Full coverage dental insurance with no waiting period is under ERISA is under federal law and your state law for keep recapping is worthless so these doctors that think that our state’s passed a law it’s going to protect me it protects that doctor with say percent of the patients with full coverage dental insurance.
but not the other now a self-funded plan is under ERISA how does that work let’s say it’s Bank of America let’s say that Bank of America hires MetLife well MetLife provides an actuary to design the plan for Bank of America to keep it within Bank of America’s budget.
MetLife provides a low-cost dr. network and then MetLife pushes the paperwork so MetLife handles all of the claims submissions well MetLife is paid a fee per claim a typical fee in the marketplace understand is about seven dollars per claim so MetLife is making seven bucks per claim that life is not at any financial risk.
Whatsoever it’s Bank of America and so the self-funded plan of is can be capped you and how do we know it’s self-funded well it could be a union they could be schoolteachers it could be a hospital it could be a major corporation it could be American Airlines if the patient has an identification card on the back of the card.
It says administered by guardian or it says administrative services only so if there is a patient card on the booklet and by the way when the patient brings full coverage dental insurance with no waiting period and their booklet that’s the technical name of that is summary plan description.
The summary plan description on the back page it may say administrative services only that life as an example now by the way this little booklet the patient brings is not the keys to the kingdom the plan.