Ancillary. Solutions. Product 01MK5262 R10/13

Transcription

1 Ancillary Product Solutions 01MK5262 R10/13

2 Life...3 Disability...9 Vision Dental Customer Service Information... 28

3 PROTECTING DREAMS FOR THE FUTURE TODAY Your LABI membership and support allow you to impact decisions of the legislative, executive, regulatory and judicial branches of state government on a broad range of issues that affect your bottom line. LABI keeps you informed when your group s interests are threatened, provides you with valuable compliance information and gives you access to business decision-making tools. LABI s efforts on a single issue could save your group thousands of dollars! Your LABI membership can also save you money by providing you with access to multiple benefit plans. Bundle up & save We know how important the right benefit package can be to recruiting and retaining quality employees. That s why we have partnered with Blue Cross and its subsidiaries to offer you the Blue Bundle. Employers have the option to bundle employee benefits with affordable, high-quality health and wellness benefits. With one team to administer all your benefits, you save time, and time is money. SOLUTION. SOURCE. ONE BILL. 01MK /12

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5 Lie f Southern National Life is an independent licensee of the Blue Cross and Blue Shield Association. 3

6 Whether your company has two employees or 10,000, we have plans that fit. Life insurance is something that no one likes to think about. All the same, 86 percent of Americans believe that life insurance is something most people need, and most of us have some. 1 That s the good news. The bad news is that most Americans don t have enough. More than a third don t have any life insurance at all, and those who are insured have coverage equal to less than four times their annual income. 2 Most experts believe that coverage equal to 10 times one s annual income is a more reasonable rule of thumb. Basic Group Term Life/AD&D Employee and dependent life coverage paid for by the employer. Did you know Strong life insurance coverage is essential to creating a robust and competitive benefit package for your employees. Life insurance offers your employees and their families a safeguard from many unexpected expenses if something should happen to them. Employers can offer this high-value benefit at a great price and employer-funded plans generally count as a business deduction for employers. VOLUNTARY TERM LIFE/AD&D Optional employee and dependent life coverage paid for by the employee through the convenience of payroll deduction. Did you know Voluntary plans offer extra value to employees at no added cost to the employer s company. Premiums are payroll-deducted, which means benefits are convenient for employees and economical for employers. Voluntary Term Life insurance is a way to provide the same protection as our Basic Group Term Life in a way that is cost-effective to both employers and their employees. Employers can offer Voluntary Term Life coverage with any Basic Life plan or as a stand-alone plan. This option allows employees to purchase additional coverage above what an employer may offer with our Basic Life insurance. This helps provide financial stability and would protect employees families from some unexpected expenses, if something were to happen to them. Voluntary high-limit AD&D Accidental Death & Dismemberment (AD&D) coverage provides protection for accidents. Why add Voluntary High-Limit AD&D? It s a fact of life accidents happen. By choosing Voluntary High-Limit Accidental Death & Dismemberment (AD&D) coverage, employees can give themselves and their family members 24-hour protection in case of accidental loss of life, limb, hearing or sight. We offer Voluntary AD&D coverage to employers and their employees at low, affordable rates. This option can also be offered with any group life insurance coverage or as a stand-alone plan. Just like with our Voluntary Life coverage, premiums are paid for by the employee through payroll deduction. This plan requires no underwriting and it s all guaranteed issue! 1 LIMRA and LIFE Foundation 2011 Insurance Barometer Study 2 LIMRA International, Trends in Life Insurance Ownership,

