DR permits flexibility and simplicity. It is flexible because the plan can be designed to cover as much or as little as the employer wants. Many plans are capped at about $1,000 per family member per year. I believe that once companies have had DR for a while, they begin to see how they are saving money, and many will increase their level of benefits.

	Coverage.

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
DR is based on expense, not on type of treatment. There is no worry about which procedures are covered, or at what rate. If the treatment is dental, it is covered, provided the procedure is not otherwise covered by a medical benefit plan or specifically excluded. A DR plan might pay 100 percent of the first $150 of fees, which typically covers the routine preventive care of semiannual cleanings and possibly radiographs. Although employers usually want to be sure that these preventive services are fully covered, traditional dental indemnity insurance almost always seems to be designed to discourage preventive dental care, because such care often falls under a category involving a deductible, which the patient must pay before insurance coverage begins.¹ The DR plan might then cover 80 percent of the next $500, and 50 percent thereafter, up to an annual maximum of $1,000.

With DR, there is no need to worry about crowns being covered at 50 percent, or restorations at 80 percent, because DR does not divide dental treatment into categories such as basic dental services, major dental services and orthodontics. It simply provides coverage for dental treatment.

	Efficient consumers.

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
DR encourages cost containment and appropriate use of benefits because employees act as efficient consumers; they receive dental treatment designed to satisfy their wants and needs, without interference from an insurance company. With DR, dental treatment to suit the patient’s needs is determined only after appropriate professional consultation has taken place.

With traditional insurance, insurance companies often tell employers that a third party needs to examine all dental radiographs and claims and make sure that the dentist is not double-billing or otherwise trying to defraud the employer. No reasonable employee would attempt to defraud his or her employer and risk losing the job to obtain the DR maximum benefit. In effect, the employee provides the fraud protection services that the insurance company claims to provide (and for which it charges), but the employee performs these services for free, purely out of self-interest.

If the employer does not want to handle the minimal paperwork required, the company can hire a third-party plan administrator, or TPA, whose trained personnel will examine claims to make sure there is no abuse or fraud going on. The TPA’s charges for such services are considerably less than those of dental insurance companies, because there is no need for submission of radiographs or predetermination of treatment.²

	BACKGROUND

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
The concept of DR was developed by Dr. W.K. Carr, an Indiana orthodontist, in 1972.³ Initial adoption of DR was minimal. Although Dr. Carr advocated DR for almost a decade, it was not until 1979 and 1982 that the American Association of Orthodontists, or AAO, and the Indiana Dental Association, respectively, began to support the concept.³ Even so, it has been only since the 1990s that DR has begun to be widely accepted in the marketplace. Many employers might have chosen a DR plan in the past, but found little assistance in developing and customizing such a plan for their companies.⁴

In 1995, the Alliance for Dental Reimbursement Plans, or ADRP—composed of representatives from dentistry, dental association management, the insurance industry and the dental trade industry—was begun in Atlanta. The ADRP’s purpose was to establish a network to foster marketing of DR.⁵ This task would not be quick or easy, as many barriers to the sale of DR were quickly identified (Box, "Early Impediments to Direct Reimbursement").

	ADVANTAGES OF DR

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
There are many advantages of DR for employers, employees (patients) and dentists. Some disadvantages to employers and employees also have been suggested, while there are no apparent disadvantages for dentists.

Advantages for employers. Advantages for employers are numerous and substantial. Perhaps most important is that DR is a simple, cost-effective alternative to traditional dental insurance.⁷ Administrative costs for traditional dental insurance range from 19 to 35 percent of the premium dollar; under DR, this cost drops to 3.5 to 7.5 percent.^8–10 Most employers with some form of dental coverage for their employees have purchased it as an "add-on" to existing medical plans, but this is not necessary with DR, which can be established independently of any other health coverage. DR also eliminates the "price differential" charged by insurance companies, in which small firms pay more for similar coverage than do large firms.¹¹ This price differential facing smaller firms can be a significant burden; one study found that firms with fewer than 250 employees paid 20 to 40 percent more for health insurance than did larger firms.¹²

Benefits are easily understood and calculated under direct reimbursement, a feature well-received by patients.

