The Process
How Dollar Based Dental Works
Dollar Based Dental replaces the traditional network-dependent dental insurance model with a self-funded, dollar-based benefit structure. Here is how the plan works from adoption through claims payment.
Employer Selects Plan Design
Eagles works with the employer — and their broker or consultant if applicable — to build a plan design that fits the workforce and budget. The employer adopts a plan document that defines covered services, benefit levels, annual maximums, deductibles, and any exclusions.
Plan design is fully customizable. Eagles provides sample plan designs as a starting point, but every employer plan can be tailored.
Employees Receive Plan Documents & ID Cards
Once the plan is adopted, employees receive their plan documents and participant ID cards. These materials explain their benefits, how to use them, and how claims are submitted.
Employees are not restricted to a network. They may choose any licensed dental provider, subject to the terms of the employer's plan.
Employee Chooses Their Dentist
The employee schedules care with the dental provider of their choice. There is no network requirement. The employee presents their Dollar Based Dental ID card at the time of service.
Provider participation in a traditional dental network is not required. Any licensed dental provider may serve Dollar Based Dental members.
Provider & Patient Determine Treatment
The provider and patient discuss treatment options and make care decisions together — without traditional network contract limitations affecting the clinical conversation.
Treatment decisions are between the provider and patient. Benefits are determined by the employer's plan documents, not by a carrier's network fee schedule.
Claim Is Submitted
Claims are submitted by the provider or member to Eagles as the plan administrator per the process outlined in the plan documents.
Standard dental claim forms (ADA claim form) are accepted. Providers may submit directly or members may submit after receiving a statement.
Benefits Paid Per Plan Design
Covered claims are reviewed and paid according to the employer's adopted plan documents. Explanation of Benefits (EOB) statements are issued to both the member and provider.
Payment is based on the dollar-based benefit structure defined in the plan — not a network fee schedule or UCR table.
Side-by-Side Comparison
Dollar Based Dental vs. Traditional Dental Insurance
Understanding the structural differences helps employers, employees, and providers know what to expect from a Dollar Based Dental plan.
| Topic | Traditional Dental Insurance | Dollar Based Dental |
|---|---|---|
| Provider Access | Limited to contracted network providers | Any licensed dental provider |
| Benefit Structure | Procedure codes + UCR fee schedules | Dollar-based maximums defined by employer |
| Employer Control | Carrier-defined plan designs | Fully customizable plan documents |
| Cost Predictability | Premium increases driven by carrier | Self-funded — employer controls the plan |
| Treatment Decisions | Influenced by network contract limitations | Between provider and patient |
| Claims Administration | Carrier-managed | Administered by Eagles, Benefits by Design |
| Network Dependency | High — plan value tied to network access | None — no network required |
| Regulatory Structure | Fully insured — state insurance regulation | Self-funded — ERISA governed |
This comparison is for general informational purposes. Plan features, regulatory treatment, and benefit structures vary by employer plan design. Consult your plan documents for specific terms.
A Note on Self-Funded Plans and ERISA
Dollar Based Dental is a self-funded employee benefit plan governed by ERISA (the Employee Retirement Income Security Act of 1974). Self-funded plans are not subject to state insurance mandates in the same way fully insured plans are, which gives employers greater flexibility in plan design.
Employers adopting a Dollar Based Dental plan take on the role of plan sponsor and are responsible for the plan's financial obligations. Eagles, Benefits by Design, Inc. serves as the plan administrator and third-party administrator (TPA).