7 LABI Basic Group Term Life Lie f Choice of Coverage Rates Employers with 2-9 Eligible Employees Maximum Benefit - Up to $50,000 Minimum Benefit - Up to $10,000 Choose between a flat benefit option or salary-based benefits DEPENDENT LIFE Spouse: $5,000; Child: 14 days old to age 26, $5,000 Spouse: $10,000; Child: 14 days old to age 26, $10,000 Spouse and children coverage is guaranteed issue Age-based Employers with 10 or More Eligible Employees Maximum Benefit - Up to $700,000 Minimum Benefit - Up to $10,000 Choose between a flat benefit option or salary-based benefits DEPENDENT LIFE Spouse: $5,000; Child: 14 days old to age 26, $5,000 Spouse: $10,000; Child: 14 days old to age 26, $10,000 Spouse and children coverage is guaranteed issue Composite Multi-year rate guarantees Guaranteed Issue Up to $50,000 Up to $500,000 Contributions/ Participation Non-Contributory: 100% employer contributions of premiums 100% participation Non-Contributory: 100% employer contributions of premiums 100% participation Contributory: Minimum employer contribution of 25% Requires 75% participation AD&D Living Benefits- Accelerated Death Disability Premium Waiver Conversion Privilege Accident Benefit equal to the amount of basic life for accidents resulting in loss of life, limbs, hearing or sight. Seat Belt Benefit pays an additional 10 percent of the principal sum amount to a maximum of $10,000. Air Bag Benefit pays an additional 5 percent of the principal sum amount to a maximum of $5,000, if seat belt is also used. Exposure and disappearance benefit allows covered benefits to be paid within 12 months of disappearance, if due to a forced landing, stranding, sinking or wrecking of a conveyance. Option for terminally ill employees to receive up to 50 percent of their basic life insurance benefit up to $125,000 while they are still living, if they are given a terminal diagnosis of 12 months or less. Employees or their dependents may continue coverage without paying their premium if the employee becomes disabled prior to age 60. Coverage ceases when the employee is no longer disabled or reaches the Social Security normal retirement age. Employees and their dependents may apply to convert part or all of their group insurance to an individual policy, if they terminate or are no longer eligible for coverage. Employees must apply within 31 days of termination or from the date they are no longer in an eligible class. 5

8 LABI voluntary Term Life Employers with 10 or More Eligible Employees Choice of Coverage Rates Guaranteed Issue Enrollment Portability AD&D Living Benefits- Accelerated Death Disability Premium Waiver Conversion Privilege Choose between incremental, flat or salary-based benefit options Maximum benefit Up to $500,000, not to exceed five times salary Spouse coverage Up to 50 percent of employee benefit with up to a guarantee issue of $50,000 and a benefit maximum of $250,000 Dependent children coverage Up to $10,000 benefits Age-based Preferred, Standard and Non-Standard based on Standard Industrial Classification (SIC) Guaranteed issue is available for all active, full-time employees. Evidence of insurability is required for amounts above the guaranteed issue. Greater of 6 enrolled or 25% participation required. Pre-filled employee applications and summary benefit descriptions are available to assist with enrollment meetings for groups with 50 or more eligible lives. Participation can be modified when a mandatory employee meeting is scheduled with one of our representatives. Employees have the option to continue a portion or all of their voluntary coverage when they leave employment for any reason other than retirement, sickness or injury. Employees must apply within 31 days of termination or from the date they are no longer in an eligible class. Accident benefits are equal to the amount of the voluntary life benefits for accidents resulting in loss of life, limbs, hearing or sight. Seat Belt benefit pays an additional 10 percent of the principal sum amount to a maximum of $10,000. Air Bag benefit pays an additional 5 percent of the principal sum amount to a maximum of $5,000, if seat belt is also used. Exposure and disappearance benefit allows covered benefits to be paid within 12 months of disappearance, if due to a forced landing, stranding, sinking or wrecking of a conveyance. Option for terminally ill employees to receive up to 50 percent of their voluntary life insurance benefit up to $125,000 while they are still living, if they are given a terminal diagnosis of 12 months or less. Employees or their dependents may continue coverage without paying premium if the employee becomes disabled prior to age 60. Coverage ceases when the employee is no longer disabled or reaches the Social Security normal retirement age. Employees and their dependents may apply to convert part or all of their voluntary group insurance to an individual policy, if they terminate or are no longer eligible for coverage. Employees must apply within 31 days of termination or from the date they are no longer in an eligible class. 6