Another important consideration for employers is that only about 50 to 60 percent of their employees visit a dentist every year, but traditional dental insurance premiums must be paid for all employees. With DR, payment is required only for treatment rendered, so employers are not paying premiums for employees who do not use the benefit.⁸ Also significant from the standpoint of management is the fact that DR allows customization of benefits (for example, executives can receive different benefits from hourly employees), which is much more difficult and expensive to do in traditional dental insurance plans. In addition, the employer, rather than an anonymous insurance company, clearly is the provider of the dental benefit.¹² Finally, DR provides several other purely financial advantages over traditional dental insurance:

– If the DR plan includes a yearly plan maximum, this limits the employer’s annual risk and avoids annual premium hikes.

– Instead of paying monthly premiums to an insurance company, the employer can establish cash reserves, which can be invested and the income used to further reduce the costs of dental coverage.

– Since DR is not insurance, state insurance premium taxes (if applicable) are eliminated.¹² If the employer wishes to limit his or her risk further, inexpensive stop-loss insurance is available.¹³ With DR, there also is considerable support from organized dentistry in the form of software, information about DR plans and actuarial estimates.

Advantages for employees. Advantages of DR for employees (patients) include the freedom to select a dentist and dental treatment without any third-party restrictions.^8,12 Benefits are easily understood and calculated under DR, a feature well-received by patients, who tend to keep close track of benefits used. Patients also appreciate the simplicity of DR plans, which require no preauthorizations and have no exclusions for pre-existing conditions.¹² If a DR plan is linked to a flexible spending account or is part of a cafeteria plan, employees pay for dental treatment with pretax earnings, substantially increasing their total benefit.⁹

Perhaps most appreciated by employees is that they decide how their dental benefits will be spent.¹⁴ For example, if an employee has a child requiring orthodontic treatment, he or she may elect to have that treatment done, and put off major treatment for other family members until the orthodontic care has been completed.¹⁴ The average annual expenditure per patient in DR plans is less than $200,¹⁵ which is equivalent to a few weeks’ grocery expenses. If patients can make appropriate decisions as to what foods to buy, they certainly can be trusted to make appropriate decisions about dental care.¹⁵ With DR, employees make their own treatment decisions, after consulting with their dentists.

Advantages for dentists. There are a number of advantages of DR for dentists. First, DR maximizes actual patient benefits, so patients have to pay less "out of pocket" than they would under a traditional dental insurance plan. This results in less treatment being deferred or refused on financial grounds. Dentists also receive their fees up front (unless there is an assignment of benefits), with the patient being responsible for obtaining reimbursement from his or her employer.

DR plans are extremely simple to administer—detailed claim forms, second opinions and utilization review are eliminated.^8,16 Also, patients may seek the services of any dentist they choose; closed panels are not a factor, and DR preserves fee-for-service dentistry.¹⁷ DR does not offer enticements for dental practitioners to attempt to shift costs to patients who can afford higher fees.¹⁸ Finally, and most important, patients and dentists make the treatment decisions—not insurance companies—based on professional diagnoses and patients’ needs and wants. If the patient and his or her dentist decide that cosmetic treatment is indicated, DR pays as it would for any other dental procedure, provided there is no plan limitation regarding type of treatment covered.⁸

	DISADVANTAGES OF DR

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
Disadvantages of DR have been advanced mostly by dental insurance industry representatives and consultants, and I present them below. Since these assertions have been shown to be inaccurate or inappropriate, I also cite specific refutations for each assertion.

