Children s Dental Insurance Plan Rates 2014

Transcription

1 Children s Dental Insurance Plan Rates 2014 June 25, 2013 updated Sept. 6, 2013

2 About Covered California TM Covered California is the state s marketplace for the federal Patient Protection and Affordable Care Act. Covered California was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California will help individuals determine whether they are eligible for premium assistance that will be available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses will be able to purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits. Covered California is an independent part of the state government whose job is to make the new market work for California s consumers. It is overseen by a fivemember board appointed by the Governor and the Legislature. For more information on Covered California, please visit CoveredCA.com. Table of Contents About the Covered California Children s Dental Insurance Plans...3 Dental Insurance Companies by Pricing Region...6 Pricing Regions...11 Profiles of Participating Dental Insurance Companies...48 Glossary...54 This booklet does not include pediatric dental rates for the Small Business Health Options Program (SHOP) Covered California Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

3 About Covered California s Children s Dental Insurance Plans California children will get expanded opportunities for better dental health, thanks to Covered California s offerings of children s dental insurance plans. The plans are for children up to 19-years-old. Purchase of the children s dental insurance plan is not required. However, the plans offer comprehensive child dental coverage, particularly important for consumers of child-only coverage and family plans. The participating dental insurance plans are: Blue Cross of California of California Dental of California Dental Plan of California Dental and Vision There are three different product types available, depending on where the child lives. The Dental Preferred Provider Organization () product offers a wide variety of provider choice within a network of participating dentists and coverage for some out-of-network services. The Dental Exclusive Provider Organization (DEPO) works like a but does not provide coverage for services provided by dentists outside the network. The Dental Health Maintenance Organization () limits coverage to services provided by a dentist within a network and generally requires a referral to be seen by a specialist. Covered California children s dental insurance plans feature standard copayments, deductibles and coinsurance requirements. Dental plans come in two actuarial value options: 85 percent, which features higher premiums but lower average out-ofpocket costs; and a 70 percent value plan with lower premiums and higher average out-of-pocket costs. An actuarial value is the percentage of total average costs for benefits that a dental plan will cover. These premiums are for stand-alone plans, insurance products that can be purchased by themselves to cover a specific service. Dental insurance plans must follow Covered California standard benefit designs. Standardizing benefits ensures that the selected plans define what the consumers get and limit the consumer s out-of-pocket costs. 2 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

4 Children s Dental Plan Standard Benefit Designs Children s Dental Plan Standard Benefit Designs ENROLLEE PAYS Coverage category High Low Diagnostic & preventative 0% * 0% * ENROLLEE PAYS Coverage category High Low Diagnostic & preventative $0 $0 Office visit N/A N/A Basic services 20% 50% Office visit $0 $20 Basic services $40 * $95 * Major services $365 ** $365 ** Major services 50% ** 50% ** Orthodontics 50% 50% Enrollee costs Orthodontics $1,000 $1,000 Enrollee costs Deductible none none Deductible $50 (does not apply to diagnostic & preventative services) $60 Annual maximum none none Out-of-pocket maximum $1,000 $1,000 Annual maximum none none Waiting periods none none Out-of-pocket maximum $1,000 $1,000 Actuarial value 87% 72% Waiting periods none none Actuarial value 86% 72% * Diagnostic and preventative services include x-rays, exams, cleanings and sealants. **Major services include: crowns and casts, prosthodontics, endodontics, periodontics and oral surgery. * basic services copayments vary by procedure within this category. The plan s average copay charge for procedures in this category cannot exceed the stated amount, but may be lower. ** major services copayments vary by procedure within this category. The plan s average copay charge for procedures in this category cannot exceed the stated amount, but may be lower. 1 When more than one child is covered by a pediatric dental plan or policy, the policy/plan deductibles and out-of-pocket maximum amounts are equal to two times the individual values, however, each individual child is responsible only for the single deductible and out-of-pocket maximum in a plan year. 2 DEPO products conform to Benefit Plan Design 4 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

5 Dental Insurance Companies by Pricing Region Region Counties Insurance Companies 1 Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne 2 Napa Sonoma Solano Marin 3 Sacramento Placer El Dorado Yolo,, DEPO,,, DEPO,,,, 4 San Francisco,,, 5 Conta Costra,, DEPO, Dental Insurance Companies by Pricing Region Region Counties Insurance Companies 6 Alameda,,, 7 Santa Clara,,, 8 San Mateo,, DEPO, 9 Santa Cruz Monterey San Benito,, DEPO, 10 San Joaquin Stanislaus Merced Mariposa,, DEPO, Tulare 6 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

6 Dental Insurance Companies by Pricing Region Region Counties Insurance Companies Dental Insurance Companies by Pricing Region Region Counties Insurance Companies 11 Fresno Kings Madera,, DEPO, 16 Los Angeles (partial),,, 12 San Luis Obispo Ventura Santa Barbara,, DEPO, 17 San Bernardino Riverside,,, 13 Mono Inyo Imperial,, DEPO, 18 Orange,,, 14 Kern,,, 19 San Diego,,, 15 Los Angeles (partial),,, 8 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