9 LABI voluntary high-limit ad&d Lie f Employers with 10 or More Eligible Employees Choice of Coverage Minimum Benefit $50,000 Maximum Benefit Up to $250,000, not to exceed 10 times salary Rates Employee only Employee and family Participation Participation must be the greater of 15 percent of eligible employees or 10 lives. Sample Benefit Summary COVERAGE (for covered employees) Loss of Life... Loss of Two or More Members*... Loss of One Member... Loss of Thumb & Index Finger of Same Hand... principal sum principal sum 1/2 the principal sum 1/4 the principal sum * Member means hand, foot or eye BENEFIT MAXIMUMS Employee... Up to $250,000 Spouse... 60% of Employee principal sum up to $125,000 Child(ren)... 10% of Employee principal sum up to $25, % BENEFIT REDUCTIONS (beginning at age 70) % % 85 and over... 85% Employee benefits terminate at retirement Spouse benefits terminate at age 70 General Conditions for All Life Products For consistency and accuracy, when adding life or disability benefits to existing medical insurance with a first-of-the-month billing date, the new benefits will have a first-of-the-month effective date. The same applies for groups with a 15th-of-the-month billing date. Eligibility for actively at work, full-time employees requires a minimum of 30 hours per week for our medical, life, disability and other ancillary products. Waiting periods are allowed to vary by product within a single group. Employers have the option to tie their life and/or disability coverage to their medical coverage. Evidence of insurability is required for amounts above the guaranteed issue. 7

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11 Dsabi i lity Southern National Life is an independent licensee of the Blue Cross and Blue Shield Association. 9

12 Impact of disability on the workforce Almost 3 in 10 workers entering the workforce will become disabled before age 67. National Safety Council, Injury Facts, 2010 Ed. In the last 10 minutes, 490 Americans became disabled. US Social Security Administration, Social Security Basic Facts, Aug Approximately 90% of disabling accidents and illnesses are not work related; therefore, not covered by workers compensation. Council for Disability Awareness, CDA 2010 Long Term Disability Claims Review These are alarming statistics. It just goes to show how important protection against lost income can be to a workforce. Unfortunately, many people have not planned for the financial burden they will face if they should become disabled and unable to work for an extended period of time. Helping employees stay at work. Our disability coverage encourages employees to continue working as long as they are safely able protecting their eligibility for benefits and without penalty. Employees are able to satisfy the elimination period with only a loss of duties. We can extend the elimination period up to a year for disabled employees who do not meet the earnings loss amount. An employee doesn t have to be totally disabled to receive benefits. Our disability coverage allows disabled employees to return to work for up to one-half of the elimination period without restarting it if they are unable to endure their return to work. Protecting employers and employees. Our disability coverage helps protect employees, which in turn protects the employer s company. Here are a few highlights see this booklet for more specific details. Our disability coverage does not have limitations for symptoms that are self-reported or subjective. We manage all employees claims carefully and effectively. There is a treatment-free period within the pre-existing condition limitation. During this period, if the employee does not receive treatment for the pre-existing condition, he or she may qualify for benefits before completing the continuous days of coverage period. WHO PAYS THE PREMIUM? PREMIUM TAXABLE? BENEFIT TAXABLE? how are benefits taxed? Non-Contributory Employer pays 100% Contributory Employer pays 50% Employee pays 50%... No... Yes... 50%... 50% Voluntary Employee pays 100%... Yes... No The above illustration assumes disability insurance premiums are not deducted on a pre-tax basis in an employer-sponsored cafeteria plan. Blue Cross and Blue Shield of Louisiana is not engaged in rendering tax, legal or investment advice. We recommend you seek the guidance of a tax professional or financial advisor. 10