Disadvantages for employers. Basic to arguments regarding disadvantages of DR for employers is the assertion that general cost management is poor,¹⁹ because the system has no method to track whether dentists’ fees are reasonable.⁸ However, the marketplace keeps dentists’ fees in line, and employees are unlikely to use a dentist whose fees are exorbitant.¹⁶ In addition, annual maximum benefits still apply in DR plans, and if one makes the reasonable assumption that patients want to maximize available benefits, employees certainly would be aware of their dentist’s fees. In fact, the data show that employers should expect to pay considerably less than their potential maximum liability under a DR plan. In 1991, few employees incurred annual costs exceeding $150.⁸

The data show that employers should expect to pay considerably less than their potential maximum liability under a direct reimbursement plan.

My review of the literature revealed further evidence of efficient cost management by patients under DR plans. For example, United Bancshares in Eagen, Minn., did not find that unrestricted utilization occurred after implementing a DR plan in 1997,²⁰ and The Rutland [Vt.] Herald found that only two of 97 employees reached their maximum benefit after starting a DR plan in 1988.⁸ Mean per-employee annual payments for dental care under the Rutland Herald’s DR plan were $255.54.⁸

Specific DR plan experiences, which include short-term cost savings, include the following: Pattie E. Clay Hospital in Richmond, Va., saved $300,000 during the first year; the city of Wilmington, Del., found that its first year’s claims under DR were about 20 percent of the previous year’s dental insurance premiums⁸; and United Bancshares found that the company paid 10 percent less for dental benefits under DR than under its previous preferred provider organization plan.²¹

Dental insurance company representatives have contended that long-term cost savings associated with DR have been overstated greatly.²² However, long-term cost savings were demonstrated by the Pattie E. Clay Hospital, which found that costs remained constant after implementing a DR plan. Between 1973 and 1980, the Eli Lilly company’s DR dental plan costs rose only 29.3 percent, compared with the almost 60 percent jump in the Consumer Price Index for dental services. These savings actually understate the company’s savings, because Eli Lilly purchased stop-loss insurance for both medical and dental claims during this period.²³ Eli Lilly maintains its DR program today (R. O’Neil, Eli Lilly Human Resources Department, oral communication, May 2001).

Another proposed disadvantage for employers is the potential for fraud, including inflated charges and unnecessary or inappropriate treatment.^20,21 However, fewer opportunities for fraud exist with DR than they do with traditional dental insurance,¹² if only because the patient actually sees and presents the dentist’s bill to his or her employer, rather than the dentist sending a request for payment directly to the insurance company. Little or no fraud has been demonstrated in DR plans.²⁴

Schultz² and Bell⁸ have suggested that the burden of administering a DR plan falls heavily on company employees. However, this administrative burden has been shown to be small (for every 100 employees, companies that self-administer DR plans typically devote about one person-hour per week to administration), and computer software is available to simplify the tasks required for DR plan administration.²⁵ Companies can choose to use the services of a TPA, an inexpensive option.¹²

Finally, Smith⁵ noted that services provided by dental insurance companies (for example, quality control, treatment necessity and utilization review) are missing under DR plans. Delta Dental Plans Association has even claimed that a patient receiving substandard treatment from a participating Delta provider might be entitled to have this work redone by a different dentist at no additional charge.²² While this might be possible, I could find no documentation in the literature of such free re-treatment ever having been given. In fact, third-party payment has not been shown to improve the quality of care rendered.²⁴

Disadvantages for employees. Disadvantages of DR for employees also have been suggested.^{8,13,14,20,21} Foremost among these is the fact that, in traditional DR plans, patients must pay for services rendered in full and then wait for reimbursement from their employers. Those who argue against DR assert that this delay creates a financial hardship on the employee.^8,14 However, an assignment of benefits feature via a TPA now is available,¹³ and payment via credit card allows about 30 days before actual payment must be made. Some employers provide employees requiring major dental treatment with a two-party check to cover their costs, or the dentist may accept a postdated check.²⁵

Any of these options would allow adequate time for most companies to process DR claims and pay employees. I should note that most traditional indemnity dental plans pay less than 50 percent of the costs of major dental services, so patients are never reimbursed for the noncovered out-of-pocket costs,¹⁴ a fact that insurance companies offering traditional dental insurance somehow fail to mention.

