FAQs | Dollar Based Dental

Question 1

What is Dollar Based Dental?

Accepted Answer

Dollar Based Dental is a self-funded employer dental benefit plan governed by ERISA. Instead of using a carrier network and fee schedule, the employer sets a dollar-based annual maximum and coinsurance rate. Members can use any licensed dental provider, and benefits are paid based on the employer's plan documents — not a carrier's contracted rates.

Question 2

Is Dollar Based Dental insurance?

Accepted Answer

No. Dollar Based Dental is not a health insurance product and is not subject to state insurance regulation. It is a self-funded employer benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Benefits are provided directly by the employer's plan, not by an insurance carrier.

Question 3

Who administers Dollar Based Dental?

Accepted Answer

Eagles, Benefits by Design, Inc. serves as plan sponsor and third-party administrator (TPA), handling claims processing, eligibility management, participant communications, and ERISA compliance.

Question 4

What does "dollar-based" mean?

Accepted Answer

Dollar-based means that benefits are defined as specific dollar amounts — not as percentages of a carrier's fee schedule or UCR table. The employer sets an annual maximum (e.g., $1,500, $5,000, or $10,000) and a coinsurance rate. Members and providers know exactly what the plan covers without needing to reference a network contract.

Question 5

Is there a provider network?

Accepted Answer

No. Dollar Based Dental does not use a restricted provider network. Members may use any licensed dental provider. Providers do not need to sign a participation agreement or accept a fee schedule to serve Dollar Based Dental members.

Question 6

What plan designs are available?

Accepted Answer

Dollar Based Dental offers three sample plan designs — Plan A ($1,500 annual max), Plan B ($5,000 annual max), and Plan C ($10,000 annual max) — as well as fully custom plan designs. Employers can adjust annual maximums, deductibles, coinsurance rates, and covered service categories to fit their workforce and budget.

Question 7

What is ERISA and why does it matter?

Accepted Answer

ERISA (Employee Retirement Income Security Act of 1974) is the federal law that governs self-funded employer benefit plans. Because Dollar Based Dental is an ERISA plan, it is not subject to state insurance mandates or state insurance regulation. This gives employers more flexibility in plan design and administration.

Question 8

How does an employer adopt Dollar Based Dental?

Accepted Answer

Eagles works with the employer to select or design a plan, prepares the ERISA-compliant plan documents, and coordinates setup. The employer formally adopts the plan by executing the plan documents. Eagles and your broker guide you through each step.

Question 9

Can we customize the plan design?

Accepted Answer

Yes. While Eagles offers three sample plan designs (Plan A, B, and C), every plan is fully customizable. Employers can set their own annual maximums, deductibles, coinsurance rates, and covered service categories. Contact Eagles to discuss a custom plan design.

Question 10

How is the plan funded?

Accepted Answer

Dollar Based Dental is a self-funded plan, meaning the employer funds benefit payments directly rather than paying premiums to an insurance carrier. Employers typically set aside funds based on expected utilization. Eagles can provide guidance on funding structures.

Question 11

What are the employer's responsibilities under ERISA?

Accepted Answer

As the plan sponsor, the employer is responsible for adopting and maintaining the plan documents, funding benefit payments, and ensuring the plan is administered in accordance with ERISA. Eagles prepares the plan documents and handles day-to-day administration as TPA, significantly reducing the employer's administrative burden.

Question 12

How does enrollment work?

Accepted Answer

Eagles manages participant enrollment and eligibility. Employers submit enrollment data to Eagles, which maintains participant records and issues ID cards.

Question 13

Can Dollar Based Dental replace our existing dental insurance?

Accepted Answer

Yes. Many employers adopt Dollar Based Dental as a replacement for a traditional fully insured dental plan. The self-funded structure typically offers more flexibility in plan design and can be more cost-effective for employers with stable or predictable dental utilization.

Question 14

Is Dollar Based Dental available in all states?

Accepted Answer

Because Dollar Based Dental is an ERISA self-funded plan, it is not subject to state insurance mandates and can generally be offered in any state. Contact Eagles to discuss your specific situation.

Question 15

Can I use my current dentist?

Accepted Answer

In most cases, yes. Dollar Based Dental is designed as a provider-choice plan. You are not restricted to a network. Any licensed dental provider can serve Dollar Based Dental members. Check your employer's plan documents for any specific requirements.

Question 16

How do I know what my plan covers?

Accepted Answer

Your employer's plan documents define your covered services, annual maximum, deductible, coinsurance rate, and any exclusions. Contact your HR department or Eagles for a copy of your plan documents. You can also log in to the participant portal to view your benefits.

Question 17

How do I submit a claim?