13 LABI Short-Term Disability Products Dsabi i lity Group Employers with 2-9 Eligible Employees Group + voluntary Employers with 10 or More Eligible Employees Contributions/ Participation Benefit Percentages Non-Contributory: 100% employer paid 100% participation 60% Non-Contributory: 100% employer paid 100% participation Contributory: Minimum employer contribution of 25% 75% participation Voluntary: Employee paid Greater of 25% or 10 eligible employees enrolled Group: 50%, 60% or 66 2/3% Voluntary: employees: 60% 36+ employees: 50%, 60% or 66 2/3% Day Benefit Begins 1st, 8th or 15th day for accident 8th or 15th day for sickness 1st, 8th or 15th day for accident 8th, 15th or 30th day for sickness Benefit Duration 13 or 26 weeks 9, 11, 13 or 26 weeks Guaranteed Issue and Maximum Benefit Up to $400 per week employees: Up to $1,000 per week 36+ employees: Up to $2,500 per week Disability Definition Totally disabled or disabled and working Loss of duties and income Totally disabled or disabled and working Loss of duties and income Features Maternity No pre-existing limitation Maternity Group: No pre-existing limitation Voluntary: Pre-existing limitation 3/6/12 months (look back period/treatment free/continuously insured period) Continuity of coverage Product Eligibility Must be in business for minimum of two years. Must not insure more than 50% immediate family members. Group STD can only be written with group term life; stand-alone STD is not available. Must be in business for minimum of two years. Must not insure more than 50% immediate family members. Group STD can only be written with group term life; stand-alone STD is not available. 11

14 LABI Long-Term Disability Products Contributions/ Participation Benefit Percentages Elimination Period Benefit Duration Guaranteed Issue and Maximum Benefit Disability Definition Pre-existing Limitation (in months) Features Product Eligibility Group Employers with 2-9 Eligible Employees Non-Contributory: 100% employer paid 100% participation 60% 2-3 employees: 180 days 4-9 employees: 90 or 180 days 2-3 employees: five year graded 4-9 employees: five year graded, or ADEA 1 1 with SSNRA employees: Up to $3,000 per month 4-9 employees: Up to $6,000 per month 24 month own occupation and any occupation thereafter Loss of one essential duty during elimination period 12/24 (look back period/continuously insured period) Standard: - Waiver of premium - Survivor income benefit - Return to work incentive - Workplace modification - Disability guidance (EAP) - LTD continuity of coverage - Mental, nervous, substance abuse coverage Must be in business for minimum of two years. Must not insure more than 50% immediate family members. Can be written stand-alone or with any other life or disability product. Group + voluntary Employers with 10 or More Eligible Employees Non-Contributory: 100% employer paid 100% participation Contributory: Minimum employer contribution of 25% 75% participation Voluntary: Employee paid Greater of 25% or 10 eligible employees enrolled employees: 60% 36+ employees: 50%, 60% or 66 2/3% employees: 90 or 180 days 36+ employees: 60, 90, 120, 180 or 365 days employees: five year graded, or ADEA 1 with SSNRA 36+ employees: ADEA 1 with RBD 3, or ADEA 1 with SSNRA Group:* employees: Up to $10,000 per month 36+ employees: Up to $15,000 per month Voluntary:* employees: Up to $6,000 per month 36+ employees: Up to $15,000 per month 24 month own occupation and any occupation thereafter Loss of one essential duty during elimination period 36+ employees: Other options available employees: 12/ employees: 3/12, 12/24, 3/6/12, 12/6/24, 12/12 Standard: - Waiver of premium - Survivor income benefit - Return to work incentive - Workplace modification - Disability guidance (EAP) - LTD continuity of coverage - Mental, nervous, substance abuse coverage Optional (Group): - Cost of living adjustment - Activities of daily living - Accidental dismemberment/loss of sight benefit Must be in business for minimum of two years. Must not insure more than 50% immediate family members. Can be written stand-alone or with any other life or disability product. * Industry restrictions could lower guaranteed issue amounts. 1 ADEA 1 Age Discrimination Employment Act 2 SSNRA Social Security Normal Retirement Age 3 RBD Reduced Benefit Duration 12

