Health and Welfare
Employer Advantages

Through our Direct Reimbursement Dental Program and Direct Reimbursement Vision Program, Leggette Actuaries provides consulting and administrative services you and your employees can rely upon for smooth, efficient operation. Leggette offers a full spectrum of services including plan design, administration, and employee communications. Dental Direct and Vision Direct offer a broad range of options while taking your company's current benefit needs into consideration. Dental Direct and Vision Direct can be used in conjunction with Flex Benefits to maximize employee participation.

How Dental Direct Works

How does this plan benefit your employees?
Employees can go to any dentist they choose and pretreatment authorizations are not required. Their dentist determines the best method of treatment. The employer chooses what procedures are covered by the plan.

How does the plan work?

  1. Employees pay for the service (cash, check, credit card or other credit arrangement).
  2. Obtain an invoice and complete a Dental Claim Form. Submit a completed claim form along with the invoice or have the dental office submit it.
  3. Once a claim is received in our office it is adjudicated and payment is mailed within 48 hours.

Dental Direct
Employers can design their Dental Direct Plan to meet their needs. Direct Reimbursement Dental Programs are cost effective, self-funded plans that reimburse employees for dental expenses. Employees are reimbursed from a fund established by the employer, which is funded by employer and/or employee premiums.
Below is an example of a common plan design.

Expense Plan Share Participant Share Paid Benefit
First $100 100% ($100) 0%($0) $100
Next $200 75% ($150) 25%($50) $150
Next $1,500 50% ($750) 50%($750) $750
Annual Maximum Benefit Paid Per Covered Person $1,000
Orthodontia is limited to $1000 lifetime maximum per insured for participants to age 19. Plan exclusions are cosmetic dentistry, implants, TMJ and teeth extracted prior to the effective date of coverage.


Vision Direct
Vision Direct works very similar to the Dental Direct and is custom designed for your company. The plan can include coverage for glasses, vision exams, prescription sunglasses, contact lenses and accessories. Vision Direct can exclude Lasik Vision Surgery, non-prescription glasses or contacts.

Below is an example of a common plan design.

Expense Plan Share Participant Share Paid Benefit
First $100 100% ($100) 0%($0) $100
Next $200 75% ($150) 25%($50) $150
Next $500 50% ($250) 50%($250) $250
Annual Maximum Benefit Paid Per Covered Person $500



Your Team

With the establishment of your Dental Direct or Vision Direct Program, a team of specialists takes responsibility for the long-term management of your plan. You will be assigned an Account Manager to manage your plan who will be knowledgeable about your plan. This member of your team will provide timely information and accurate reporting.

    Administration
  • Administrative Handbook with forms and procedures
  • Monthly year-to-date reports
  • Toll-free number
  • Dedicated account manager
  • Daily claims processing
  • Prepare a "signature ready" annual IRS 5500 and other related schedules, if required
    Enrollments
  • Webcasted educational enrollments
  • Online enrollments
  • Electronic enrollment kits
  • Custom enrollment forms
Our staff of actuaries will help you analyze costs on an on-going basis to assure that your plan, and your employee's participation, continues to operate at peak efficiency. Our actuaries will also help you set premiums for your Dental Direct and Vision Direct Plans.

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