Accepted Answer

Claims are submitted to Eagles as the plan's third-party administrator. Your provider can submit a standard ADA dental claim form on your behalf, or you can submit after receiving a statement. Your plan documents include claim submission instructions.

Question 18

What if my dentist has never heard of Dollar Based Dental?

Accepted Answer

That's common and not a problem. Dollar Based Dental does not require providers to sign a network agreement. Show your ID card and explain that your plan is a self-funded employer benefit administered by Eagles, Benefits by Design, Inc. Your provider can submit a standard ADA dental claim form using the information on your ID card.

Question 19

Is there a deductible?

Accepted Answer

Deductibles depend on your employer's plan design. The sample plan designs include a $50 per-person annual deductible, but your employer may have selected a different amount. Review your plan documents or contact your HR department for your specific plan terms.

Question 20

What is my annual maximum?

Accepted Answer

Annual maximums vary by plan design. Your employer selects the plan structure. Common plan designs range from $1,500 to $10,000 per person per year. Check your plan documents or the participant portal for your specific maximum.

Question 21

How do I access the participant portal?

Accepted Answer

The participant portal is available at mediconnx.com/mediclm/login.aspx. You can log in to view your benefits, check claim status, and access your Explanation of Benefits (EOB) statements.

Question 22

Does the plan cover orthodontics or implants?

Accepted Answer

Coverage for orthodontics and implants depends on your employer's plan design. Plan B and Plan C include orthodontic and implant coverage; Plan A includes orthodontic coverage but not implants. Check your plan documents for your specific covered services.

Question 23

Do I need to join a network or sign a contract?

Accepted Answer

No. Dollar Based Dental is not a traditional dental network. There is no participation agreement, no fee schedule to accept, and no credentialing process required to serve Dollar Based Dental members. Any licensed dental provider can treat members.

Question 24

How is payment determined?

Accepted Answer

Payment is determined by the employer's plan documents, which define covered services, dollar-based benefit maximums, deductibles, and any exclusions. Payment is not based on a network fee schedule or UCR table. You bill your standard fees; benefits are paid up to the applicable dollar-based maximum.

Question 25

Where do I submit claims?

Accepted Answer

Claims are submitted to MediConnx, the plan's third-party administrator, using the standard ADA dental claim form. Contact information for MediConnx is printed on the member's participant ID card.

Question 26

Can I verify benefits before treatment?

Accepted Answer

Yes, and we strongly recommend it. Contact MediConnx before major treatment to verify the member's benefits, annual maximum remaining, deductible status, and covered services. This helps avoid surprises for both you and the patient.

Question 27

Is there a fee schedule I need to follow?

Accepted Answer

No. Dollar Based Dental does not impose a network fee schedule on providers. You bill your standard fees. Benefits are paid to the member (or assigned to you if the member assigns benefits) based on the employer's plan design, up to the applicable dollar-based maximum.

Question 28

What if I have never heard of Dollar Based Dental before?

Accepted Answer

That's common. Dollar Based Dental is a self-funded employer benefit plan administered by Eagles, Benefits by Design, Inc. through MediConnx. It operates similarly to other self-funded ERISA plans. The member's ID card includes all the information you need to verify benefits and submit claims.

Question 29

How is Dollar Based Dental different from traditional dental insurance?

Accepted Answer

Traditional dental insurance is built around carrier networks, carrier fee schedules, and carrier-controlled plan designs. Dollar Based Dental is a self-funded ERISA plan with no network requirement, dollar-based benefits, and employer-controlled plan design. Employers get more flexibility; employees get provider choice; and brokers can differentiate their offering.

Question 30

What types of employers are the best fit?

Accepted Answer

Dollar Based Dental is well-suited for employers who are frustrated with network limitations, want more control over plan design, have employees in areas with limited network coverage, or are looking for a cost-effective alternative to fully insured dental. It works for groups of various sizes.

Question 31

How does broker compensation work?

Accepted Answer

Broker compensation is discussed directly with Eagles during the proposal process. Contact Eagles at James@CPS125.com to discuss compensation structures for your group.

Question 32

What support does Eagles provide to brokers?

Accepted Answer

Eagles provides proposal support, plan design consultation, ERISA plan document preparation, implementation coordination with MediConnx, and ongoing plan management support. Brokers are not left to navigate the self-funded structure alone.

Question 33

How do I request a proposal for a group?

Accepted Answer

Contact Eagles directly at James@CPS125.com or use the Request a Proposal form on this site. Provide basic group information (size, location, current dental plan) and Eagles will prepare a proposal.

Question 34

Can Dollar Based Dental be offered alongside other benefits?

Accepted Answer

Yes. Dollar Based Dental can be offered as a standalone dental benefit or alongside other employer-sponsored benefits. It does not conflict with medical, vision, or other benefit plans.

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