Cumulative Premiums Paid
Net Insurance Benefit Paid
$1,200
30.8% Premium Payout Ratio
Patient Out-Of-Pocket
$3,800
Total Spend: $7,700
Self-Insurance Fund Yield
$4,312
+$412 Interest Earned
5-Year Financial Trajectory & Breakeven Crossover
Comparing Total Premiums vs Covered Payouts vs Out-Of-Pocket vs HYSA Emergency Fund
Premiums Paid
Net Payout
Out-Of-Pocket
Self-Insurance Fund
Month 60 (Yr 5)
Procedural Ledger & Claim Denial Breakdown
Detailed month-by-month financial treatment audit
| Month | Procedure Name | Billed Cost | Claim Status | Insurance Paid | Patient Out-Of-Pocket | Annual Cap Depletion |
|---|
Why Dental Insurance Math Favors Self-Insurance in Major Procedures
Dental insurance differs fundamentally from medical insurance. Rather than providing catastrophic risk transfer, dental policies operate with strict annual maximum benefit caps ($1,000–$1,500) that have remained stagnant since the 1970s. Combined with 50% major service coinsurance, waiting periods, and frequent denial of implants/crowns as "not medically necessary", total premium payments ($3,900 over 5 years) frequently exceed net paid claims ($1,200). Diverting premiums into a 4.0% HYSA provides immediate liquid emergency reserves without claim denials.