Dental and vision plans have remained unchanged since they originated nearly 50 years ago. All plans are nearly identical in design from one insurer to another.

Their plans are complex, with over 75 rules that restrict care and shift costs to the patient. They all promote the need for PPO networks, which result in limiting access and the quality of care. Providers are capped at what they can charge and must resort to lower-quality labs and materials, and less time with the patient.

However, there is a better way — as in simpler, more cost-efficient, fairer and self-funded. Today, over 3,600 employers use the direct-reimbursement model for dental benefits. Unfortunately, the insurance industry has not adopted this model, and most brokers who recommend the industry's products are not familiar with the reimbursement concept.

The reimbursement plan simply reimburses the patient a percentage of incurred charges up to a maximum dollar limit per year. When I first learned about this simple dental plan in 1993, I was apprehensive that something this simple would work so well. I was wrong.

The plans perform well. Costs are no higher than the traditional indemnity plan. However, less money goes to overhead; patients can determine, in advance, what the plan will pay, and employers seldom need to change plans again.

Why is this significant? Because insurers, on average, lose 25% of their policyholders each year. This is expensive and disruptive to employers, employees and brokers. When asked why they change dental policies, employers' replies are most often, "Someone offered us better rates" or "We have too many employee concerns with the current policy."

So look at your current dental policy and ask:

Why are procedures grouped into four categories, and why does each category have differing levels of benefits? Who determines which procedures go to into which category?

Why are so many procedures excluded or limited as to their frequency of use?

Why do the plans pay higher percentages on the least expensive procedures and the lowest percentages on the most expensive procedures?

Why do insurers need to review X-rays and dentists' treatment plans? In most instances, it is not a dentist reviewing the treatment plan and making a decision on whether to approve the claim, deny it or approve it with a reduced benefit.

Why does a 100/80/50/50% plan actually pay 81/56/38/26%? Did you know this? Do the employees know this?

Why are most dental policies capped at $1,000 per year when it costs only 8% more to double the benefits?

Why are PPO networks needed when the average claim payment per person per year is just $240? In a recent study for an employer with 2,500 employees, we found there were 274 dentists used, but 52% of the patients used only 18 of the dentists. None of the 18 were in a PPO network. Of the remaining 256 dentists, less than 30% were in a network.

Why is insurance necessary when the average person's dental claim costs are only $240 per year? Insurance is needed for non-budgetable and non-predictable claim costs. Even medical claims of $500 to $2,000 per year are now being self-insured by the employee due to deductibles and copays.

I invite you to rethink the current dental plans. Direct reimbursement makes sense; it is easy to explain, understand and use. There are low administrative fees. All procedures are covered equally, and the patient can use any dentist he or she desires. All claim costs are managed by three criteria — the annual maximum, the percentage the plan reimburses and the exclusion of elective cosmetic dentistry.