15 Disability Claims Expertise Dsabi i lity STD CLAIM SEAMLESS DISABILITY CLAIM TRANSITION At the mid point of STD, the claim is given to an LTD analyst who manages the end of the STD claim, gathers LTD information and develops a plan for ongoing claim management. LTD CLAIM Short-Term Disability We offer provisions in our policy that help make it easier for disabled employees who are able to work to continue to do so while still qualifying for the benefits they need. Dedicated STD return-to-work coordination helps employees get back to work faster. Our contract does not require a period of total disability to qualify for benefits. Our STD and LTD contracts work together to allow disabled employees to return to work for up to one-half the LTD elimination period without restarting it; and, without having to start a new STD claim should they be unable to sustain their return to work. We offer telephonic claims intake for groups of all sizes. telephonic std intake Telephonic Intake Analyst Gathers information from employee. Contacts the employer. Short-Term Disability Analyst Reviews employee s claim based on automatic system prompt or referral from intake analyst. Utilizes specialized resources to make decisions and determines ongoing case management plan. Dedicated Rehabilitation Expert Reviews claims for return to work potential at specific intervals. Coordinates with employee, physician and employer to facilitate faster, smoother return to work. 13

16 LABI Long-Term Disability Our LTD plan supports employers so they can focus on helping their employees, while also encouraging employees to stay on the job as long as they can or return to work sooner. Our definition of disability allows employees to satisfy the elimination period with only a loss of duties. Return to work incentive: Allows employees to receive up to 100 percent of their pre-disability income for the first 12 consecutive months following the date they first returned to work. Workplace modifications: Helps with expenses for adaptations to the worksite that are necessary for a disabled employee to return to work. Family care credit: A disabled employee can use this credit to help with expenses needed to care for any dependent family member if the employee is participating in an approved rehabilitation program. Disability Guidance: Supporting a healthy return to work When an employee becomes disabled, coming back to work is often a long and bumpy road. Our disability coverage provides support to help smooth out the bumps and make a healthy return to work easier for employers and their employees. Our Disability Guidance service provides insured employees, whether disabled or actively at work, with Long-Term Disability up to five counseling sessions per year that give confidential support for emotional, legal and financial issues. EMPLOYEE ASSISTANCE PROGRAM Telephonic assessments and counseling that include confidential sessions with a counselor, financial planner and/or an attorney. 24-hour access to counselors with master s or doctoral degrees in counseling via a dedicated toll-free phone number 365 days a year. Referrals to resources and services in callers communities are provided, such as community and governmental agencies serving the disabled, homemaker services, assistive equipment and day care for children and elderly parents. Employees are provided access to self-assessment tools, information and other resources through a password-protected interactive website. General Conditions for All Disability Products For consistency and accuracy, when adding life or disability benefits to existing medical insurance with a first-of-the-month billing date, the new benefits will have a first-of-the-month effective date. The same applies for groups with a 15th-of-the-month billing date. Eligibility for actively at work, full-time employees requires a minimum of 30 hours per week for our medical, life, disability and other ancillary products. Waiting periods are allowed to vary by product within a single group. Employers have the option to tie their life and/or disability coverage to their medical coverage. 14

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20 BENEFITS you can see Standard Vision Benefits (When visiting a Davis Vision network provider) National network Eye exams Eyeglass lenses Eyeglass frames Contact lenses Lasik surgery Network of more than 35,000 providers including optometrists, ophthalmologists and regional retail locations. Your employees pay little or no copayment for a comprehensive eye exam. Your employees pay little or no copayment for single vision, bifocal or trifocal lenses. Your employees pay little or no copayment for frames from the Davis Vision Collection, or receive up to a $175 allowance toward the cost of other frames. Your employees pay little or no copayment for contact lenses from the Davis Vision Collection or receive up to a $150 allowance toward the cost of contact lenses. Your employees may access discounts from participating providers but this is not an insured benefit. IN-NETWORK BENEFITS (must visit a Davis Vision Provider) VISION PLAN OPTIONS PLAN 1 PLAN 2 PLAN 3 Frequency - Once Every: Eye Health Examination Including Dilation (when professionally indicated) 12 Months 12 Months 12 Months Spectacle Lenses 12 Months 12 Months 12 Months Frame 12 Months 24 Months 24 Months Contact Lens Evaluation, Fitting and Follow Up 12 Months 12 Months 12 Months Contact Lenses (in lieu of eyeglasses) 12 Months 12 Months 12 Months Copayments Eye Health Examination $0 $0 $10 Eyewear (Spectacle Lenses and/or Frames) $0 $15 $25 Davis Vision is an independent company that provides an extensive network of vision care providers on behalf of Blue Cross and Blue Shield of Louisiana. 18

