What are Self-Funded Dental and Vision Plans?
With our Self-Funded Dental and Vision plans, employers completely fund all dental and vision claims for their employees. However, they have the freedom to design and tailor the benefit plan to what fits their company’s needs the best. Most employers design their plan to include a share of costs arrangement with their employees.
Share of Costs – A share of costs is a concept that allows employers to make employees financially responsible for a portion of their benefit plan. For example, if the benefit amount per employee is $100, your client could design a share of cost plan of 50/50, where they would pay 50% of the $100 and their employee would pay 50% of the $100. That means they would both owe $50. Employers can also require the employees to pay a monthly “premium” towards the costs as well.
Self-funded dental and vision plans allow an employer to only pay for claims that are actually incurred. Under traditional fully insured dental and vision plans, an employer must pay premiums for a participating employee even if they do not use the plan. These plans can implement claims being paid based on Usual, Customary and Reasonable (UCR) fees. Under this scenario, the benefits paid will be restricted to a certain UCR percentile chosen by you. This protects you from paying claims to providers whose fees are higher than UCR.
Dental and Vision Networks
Dental Networks
With our dental plans, we offer several different networks to choose from to give your employees a bigger discount when seeing a contracted dental provider. Below are the networks you can choose from:
Vision Network
With our vision plans, we do not offer a network. The participants will receive an benefit ID card and they can go to any provider to receive vision services. Some vision providers choose to require payment up front for services, which means your employees will have to pay out-of-pocket upfront and then submit an itemized statement to us for reimbursement.
Participant Features
- Lower out-of-pocket dental and vision expenses
- Quick, easy, versatile online and mobile account access
- Simple claim submission
- Pay to provider directly or option for member reimbursement
- Access to large range of providers with multiple network options
- Comprehensive benefit education
- Dedicated plan service representatives
Employer Features
- Configurable support and flexible plan designs
- Significant savings compared to traditional health plans
- Full plan design capability
- Comprehensive enrollment assistance
- Annual reporting and claims utilization data
- Employer portal for plan administration and reporting
Open Enrollment Support
Navia’s clients who participate in our OE webinars see an average 6% increase in enrollment, and clients who participate in our email campaign see an average 15% increase!
Check out our Navia Benefits Academy for our robust open enrollment program to help increase your enrollment year over year!
Interested in learning more?
Contact our sales team at 425.452.3498 or sales@naviabenefits.com
What are Self-Funded Dental and Vision Plans?
Self-Funded Dental and Vision plans are an employer provided dental or vision benefit plan. A Self-Funded Dental and Vision plan is set up and funded by your employer to reimburse you or your provider for qualified healthcare expenses.
Who and What is Covered?
Dental and Vision plans typically covers eligible out-of-pocket dental and vision expenses incurred by you and/or your covered dependents. However, since these plans are customizable by your employer, the design for each plan is endless. Eligible expenses are determined by your employer.
In order to determine who and what services are eligible for coverage/payment, please refer to your plan’s Schedule of Benefits.
How Does it Work?
- Enroll in your Dental and Vision plan. During your open enrollment select the dental and/or vision plan provided by your employer.
- Learn about your specific plan. Since each plan is different, you will need to make sure you know your plan details. You will receive a Summary of Benefits. This will be your guide to all of your plan specifics.
- See provider for services. Give your provider both your provided benefit ID card. Once you’ve received dental or vision services from a provider, they will bill your insurance. In some cases, you may have to pay out-of-pocket for expenses and then submit a claim for reimbursement.
- Submit claims online! Claims can be submitted online on the participant portal or through the mobile app. You will need a copy of your Explanation of Benefits (EOB) or receipt when sending your claim to Navia.
Accessing Your Benefits
Participant Portal
Get 24/7 access to your benefits with the our Participant Portal. Submit claims, view account balances and history, get alerts and notifications, and much more!
Mobile App
Whether you’re at the doctor’s office or on vacation, the mobile app allows you to manage and access your benefits right from your smartphone! Available for iPhone and Android devices, the mobile app is a free-to-download and free-to-use tool for any Scheduled HRA participant.
Dental Networks
With our dental plans, we offer several different networks to choose from to give your employees a bigger discount when seeing a contracted dental provider. Below are the networks you can choose from:
Vision Benefit Card
With our vision plans, we do not offer a network. You will receive an ASi/Navia Benefit ID Card and can go to any provider to receive vision services. Some vision providers choose to require payment up front for services, which means you will have to pay out-of-pocket upfront and then submit an itemized statement to ASi/Navia for reimbursement.
Questions?
Call us at 866-777-1320 and ask to speak to a SPS representative.