Reform -- Perspective. small business

Transcription

1 Health Care Reform -- the Dental Perspective How it effects How it effects small business

2 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 consider consulting with your lawyer or tax advisor before acting based on this information. 2

3 Background

4 Dental Matters 4

5 ACA Quick Facts Dental benefits in small group (50 employees and under) and individual markets required to be compliant in 2014 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 is the minimum package of benefits to be offered on and off the public marketplace and includes pediatric dental services 5

6 Required Pediatric Dental Benefit Under age 19 Annual out-of-pocket limits not to exceed $700 per 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 requirement to purchase 6

7 Required Actuarial Values Medical Coverage Levels Stand-Alone Dental Coverage Levels Bronze Silver High 60% 70% 85% Gold 80% Platinum 90% Low 70% 7

8 Key Points: Employers do not have to purchase dental coverage from a medical carrier 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 medical coverage 98% of all dental plans are purchased separate from medical plans 8

9 Levels Requireme nts Cost Sharing Stand-Alone Pediatric Dental Plan High Plan Low Plan Dental coverage must meet ACA requirements Not to exceed $700 per child /$1,400 per contract Pediatric Dental Embedded with Medical Part of overall metal level bronze thru platinum. Metal levels have to meet overall metal actuarial value not dental levels. A high metal plan could still have low dental coverage. MAY BE Subject to medical outof-pocket (OOP) - annuals are $6,350 individuals/ $12,700 for family. 9

10 Stand-Alone Dental Is Better Facilitates transparency and informed decision making Flexibility on plan choice Provides employees choice in coverage Transparent disclosure of dental benefit plan design and pricing 10

11 Delta Dental of Illinois Small Group Offering

12 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 rider members can use both benefits 12

13 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 13

14 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 necessary 14

15 Kids Dental Wellness Plus (Illinois Children Under 19) Deductible (benefit year; per person, applies to basic and major services only) Out-of-pocket limit $25 $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) Basic Services (fillings, simple extractions, gum disease 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) Medically Necessary Orthodontia 100% Delta Dental PPO network/0% out-of-network 80% Delta Dental PPO network/0% out-of-network 50% Delta Dental PPO network/0% out-of-network 50% Delta Dental PPO network/0% out-of-networkof Enhanced Benefits Program Included

16 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 0.5% to single +1 rate 7.5% to single +2 or more 16

17 Key Points: Adult coverage unchanged Enhanced Benefits Program included in both plans compliments wellness programs and underscores link between oral health and overall health ToGo SM Annual Maximum Carryover stays in plans that have it Covered dependents under age 19 can continue to 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 17

18 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 small groups to renew 12/1/

19 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 No stand-alone option -- must be part of a qualified health plan No changes to DeltaVision plans 19

20 Delta Dental of Illinois Small Group Renewals: Cover letter explaining EHB rider option Existing gplan renewal Renewal with EHB rider added Renewal options Support collateral Delta Dental of Illinois Small Group Quotes: Cover letter explaining i EHB rider option Quote will include EHB rider option 20

21 Voluntary Coverage Delta Dental PPO Maximum Allowable Charge Voluntary Feature Good option for small groups that don t offer dental No employer contribution 21

22 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 Will introduce to individual members at renewal 22

23 Working Together

24 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 benefits from standard plan design as well Allows members to keep current dentists Provides minimal disruption at reasonable rates 24

25 Delta Dental Mobile App

26 Delta Dental Mobile App (the Smart Way to Manage Your Benefits on Your Smart Phone) Without logging in: Find a network dentist Brush for the recommended 2 minutes with our Toothbrush h Timer tool With log in: View a mobile ID card View coverage and claims information Available using Apple and Android devices Search for Delta Dental 26

27 Effective Discount Methods of Measurement

28 Delta Dental PPO Plus Premier Delta Dental Network Delta Dental PPO 176,492 dentist locations Dlt Delta Dental tlpremier 260,413 dentist locations Non-network Other PPO Carriers Other PPO Networks 110, ,000 dentist locations Delta Dental Premier PPO Plus Non-networknetwork 28

29 Know the Numbers Behind a Dental Carrier s Network Delta Dental offers access to the largest network nationwide with an industry- leading effective discount averaging 20.3 percent nationally. Sources: March 2013 Independent NetMinder Data; based on the Delta Dental Premier network / Ruark Consulting LLC s 2012 Dental PPO Network Study 29

30 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 assessment an accurate 30

31 Questions?