Reform -- Perspective. small business

Health Care

Health Care

Reform

--the Dental

the Dental

Perspective

Health Care Reform Update – the

Dental Perspective

The content provided is for informational purposes only, and is not intended as legal or tax advice or opinion relative to any specific issue. Additional changes may be made to the Federal or State

regulations described in this message. You should regulations described in this message. You should consider consulting with your lawyer or tax advisor before acting based on this information.

Health Care Reform Update – the

D

t l P

ti

Dental Perspective

Health Care Reform Update – the

Dental Perspective

ACA Quick Facts

ACA

Quick

Facts

• Dental benefits in small group (50 employees and

under) and individual markets required to be compliant under) and individual markets required to be compliant in 2014

• Must be compliant with ACA provisions by January 1 • Must be compliant with ACA provisions by January 1,

2014 or 2014 plan year unless plan is grandfathered The 10 Essential Health Benefit (EHB) package

• The 10 Essential Health Benefit (EHB) package is the minimum package of benefits to be

offered on and off the public marketplace and includes pediatric dental services

includes pediatric dental services

Health Care Reform Update – the

Dental Perspective

Required Pediatric Dental Benefit Required Pediatric Dental Benefit • Under age 19

• Annual out-of-pocket limits not to exceed $700 per p $ p child or $1400 for all children on the policy

• No annual maximums or lifetime limits on benefits • Medically necessary orthodontia included

• Adult Dental Coverage NOT part of 10 EHBs – can be offered inside and outside of Marketplace but no be offered inside and outside of Marketplace but no requirement to purchase

Health Care Reform Update – the

Dental Perspective

Medical Stand-Alone Dental

Required Actuarial Values

Bronze Silver High

Medical

Coverage Levels

Stand Alone Dental Coverage Levels Bronze 60% Silver 70% High 85% Gold 80% Platinum 90% Low 70% 7

Health Care Reform Update – the

Dental Perspective

Key Points: Key Points:

• Employers do not have to purchase dental coverage from a medical carrier

• The pediatric oral EHB does NOT have to be embedded • The pediatric oral EHB does NOT have to be embedded

in a medical plan

• Just as today, your clients have the CHOICE to purchase dental only coverage separate from their purchase dental only coverage separate from their medical coverage

98%

98%

of all dental plans are purchased separate from medical plans separate from medical plans

Health Care Reform Update – the

Dental Perspective

Stand-Alone Pediatric Pediatric Dental Embedded Dental Plan with Medical

Levels High Plan Low Plan

Part of overall metal level bronze thru platinum.

Requireme

nts Dental coverage must meet ACA requirements Metal levels have to meet overall metal actuarial value not dental levels. A high metal plan could still have low dental coverage.g Cost

Sharing Not to exceed $700 per child /$1,400 per contract MAY BE Subject to medical out-of-pocket (OOP) - annuals are $6,350 individuals/ $12,700 for family.y

Health Care Reform Update – the

Dental Perspective

Stand Alone Dental Is Better

Stand-Alone Dental Is Better

• Facilitates transparency and informed decision ki

making

• Flexibility on plan choice

• Provides employees choice in coverage • Provides employees choice in coverage

• Transparent disclosure of dental benefit plan design and pricingg

Delta Dental of

Delta Dental of

Illinois Small

Group Offering

Group Offering

Health Care Reform Update – the

Dental Perspective

• Delta Dental of Illinois filed a plan that meets the • Delta Dental of Illinois filed a plan that meets the

pediatric oral EHB required be ACA

• Groups can add plan as a “rider” to existing coverage

• Existing groups can keep comprehensive dental benefit coverage they have today and add EHB benefit coverage they have today and add EHB rider – members can use both benefits

Health Care Reform Update – the

Dental Perspective

Kids Dental Wellness Plus Kids Dental Wellness Plus

• Uses an Exclusive Provider Feature – Delta Dental PPO network only

• Freedom to visit any Delta Dental PPO dentist • No requirement to choose a primary dentist • Flexible coverage options

• Rich coverage for preventive services

Health Care Reform Update – the

Dental Perspective

• To receive benefits under Kids Dental Wellness Plus EHB plan, members MUST use a Delta Dental PPO dentist

• Medically necessary orthodontia is covered:

pre-determination for ortho benefits under Kids Dental Wellness Plus EHB plan necessaryy

Health Care Reform Update – the

Dental Perspective

Kids Dental Wellness Plus (Illinois Children Under 19) (Illinois Children Under 19)

Deductible (benefit year; per person, applies to basic and major services only)

$25

Out of pocket limit $700 individual child Out-of-pocket limit $700 individual child

Family maximum (for children under 19) $1,400

Covered Dental Services

Preventive Services(exams, cleanings, x-rays, fluoride treatment, space maintainers, sealants under age 18)

100% Delta Dental PPO network/0% out-of-network

Basic Services (fillings, simple extractions, gum disease treatment root canals surgical extractions)

80% Delta Dental PPO network/0% out-of-network

treatment, root canals, surgical extractions)

