Participating dentists have agreed to provide services at a negotiated rate for both covered services
as well as noncovered services such as cosmetic tooth whitening and orthodontic care.
Aggregation of covered services
is permitted for allocation purposes, taking into account whether relative benefits are reasonably reflected, and need not follow the same groupings used for evaluating low-margin services.
Healthcare, contract with independent physicians and other health care providers who agree to provide covered services
for the HMO's members.
While the definition of covered services
will obviously influence to some degree the supply of services, the way in which delivery of care will be organized, the mix or composition of institutional providers, and the supply of health manpower, mere influence is often not enough.
Physicians who participate with the Blues accept Blues payment as payment in full for covered services
, minus any co-pays or deductibles required under the patient's benefit plan.
There is also an out-of-pocket maximum that caps the amount a health plan member is required to pay outside of his or her benefits plan for covered services
Bernard also noted the simultaneous release of Announcement 2006-50, a proposed revenue procedure that details specific services--including accounting, public relations, treasury, training, database administration, and legal--that qualify for a cost-only safe harbor for "specified covered services
In addition to describing the options' covered services
and reimbursements, the Web site makes it easy for Federal employees to see which dentists are part of MetLife's Preferred Dentist Program (PDP) - a nationwide network of over 90,000 dentist locations consisting of carefully credentialed general and specialty dentists.
Our Dental PPO Plan covers routine and restorative dental care from more than 86,000 dental practices in Aetna's nationwide network and there is no deductible to pay, whether you go in or out of our network for covered services
," said Bernatavitz.
MetLife's dental plan participants have the freedom to utilize any practicing dentist and receive benefits for covered services
BlueEdge HSA health plans will provide 100 percent coverage for covered services
rendered by participating providers after policyholders meet their annual deductibles.
Ultimately, we think the true value of a dental plan is measured not only in the cost of premiums and/or administrative fees, but in the overall savings a carrier can achieve when the total cost of covered services
are taken into account.