21 Contribution Requirements Participation Requirements Employer-paid: Contributory: Voluntary: 100% Employer funding 100% of eligible employees must enroll 25%-99% Employer funding Greater of 75% or 10 eligible employees must enroll 0%-24% Employer funding Greater of 25% or five eligible employees must enroll for groups with eligible employees Greater of 25% or 10 eligible employees enrolled for groups with more than 50 eligible employees Groups with 2-9 eligible employees may only choose employer-paid contribution. There s no such thing as a plan that s too good. That s why each of our vision plans is packed with features that don t cost you or your employees anything extra. One-year breakage warranty for eyeglasses Features Eyeglasses covered by your plan come with a one-year warranty for repair or replacement, which begins on the date you receive your glasses. Your plan covers: Spectacle lenses Davis Vision collection frames National retailer frames, where exclusive collection is not displayed Medically necessary contacts Your provider may presrcibe contact lenses in lieu of eyeglasses for treatment of certain conditions. When contact lenses are medically necessary, they will be covered subject to prior approval and applicable copayments and allowances. Replacement contact lens It s easy to replace your contacts through the Lens program mail order program. Just call LENS-123 or visit with your prescription to get started. 20% discount At most of our network retailers, you ll get a 20% 1 discount on items not covered by your plan, like second pairs, sunglasses, etc. In most cases, disposable contact lenses are available at a 10% 1 discount. Laser vision correction discounts You can get up to 25% off of the cost of laser vision correction surgery when you use doctors in the Eye Centers of Excellence network. 1 Discount not available at Walmart and Sam s Club locations. General Conditions For consistency and accuracy, when adding vision benefits to existing medical insurance with a first-of-the-month billing date, the new benefits will have a first-of-themonth effective date. The same applies for groups with a 15 th -of-the-month billing date. Eligibility for actively at work, full-time employees requires a minimum of 30 hours per week for our medical, vision and other ancillary products. Groups may only choose one vision plan and one premium funding contribution type. 19

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24 BENEFITS THAT MAKE your employees smile DID YOU KNOW? 164 million work hours are lost every year to dental health issues. 1 Nearly 75 percent of American adults suffer from various forms of gum disease from simple inflammation to severe cases and don t even know it. 2 More than 90 percent of all systemic diseases have oral health symptoms. 3 People with dental coverage exhibit healthier behaviors and better oral health habits including brushing with fluoride toothpaste twice a day, flossing daily and visiting the dentist regularly report from Pew Center 2 American Dental Hygienist Association 3 Academy of General Dentistry report from NADP Protecting Your Employees Oral Health With the recent research showing how important oral health is to overall health, having a dental insurer who is dedicated to affordable, quality dental care is more important than ever. Whether you re looking for a dental plan to fit a business budget or your employees checkbooks, Blue Cross has the solution. Regardless of the dental plan you choose, making the decision to secure dental coverage for your employees is the right choice. 22

