Preferred Provider Organization (PPO) Plan
Preferred Provider Organization (PPO) plans offer the member with the option of choosing their dentist in the Cypress Dental PPO network or out-of-network, while still sharing a cost with Cypress Dental Insurance and the member. Members can maximize their savings when visiting a dentist in the plan’s network. The dentist will submit a claim after the visit and will not bill the member more than the agreed amount. Typically, the plan pays a percentage of the treatment cost, and the member is responsible for paying the balance. The patient’s responsibility is called coinsurance, which is the lower of the percentage cost owed by the member after the plan’s deductible is reached. The in-network dentists have agreed to charge their dental services at a reduced contracted rate, which lowers out-of-pocket costs for members. PPO Plans have a Calendar Year Maximum (CYM), which is the most a dental plan will pay for services within a benefit period (after the benefit year deductible is met). This excludes orthodontia, as plans that include this treatment are always subject to a Lifetime Maximum.
Cypress Dental offers an array of PPO plan designs to tailor the specific needs of different companies and its employees. We offer flexible and convenient group requirements, that make enrolling a simple and easy experience. Customization may be focused on any of the following: Plan deductibles; Calendar Year Maximums (CYM); services by Class Level (Class I Basic, etc.); and many other plan specifics.
Dental Health Maintenance Organization (DHMO) Plan
Dental Health Maintenance Organization (DHMO) plans, also known as capitated or pre-paid plans, require you to choose a dentist or dental facility that are in your plan network. The provider will coordinate all your dental needs, and specialty services require a referral from the primary care dentist. DHMO Plans do not have a deductible or calendar year maximums. Each dental service procedure has a fixed dollar amount, known as a co-payment (or co-pay). Covered services and fees are listed in the Schedule of Benefits, provided to the member in advance. These co-pays are generally lower than the amount the member would pay if receiving care without the DHMO plan negotiated discount. DHMO Plans allow members to plan services in advance and utilize affordable copays without the worry of capping at a calendar year maximum. However, if the member visits a dentist outside of the network, he or she may be responsible for the entire bill. With DHMO Plans, employers can provide a benefit employees value, while meeting both company and employee budgets.
Cypress Dental partners with LIBERTY Dental Plans and Western Dental Services to provide a robust network of DHMO dentists and dental practices, and to ensure optimal Quality Management Program and high-level care and service is achieved.
Cypress Hybrid Plan
Cypress Dental has developed an exclusive plan known as the Cypress Hybrid Plan that offers members the advantages of both, the PPO and DHMO plan. While PPO plans offer flexibility of choice in where the member wants to receive care, the DHMO keeps out-of-pocket costs low without ever having to reach the Calendar Year Maximum (CYM). Cypress Dental has combined each plan’s distinct advantages to offer members with this joint benefit. Each month, members can switch between each plan depending on their dental care needs to maximize their savings. To switch plans throughout the year, the member can call our Member Services Department by the 15th of the month to be effective the following month, and not be subject to an outstanding balance with dental treatments.
Maximum Allowable Charge (MAC) Plan
Mac-type dental plans pay the provider the same contracted fee for covered services whether they are in or out of network and is lower than the PPO fees. Staying in-network is a key component in this type of plan to receive a cost-effective benefit. The charge per procedure is negotiated between Cypress and the in-network provider. Out-of-network dentists are not subject to the contracted fees and can charge the member higher fees for services, while the member’s dental plan pays the dentist the same amount as the in-network provider, and balance bills the patient for the remaining amount. For example, the out-of-network dentists charges $1500 for a root canal, and the plan covers the procedure at 50%. The member’s in-network negotiated fee is $900, so the plan will pay $450 toward the $1500 procedure. The member would be responsible for a balance of $1050. MAC Plans have lower monthly premiums and fit well for employers who have employees visiting contracted in-network providers.
Dual Option Plans provide members with the option of a high or low plan. This allows the employee to select the plan that better suits their dental care needs and out-of-pocket expenses. Employers that find this plan design attractive want to provide their employees with an upgrade option of richer benefits that have a lower out-of-pocket cost for a slightly higher premium and have the employee to pay the difference. Cypress Dental offers Dual Option Plans in the following formats as Dual Option Plans: High/Low PPO, DHMO/PPO, DHMO/MAC, and High/Low MAC.
Many Cypress Dental Plans are available on a voluntary basis, which means that the employer can offer valuable benefits to its employees at no direct cost to the company and deduct the cost of the plan from enrolled employees’ paychecks each month. It is an effective solution for employees needing dental services and paying group rates rather than having to purchase an individual plan.