explanation of Benefits Statement from the other carrier.
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