	EMPIRICAL EVIDENCE SUPPORTING DR

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
The advantages and disadvantages of DR presented above are basically theoretical. More telling is actual evidence, which can be divided into macro evidence, or accumulated experience by more than one company, and micro evidence, or experience of a specific company.

Macro evidence. On the macro level, the American Dental Association’s Council on Dental Benefit Programs examined data gathered by the National Association of Dental Plans, which surveyed the transactional costs of 32 dental health maintenance organizations, or HMOs. Administration, marketing, taxes, interest and profits at dental HMOs averaged 25 to 40 percent of premium costs, while the cost of administering a DR plan was only 5 to 10 percent of the dental care dollar.^3,9

According to the AAO, as of 1992, not one of the nearly 500 companies that it has assisted in establishing DR plans has returned to traditional dental insurance.⁸ Currently, the AAO is aware of only two companies that have discontinued DR, one of which did so because the company had been purchased, and the old parent company insisted on maintaining the traditional insurance plan of the new parent company (Shelly Teal, AAO, oral communication, May 2001).

As of 1998, no company in Florida that had instituted a DR program had ever discontinued or even mentioned discontinuing DR.²⁶ The Florida Dental Association, or FDA, noted recently that of the several organizations that have discontinued their DR plans, virtually all did so because of adverse selection (that is, the companies involved did not enroll all of their employees in DR, but allowed employees to decide whether or not to enroll in DR, which created an incentive for employees requiring a large amount of dental treatment to select DR). Companies in Florida that enroll all of their employees in DR still prefer it overwhelmingly (Robert Macdonald, director, Development and Dental Benefits, FDA, oral communication, May 2001).

Micro evidence. According to a benefits broker, companies with DR plans generally give their coverage a 98 percent approval rating.²⁷ In 1995, the benefits manager for Greensboro, N.C., stated that the city receives fewer complaints about its DR plan than about any other employee benefit the city offers.⁶ The AAO discontinued its traditional indemnity dental insurance in 1982, switching to a DR plan. Within one year, the AAO cut its costs by approximately one-half, despite having no restrictions regarding pre-existing conditions.²⁸

ADA experience. In 1987, the ADA switched from Delta Dental to a DR plan. One of its objectives was to see if offering 100 percent coverage the first year (that is, no deductible but a cap of $1,300) would affect plan utilization, which it did not.²⁹ When inflation is factored out, the real cost of the ADA’s DR plan actually decreased 6.6 percent between 1988 and 1994, based on the Consumer Price Index for dental services.²⁹ Employees covered under the ADA’s DR plan typically wait less than two weeks for a reimbursement check.³⁰

The Minnesota Dental Association, or MDA, switched from a traditional indemnity-type dental insurance plan to a DR plan in 1983. Only twice during the first nine years with DR did the MDA find that the mean cost per employee exceeded the 1983 premium cost.³¹ A number of large and midsized companies unrelated to organized dentistry also have adopted DR plans (for example, White Castle, Dow Corning, Mobil Oil, and Entergy Corp.).^32–34

Texas experience. The Lubbock, Texas, Independent School District, or LISD, has perhaps the best documented continuous experience with DR outside that of an organized dental association. It implemented a DR program for its 3,500 employees in 1985. LISD adopted its DR program because the school district found that only about half of the total premiums paid to traditional indemnity dental insurance plans were used to pay for employee dental benefits; the other half were applied to commissions, fees, taxes and insurance company profits.

