Enter the relative weights of each section as a percent of the total. Use the tab key to move to the next weight.
Accountability
%
Availability/Accessibility
Cost
Total
Answer each question by placing a check for a positive response.
Response
Indicator
You received fewer than 2 complaints per 100 employees per month last quarter.
You have been asked to fill out a service questionnaire within the past 12 months.
Your account executive has been readily accessible to address questions and issues that arise.
You receive regular reports on the status of your employee’s grievances.
You have received the results of satisfaction surveys within the past 12 months.
The vendor reports the following telephone statistics to you annually,
Average time on hold
Average time to answer
Average call abandonment rate
Your service agreement allows you to audit the DHMO plan at least annually.
You have seen the vendor’s written clinical quality standards.
Dentists are required to submit reports of treatments to the administrator.
All dental offices are inspected against written criteria before they are allowed to participate in the network.
Dental offices are re-inspected against written criteria at least every 2 years.
Office inspections include assessments of infection control and dental records.
Your vendor places at least 10% of premium at risk to guarantee performance.
On an annual basis, more than 25% of employees are enrolled in the DHMO
More than 99% of employees who are enrolled in the DHMO are assigned to dental offices.
Your vendor can demonstrate that at least 80% of employees have access to at least 2 general dentists within 10 miles or within 30 minutes of their homes.
Primary dentists are able to refer DHMO patients directly to specialists without first getting approval from the network administrator.
Fewer than 8% of general primary care dentists terminated within the past 12 months.
Dentists are required to see participants within 4 weeks for routine appointments.
Dentists are required to resolve urgent care needs (via phone, by referral to another dentist, or by office visit) within 24 hours.
Unduplicated utilization (each enrolled individual using the plan at least once each year) is greater than 50%
The vendor verifies access by making test appointments.
Specialists are limited to a fixed fee schedule instead of a percentage discount of their fees.
Average trend in premium for the past 3 years is under 6% per year.
Your vendor has agreed to pay part of the cost of an annual independent audit
Direct payments to dentists for care account for greater than 75% of premium
