This arrangement represents a specific method of financing dental benefits. Rather than paying premiums to an insurance carrier, an employer or organization assumes the direct financial risk for providing dental coverage to its employees or members. As claims are incurred, the plan pays those claims directly from its own funds, typically using a third-party administrator (TPA) to handle claims processing and network management. This model contrasts sharply with fully insured plans where a predetermined premium covers the cost of expected claims and administrative fees.
The adoption of this benefits structure can offer organizations greater control over plan design and cost management. Historically, organizations have sought such control to tailor benefits packages to the specific needs of their employee demographics. Furthermore, potential savings may arise if the actual claims experience is lower than the premiums that would have been paid to an insurance carrier. This structure provides greater transparency into the actual costs of providing dental benefits, enabling data-driven decisions about plan design and wellness initiatives.