25 LABI group dental plan Blue Cross and Blue Shield of Louisiana HAS a dental solution that s right for you Ideal for individuals and families that do not have dental insurance offered through their employer. Blue Dental for individuals Utilizes the Advantage Plus PPO Network, an extensive network of nationwide dentists. Two plans offering reliable and convenient dental coverage. Available for groups with a reported Medical Loss Ratio (MLR) employee count of 50 or fewer employees. Blue Dental for small group Utilizes the Advantage Plus PPO Network, an extensive network of nationwide dentists. Allows employers to give their employees the benefits they want with little or no costs to the employer. Choose from three plans that offer a variety of comprehensive dental services. Available for groups with a reported MLR employee count of 51+ employees or groups with ASO medical. Large Group Dental Utilizes the Blue Cross Dental Network, giving your employees the freedom to choose from a large network of Louisiana dentists. Several cost-effective standardized dental plans are available. Customized plans are also available based on group size. Employee s Choice product available for groups with a reported MLR employee count of 51+ employees or groups with ASO medical. LArge group voluntary dental If dental insurance is not in the company budget as a core benefit, voluntary dental may be the solution. Allows employers to give their employees the benefits they want with little or no costs to the employer. Members may use the dentist of their choice with no network. 1 Does not apply to Diagnostic and Preventative Services Waiting periods apply to some benefits. See contract and schedule of benefits for details. 23

26 small GROUP Dental Covera ge If you are like most employers, you consider dental coverage an essential part of your employees overall health care plan. When you choose Blue Dental coverage, you re choosing a wide range of benefits and services that will encourage your employees to be the healthiest and most productive they can be. Choose from three plans that offer a variety of comprehensive dental services* Preferred Plus Preferred Essential If you would like to offer your employees a higher level of complete coverage, you can have it all with a Blue Dental Preferred Plus plan. This dental option has the highest adult annual benefit maximum of $1,500 and a $50 annual deductible per member. If you don t want to compromise on coverage, but are looking for a lower-cost option for your employees, consider a Blue Dental Preferred plan. This dental option covers the same services as Preferred Plus, but with a lower adult annual benefit maximum of $1,000 and a $50 annual deductible per member. Blue Dental Essential plans are a good balance between keeping dental care costs in check and not skimping on the coverage your employees need. This option allows you to offer excellent dental coverage to your employees while keeping the overall cost low. This plan offers a $1,000 adult annual benefit maximum, $75 annual deductible per member, and slightly lower coinsurance for covered services. Each plan option includes an unlimited annual benefit maximum and no waiting periods for majority of dental services for children under age 19. * The Preferred and Essential plans are CMS certified. The Preferred Plus plan includes all the required pediatric dental essential health benefits (PDEHB), but is not a CMS certified plan. Therefore, groups who purchase a Preferred Plus must include the PDEHB in their medical plan. Dental Plan Features Preventive Care is Covered Employees are encouraged to receive preventive dental care (including exams, cleaning and routine X-rays) since it is paid at 100 percent coinsurance and is exempt from the deductible. Good oral health habits, including receiving preventive dental exams, reduce the risk of more serious and expensive dental problems in the future. Excellent Coverage for Other Services If your employees should need significant dental care, all dental plans provide coverage for major services such as dental surgery, root canals and crowns. Basic services such as space maintainers, simple extractions and basic restorative are also covered. Product Eligibility Small groups with a reported Medical Loss Ratio (MLR) employee count of 50 or fewer are eligible to purchase Minimum of two benefit-eligible employees to be enrolled as minimum participation Employer contribution is 0% - 100% of employee cost 24

27 ADVANTAGE PLUS PPO network With Blue Dental, our members may access the Advantage Plus PPO Network*. This extensive dental network of nationwide dentists provides our members: Access to over 900 dentists and 1,600 locations throughout Louisiana Access to over 78,000 credentialed dentists nationally 45% of all dentists nationwide participate in-network Strong rural and suburban focus Over 99% of dentists in-network are accepting new patients Find a dentist: To find a dentist in the Advantage Plus PPO Network, visit FindADoctor. If your dentist is not currently participating in the network, you can nominate your dentist by calling *Advantage Plus Network PPO is administered by United Concordia Companies, Inc. United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana members. Visit an Advantage Network Dentist for Maximum Value Although you can use any licensed dentist with a Blue Dental plan, a network dentist will: Save your employees money: Network dentists have agreed to accept the Blue Cross payment, plus your deductible and coinsurance, as payment in full for covered services. They will not bill for any balance over that amount. Save your employees time: Network dentists automatically file claims with us, so it s one less thing for your employees to do. Since we pay dentists directly, there s no waiting for reimbursement. Give your employees freedom: Neither your employees nor their family members are tied to one dentist. With access to the extensive Advantage Plus network, all family members can choose a dentist they like. 25