LISD estimated that a traditional dental insurance plan would have cost more than $750,000 in 1985.³⁵ During the first year of its DR program, the school district paid out approximately $290,000 in dental claims,⁴ an immediate saving of more than 61 percent. Only 35 percent of the employees filed claims, 78 percent of which were for less than $75, and only 12 participants reached the $1,000 annual maximum. Long-term cost savings also have been documented at the LISD: program costs went up 36 percent between 1985 and 1999, while the cost of practicing dentistry rose nearly 150 percent during the same period.³⁶ The LISD’s coordinator of risk management noted that oversight, quality control and employee abuse have not been a problem nor has utilization—in the late 1990s, only about 45 percent of LISD’s employees actually used their coverage.³⁵

The effective spread of direct reimbursement plans requires the establishment of an effective national marketing campaign.

Finally, financial stress on patients as a result of their having to pay up front has not materialized in Lubbock, since most dentists accept credit card payment and employees are reimbursed by the DR plan long before the credit card bill arrives.^2,36

	WHY HAS DR MARKET PENETRATION BEEN SLOW?

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
DR appears to be good for employers, employees and dentists, and apparently bad only for insurance companies. Despite this, employers have not been quick to adopt DR for their employees’ dental benefit programs. In 1997, DR was estimated to have less than 1 percent of the employer market.⁹ Several reasons for this slow acceptance of DR have been advanced, including the fact that insurance companies have been unlikely to sell DR, and insurance brokers have not been familiar with the concept.^18,37 I believe that a more significant reason for the slow market acceptance of DR has been the lack of an effective marketing campaign. The major proponents of DR have been dentists, but dentists are trained to perform dentistry, not to promote dental care plans.

Employers almost always receive advice about dental care insurance programs from insurance brokers and insurance industry representatives.³⁸ When an employer hears about DR, his or her first inclination is to explore the idea with an insurance agent. Nationwide, 54 percent of all employers use external consultants to assist them in making decisions regarding health care benefits, with larger firms using such consultants more often than smaller ones.³⁹

Typically, the agent tells the employer that because he or she has never heard of DR, it cannot be any good. If the agent does ask someone in the insurance industry about DR, he or she is told that the concept does not work.² The employer, being relatively satisfied with his or her current dental insurance plan, does not pursue the idea of DR.² Most employers simply do not want to spend much time or effort considering their company’s dental benefits plan.²⁶ Consequently, the effective spread of DR plans requires the establishment of an effective national marketing campaign and a critical mass of knowledgeable TPAs.

	A STRONG MARKETING CAMPAIGN

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
In 1996, the ADA House of Delegates passed a resolution calling for a three-year $7.5 million marketing campaign. Advertisements promoting DR quickly began to appear in a variety of national publications, such as Employee Benefit News, Human Resource Executive, Workforce, CFO and HR Magazine.⁴⁰ An interactive computer compact disk explaining how DR works and how to contact the ADA for additional information was polybagged with the July 8, 1996, issue of Business Insurance.⁴¹ Results from this campaign were quickly apparent; the ADA Purchaser Information Service received nearly 400 requests for additional DR information, with about half of these inquiries involving requests for additional copies of the interactive disk. In addition, more than 170 people viewed a DR slide show on the ADA’s Web site.⁴¹

A direct mail program targeted at constituent dental societies was initiated in six states, and in 1997, the program was broadened to target 18 additional states.⁴⁰ These efforts were recognized by the Chicago Association of Direct Marketing, which awarded the ADA and its creative partner, the Impact Communications Group of Foote, Cone & Belding, with the first- and second-place Tempo Awards.⁴² Three 1997 ADA workshops designed to instruct representatives from participating constituent dental societies in how to promote DR were well-attended.⁴³

By 1998, 36 states had elected to participate in the ADA’s DR direct mailing campaign, despite strengthened participation requirements. Before being allowed to participate in this campaign, constituent dental societies had to demonstrate that they could provide adequate follow-up and support for prospective DR plan purchasers, through staff members, brokers or TPAs.³⁴ Recently, the ADA created a 10-minute online presentation explaining the many benefits of DR to patients and employees.⁴⁴ The ADA Board of Trustees also has recommended that the association continue to dedicate $2.5 million of the ADA operating budget for DR promotion, because the program has been so effective and well-accepted by members.⁴⁵

