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.
Your vendor guarantees performance by agreeing to return a percentage of premium if standards are not met for:
Customer service
Claims processing
All dental offices are inspected at least once every 3 years, against written criteria for infection control and completeness of dental records.
Dental offices are re-inspected against written criteria at least every 2 years.
Your agreement allows you to audit the plan at least annually.
You have seen the vendor’s written quality standards.
Upon termination of the contract, your agreement obligates vendor to provide historical service data to the new vendor.
Vendor places at least 10% of premium at risk to guarantee performance.
A live or automated system allows dentists to verify eligibility at least Monday through Saturday during normal business hours.
You are able to obtain claims status, past claims information and eligibility by making a single call to a customer service representative.
Vendor maintains a toll free telephone number for member services.
Dentists are able to speak with dental consultants about their cases.
Eligibility for all time limited services (example: dentures made almost 5 years ago) is immediately available by calling a customer services representative.
On an annual basis, more than 50% of employees are enrolled in the PPO or IPA.
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.
Your vendor can demonstrate that at least 80% of employees have access to at least 1 each of the following specialists within 20 miles or within 45 minutes of their homes.
Oral surgeon
Periodontist (gum specialist)
Endodontist (root canal specialist)
Pedodontist (children's specialist)
Fewer than 8% of general primary dentists terminated within the past 12 months.
Specialists are paid on a fixed fee schedule instead of a percentage discount of their fees.
Premiums or care cost increases over the past 3 years have averaged less than 10%.
Your vendor has agreed to pay part of the cost of an annual independent audit
At lease 84% for insured plans, or 90% for ASO plans of all money spent by the plan sponsor goes directly for dental treatment.
The administrator reduces payment for gum treatments that involve fewer teeth than usual.
Unless mandated by labor-management agreement, the UCR or schedule of benefits is no higher than the 80th percentile of charges.
If a dentist places two 2-surface fillings on a single tooth on the same day, the system would pay only for one 3-surface filling.
You have a 2 or more year fixed rate contract.
The vendor/administrator reports savings from:
Consultant review
Coordination of benefits
Re-bundling unbundled services
# of services by ADA code or category of service
Unbundling
