Employers
What does a dental plan administrator do?
Claims, support, plan documents, and the employer’s role.
Denta team · · 1 min read
A dental plan administrator helps operate a plan: handling enrollment information, claims, questions, and plan processes. The employer and written plan still determine the promised benefits. In a self-funded arrangement, hiring an administrator does not transfer claims funding to that administrator.
What to put in the scope of work
Ask who receives claims, checks eligibility, applies plan rules, sends explanations of benefits, answers employee questions, and manages appeals. Also ask who maintains the plan document and who reports spending to the employer. The Department of Labor's employer guide describes the need for claims procedures and clear participant information in covered plans.
What the employer should still review
Review the services covered, exclusions, annual maximum, network arrangement, claim funding process, and administration fees. Request a sample employee experience from enrollment through a denied-claim appeal. The Department of Labor explains why the Summary Plan Description and claims instructions matter to participants.
Denta is an administrator of self-funded dental benefits, so this topic is directly related to our service. To separate administration from funding, read what self-funded dental benefits are.