Self-funded vs. fully insured dental benefits

The central difference is who bears covered claims risk. With fully insured dental, an insurer receives premiums and pays claims under its policy. With self-funded dental, the employer funds covered claims and can hire an administrator to run the plan. HealthCare.gov defines a self-insured plan.

Compare the full cost

For insurance, compare premiums, employer contributions, renewals, and employee cost sharing. For self-funding, compare expected claims, administration fees, cash needed for claim variation, and the plan's coverage rules. A low expected-claims estimate is not a guarantee. The Department of Labor notes that self-insured employers can face claims fluctuations.

Compare the actual benefit

Funding does not tell you whether cleanings, crowns, or implants are covered. Both arrangements need written plan terms. Compare the deductible, annual maximum, exclusions, network, and claims process side by side. The ADA explains common dental plan limitations.

Denta administers self-funded dental benefits, and we write from that perspective. If you want more detail on the role of an administrator, read what self-funded dental benefits are. Ask each vendor for one year of total-cost scenarios, including a higher-than-expected claims year.