Direct Dental Reimbursement

How does it work?

• The employee/dependant visits the dentist of their choice and receives the necessary treatment.
• The employee mails/faxes a claim form with proof of treatment to Flex-Plan.
• Flex-Plan adjudicates the claim for eligibility and enters the amount into the processing system.
• The employee is reimbursed according to a straightforward plan design.
• The employer transfers funds, equal to employee claims, to Flex-Plan Services prior to the scheduled payment processing dates OR adds the claim reimbursement amount to the employee’s paycheck.
• Flex-Plan can either pay to the employee or to the provider.

Sample Plan Design

• 100% reimbursement on the first $300 of expenses, then
• 80% reimbursement on the next $500 of expenses, then
• 50% reimbursement on the next $1000 of expenses
• $1,200 annual maximum benefit

**Note that benefits are paid on dollars spent opposed to services rendered.

Eligible and Ineligible Expenses

Any dental expense under the scope of Sec 213d of the Internal Revenue Code is permissible. Some plans will offer an orthodontia benefit others will not. The only expenses that are not covered are procedures that are purely cosmetic in nature (ie. teeth whitening, veneers, etc.). Dental Reimbursement Plans have a lot of flexibility with reimbursable expenses.