Organized dentistry at the state level also has been promoting DR. For example, in 1992, Heidenrich⁴⁶ reported that the Indiana Dental Association had been aggressively promoting DR since 1983. In Pennsylvania, 646 of 1,000 leads (that is, potential customers) were a result of efforts of Pennsylvania Dental Association, or PDA, members, and the PDA in 1998 introduced a DR debit card that allowed patients to see at the time of treatment how much they would be responsible for in terms of dental fees and how much would be paid by their DR plan.⁴⁷

In 1995, the MDA spent almost $250,000 contributed by its members to develop a TPA.⁴⁸ This TPA currently administers the DR program for more than 100 employers, and covers more than 23,000 lives (Michelle Hilger, director of sales and marketing, Minnesota Dental Benefits, oral communication, May 2001). The executive director of the MDA recently characterized the state’s DR program as "successful, with steady growth" (Richard Diercks, MDA executive director, oral communication, May 2001).

As the table illustrates, effectiveness of the ADA’s DR campaign may be evaluated via a number of valid criteria.^49–52

	THIRD-PARTY ADMINISTRATORS

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
Employers need to be educated before they will become comfortable with a DR plan. Dentists typically do not have a lot of time to promote DR plans to employers, although they can mention them to patients, colleagues and friends. Beyond these opportunities, there is little that a dentist in private practice can do to promote DR. On the other hand, TPAs are trained to provide important information regarding DR to employers, but they typically do not know the local business-people. Thus, perhaps the greatest service that dentists can offer is to introduce potentially interested local employers to DR plan administrators, who will take over at that point.

Most DR plans that have been established in the last few years have been the result of coordination and cooperation between a TPA and a dentist or dental association. Typically, plans have not been sold as a result of a dentist promoting DR directly to a company, except in a few cases of quite small companies, where the owner has a personal relationship with the dentist.

Effective communication. Perhaps the most important service that TPAs provide is communicating well with industry. They can promote DR as part of a comprehensive health plan, if that seems appropriate. They can promote traditional indemnity dental plans, if the employer is not interested in DR. Typically, however, if a TPA introduces and explains the benefits of DR to a client, then the client usually chooses DR (C.P. Coyner, M.B.A., presentation on direct reimbursement, 1996 Virginia Dental Association annual meeting).

A major advantage of using TPAs is their ability to turn data into useful information for companies interested in DR. TPAs can show employers the number of claims per employee per year, the average claim size, up-to-date actuarial experience tables, cost estimates of various plan designs, advice on claims administration techniques and support at client meetings.^2,54

The ADA has recognized that knowledgeable TPAs are essential for growth of DR. Organizers of DR Days, an annual ADA promotion, decided in 1998 to substantially increase the number of sessions devoted to brokers, TPAs and benefits consultants.⁵⁵ According to the ADRP, many brokers have been so impressed with DR that many sign broker agreements immediately after the concept has been fully explained to them.³⁷

Having a cadre of insurance brokers knowledgeable about DR is mandatory for this type of benefit plan to grow, since brokers meet regularly with established groups of human resource managers who influence (if not choose) the selection of company dental benefits packages.³⁷ Consequently, the ADA Board of Trustees recently authorized a program to "recognize brokers for outstanding achievements in selling direct reimbursement dental plans."⁵⁶

	CONCLUSION

TOP ABSTRACT Coverage. Efficient consumers. BACKGROUND ADVANTAGES OF DR DISADVANTAGES OF DR EMPIRICAL EVIDENCE SUPPORTING DR WHY HAS DR MARKET... A STRONG MARKETING CAMPAIGN THIRD-PARTY ADMINISTRATORS CONCLUSION REFERENCES

 
This is the time for DR plans to grow. Dentists are aware of them, employers and patients are paying attention, and DR is affordable. TPAs exist in most states and are willing and able to help initiate and administer programs. All of these factors come together to make this the right time for DR to flourish.