28 LARGE GROUP & Large Group Voluntary Dental Covera ge Dental Solutions from the Cross and Shield Blue Cross and Blue Shield of Louisiana has dental options for large employers. Choose from seven Blue Cross dental plans that offer a variety of dental services. Or if dental insurance is not in the company budget as a core benefit, voluntary dental may be the solution. Large Group Voluntary Dental Product of Southern National Life Voluntary dental plans offering affordable protection for employees and their families Choice of annual benefit maximums: $1,000, $1,200, $1,500, $2,000 Diagnostic and Preventive Services are covered at 100% with no waiting periods Basic Services are covered at 80% and coverage for Major Services at 50% Traditional orthodontia is available Members may visit the dentist of their choice - no network Product Eligibility Large Groups with a reported Medical Loss Ratio (MLR) employee count of 51+ employees or groups with ASO medical. Greater of 10 employees or 35% of full time active eligible employees enrolled. Lower participation for larger group sizes. Employer contribution is 0-100% 26

29 Choose the Plan that is Right For Your Group Large Group Dental Coverage Product of Blue Cross and Blue Shield of Louisiana Seven dental plans to choose from Deductibles per benefit period range from $50 to $100 Maximum benefits per benefit period range from $1,000 to $2,000 Diagnostic and Preventive Services are covered at 100% with no waiting periods Basic Services are covered at 80% Coverage for Major Services ranges between 50% and 60% Traditional orthodontia is covered in some plans Members use the Blue Cross Large Group Dental Network Product Eligibility Large groups with a reported Medical Loss Ratio (MLR) employee count of 51+ employees or groups with ASO medical are eligible to purchase large group dental Employer contribution is 50% of employee cost 50% participation is required BLUE CROSS DENTAL NETWORK The Blue Cross Dental Network is a network of dentists linked together with Blue Cross to bring our members a more cost-effective dental plan. The Blue Cross Dental Network continues to give you and your employees the freedom to choose from a large network of dentists. For a list of dentists in your area, go to All participating dentists have agreed to accept the Blue Cross payment, plus your deductible and coinsurance, as payment in full for covered services. They will not bill for any balance over that amount. All claims payments go directly to the participating dentist for covered services rendered. If you choose a non-participating dentist, you may have to file your own claims and be responsible for paying the dentist for all charges. This amount may include any difference between the Blue Cross allowable charge and the fee charged by the dentist. You will receive payment for covered services by non-participating dentists and will be responsible for paying the dentist. All benefits are based on allowable charges for covered services. You and your employees have predictable out-of-pocket expenses when you use the services of a participating dentist. You can be assured that your dentist will file claims efficiently and that Blue Cross will pay these claims promptly. 27

30 Customer Service We re easy to find and happy to help you. If you need to reach us: Phone BLUE (2583) We re available Monday through Friday, 8 a.m. 5 p.m. Online Find help online 24 hours a day. Mail 5525 Reitz Ave. Baton Rouge, Louisiana Local We have eight regional offices around the state. Find us at any of the following locations. We d love to see you. More info Contact your Blue Cross Regional office for more product information and rates. Regional Offices Alexandria Coliseum Blvd., Suite A Alexandria, LA Baton Rouge Reitz Ave. Baton Rouge, LA Houma St. Charles Street, Suite 135 Houma, LA Lafayette Johnston St., Suite 200 Lafayette, LA Lake Charles West Prien Lake Road Lake Charles, LA Monroe Mercedes Dr. Monroe, LA New Orleans North Causeway Blvd., Suite 600 Metairie, LA Shreveport Ashley Ridge Blvd. Shreveport, LA

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