Major Services (denture relines and rebases,

adjustments; repairs to crowns, dentures and bridges; crowns, complete and partial dentures; fixed bridgework)

50% Delta Dental PPO network/0% out-of-network

Medically Necessary Orthodontia 50% Delta Dental PPO network/0% out of network Medically Necessary Orthodontia 50% Delta Dental PPO network/0% out-of-network

Health Care Reform Update – the

Dental Perspective

Rate impact for small group pool rates Rate impact for small group pool rates • 2-tier (single, family):

– 0% to single rate – 5.5% to family rate

• 3-tier (single, single +1, single +2 or more):

0% to single rate – 0% to single rate

– 0.5% to single +1 rate

Health Care Reform Update – the

Dental Perspective

Key Points: Key Points:

• Adult coverage unchanged

• Enhanced Benefits Program included in both plans

li t ll d d

– compliments wellness programs and underscores link between oral health and overall health

• ToGoSM _{Annual Maximum Carryover stays in plans y y p}

that have it

• Covered dependents under age 19 can continue to use benefits of existing plan and see any dentist, use benefits of existing plan and see any dentist, but can also take advantage of Kids

Dental Wellness Plus EHB plan with Delta Dental PPO dentist only

Delta Dental PPO dentist only

Health Care Reform Update – the

Dental Perspective

Small Group Options: Small Group Options:

• ADD Kids Dental Wellness Plus EHB plan as a

rider to existing coverage in 2014 (note: groups with Flex plan design cannot add EHB rider; must select new plan design)

• RENEW Delta Dental of Illinois will allow current • RENEW Delta Dental of Illinois will allow current

Health Care Reform Update – the

Dental Perspective

Pediatric Vision Care Is one of the 10 categories Pediatric Vision Care Is one of the 10 categories required in the EHB Package

• Requires pediatric vision care up to age 19

• No annual maximums or lifetime limits on pediatric benefits

benefits

• No stand-alone option -- must be part of a qualified health plan

• No changes to DeltaVision plans

Health Care Reform Update – the

Dental Perspective

Delta Dental of Illinois Small Group Renewals: Delta Dental of Illinois Small Group Renewals: • Cover letter explaining EHB rider option

• Existing plan renewalg p

• Renewal with EHB rider added • Renewal options

• Support collateral

Delta Dental of Illinois Small Group Quotes: C l tt l i i EHB id ti

• Cover letter explaining EHB rider option • Quote will include EHB rider option

Health Care Reform Update – the

Dental Perspective

Voluntary Coverage Voluntary Coverage

• Delta Dental PPO Maximum Allowable Charge Voluntary Feature

• Good option for small groups that don’t offer dental • No employer contribution

Health Care Reform Update – the

Dental Perspective

Delta Dental of Illinois Individual and Family Plans Delta Dental of Illinois Individual and Family Plans

• Delta Dental of Illinois has filed individual plans that are compliant with the ACA oral EHB – Kids Dental Wellness and Kids Dental Wellness Plus

Working

Together

Health Care Reform Update – the

Dental Perspective

Choosing and/or keeping Delta Dental of Illinois Choosing and/or keeping Delta Dental of Illinois coverage:

• Keeps adult and family dental benefits together as they are today

• Offers a clear plan design that complies with the oral EHB requirement with the flexibility of using oral EHB requirement with the flexibility of using benefits from “standard” plan design as well

• Allows members to keep current dentists • Provides minimal disruption at reasonable

Delta Dental

Mobile App

Delta Dental Mobile App

(the Smart Way to Manage Your Benefits

(the Smart Way to Manage Your Benefits

on Your Smart Phone)

Without logging in: Without logging in:

• Find a network dentist

• Brush for the recommended 2 i t ith T thb h 2 minutes with our Toothbrush Timer tool

• With log in:g

• View a mobile ID card

• View coverage and claims information

information

• Available using Apple and Android devices Search for Delta Dental

Effective

Discount –

Methods of

Measurement

Delta Dental PPO Plus Premier

Delta Dental Network

D lt D t l P i Delta Dental PPO _{Delta Dental Premier}

260,413 dentist locations Delta Dental PPO

176,492 dentist locations

Non-network

Delta Dental Premier PPO Plus

Other PPO Carriers

PPO Plus

Other PPO Networks

Non network 110,000-150,000

dentist locations

Know the Numbers Behind a Dental

Delta Dental offers access to

Know the Numbers Behind a Dental

Carrier’s Network

Delta Dental offers access to the largest network

nationwide with an industry-leading effective discount leading effective discount

averaging 20.3 percent nationallyy

.

Sources: March 2013 Independent NetMinder Data; based on the Delta Dental Premier®_{network / Ruark Consulting LLC’s 2012 Dental PPO Network Study}

Count on our Network Numbers

Count on our Network Numbers

At Delta Dental of Illinois, we:

• Regularly validate & update

network numbers

• Rely on a third‐party resource

to analyze data

• Provide groups & enrollees with an accurate

• Provide groups & enrollees with  an accurate