7 Pricing Region 1 Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne $24.90 $30.20 $19.60 $22.00 * $15.49 $19.49 $30.50 $37.98 DEPO $27.42 $29.52 ** $15.14 $16.69 $24.90 $28.13 *Only in Amador, Butte, Calaveras, Colusa, Glenn, Humboldt, Lake, Mendocino, Nevada, Plumas, Shasta, Sutter, Tehama, Trinity, Tuolumne, and Yuba counties **Only in Butte, Humboldt, Lake, Mendocino, Shasta and Sutter counties 10 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

8 Pricing Region 2 Napa, Sonoma, Solano, Marin $27.25 $33.05 $19.60 $22.00 $12.49 $15.49 $33.18 $41.31 DEPO $18.52 $21.83 * $15.14 $16.69 $27.79 $31.22 * Only in Napa, Solano and Sonoma counties 12 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

9 Pricing Region 3 Sacramento, Placer, El Dorado, Yolo $27.25 $33.05 $9.80 $10.80 $20.90 $23.50 $11.49 $15.49 $30.45 $37.91 $16.83 $19.20 $15.14 $16.69 $25.27 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

10 Pricing Region 4 San Francisco $32.00 $38.85 $20.90 $23.50 $11.49 $14.49 $35.09 $43.70 DMHO $10.29 $14.68 $15.94 $17.50 $31.46 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

11 Pricing Region 5 Contra Costa $31.05 $37.65 $19.60 $22.00 $11.49 $14.49 $33.57 $41.80 DEPO $26.65 $28.68 $15.14 $16.69 $29.84 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

12 Pricing Region 6 Alameda $31.05 $37.65 $19.60 $22.00 $11.49 $14.49 $33.89 $42.20 $10.26 $14.08 $15.22 $16.78 $30.09 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

13 Pricing Region 7 Santa Clara $31.05 $37.65 $20.90 $23.50 $11.49 $14.49 $34.54 $43.01 $10.26 $15.42 $15.80 $17.35 $33.75 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

14 Pricing Region 8 San Mateo $32.00 $38.85 $20.90 $23.50 $11.49 $14.49 $35.15 $43.77 DEPO $29.34 $31.98 $15.62 $17.17 $30.62 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

15 Pricing Region 9 Santa Cruz, Monterey, San Benito $27.25 $33.05 $19.60 $22.00 $12.49 $15.49 $32.71 $40.73 DEPO $18.52 $21.83 * $29.17 $30.55 $29.55 $33.10 *Only in Monterey and Santa Cruz counties 26 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

16 Pricing Region 10 San Joaquin, Stanislaus, Merced, Mariposa, Tulare $22.15 $26.85 $19.60 $22.00 $12.49 $15.49 $29.87 $37.20 DEPO $14.21 $17.76 * $15.14 $16.69 $24.16 $27.40 *Only in Merced, San Joaquin, Stanislaus and Tulare counties 28 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

17 Pricing Region 11 Fresno, Kings, Madera $21.05 $25.50 $18.70 $21.00 $11.49 $15.49 $29.22 $36.38 DEPO $12.32 $15.87 * $15.00 $16.51 $23.98 $27.23 *Only in Fresno and Kings counties 30 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

18 Pricing Region 12 San Luis Obispo, Ventura, Santa Barbara $24.90 $30.20 $18.70 $21.00 $11.49 $15.49 $31.03 $38.64 DEPO $18.52 $21.83 $14.07 $15.61 $24.46 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

19 Pricing Region 13 Mono, Inyo, Imperial $22.15 $26.85 $19.60 $22.00 * $11.49 $15.49 $29.43 $36.65 DEPO $30.45 $34.00 ** $25.88 $27.48 $23.76 $26.93 *Only in Imperial and Inyo counties **Only in Imperial county 34 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

20 Pricing Region 14 Kern $21.05 $25.50 $19.60 $22.00 $11.49 $14.49 $29.29 $36.47 $10.29 $13.65 $13.84 $15.38 $22.10 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

21 Pricing Region 15 ZIP Codes Pricing Region 15 Los Angeles (partial) The county of Los Angeles is made up of two Pricing Regions by ZIP code. (Regions 15 and 16). Refer to the table on the left to find out if this region includes your ZIP code. $27.25 $33.05 $19.60 $22.00 $11.49 $14.49 $30.62 $38.13 $7.73 $12.82 $12.00 $13.41 $25.34 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

22 Pricing Region 16 ZIP Codes Pricing Region 16 Los Angeles (partial) The county of Los Angeles is made up of two Pricing Regions by ZIP code. (Regions 15 and 16). Refer to the table on the left to find out if this region includes your ZIP code. $24.90 $30.20 $19.60 $22.00 $11.49 $14.49 $31.70 $39.47 $7.73 $12.82 $11.90 $13.32 $25.60 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

23 Pricing Region 17 San Bernardino, Riverside $22.15 $26.85 $18.70 $21.00 $11.49 $14.49 $30.16 $37.55 $8.76 $14.94 $13.41 $14.82 $23.63 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

24 Pricing Region 18 Orange $27.25 $33.05 $18.70 $21.00 $11.49 $14.49 $31.97 $39.81 $8.76 $13.78 $12.35 $13.77 $27.86 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

25 Pricing Region 19 San Diego $27.25 $33.05 $19.60 $22.00 $11.49 $14.49 $31.89 $39.71 $8.76 $13.25 $12.68 $14.10 $24.76 $ updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

26 Participating Dental Insurance Companies Participating Dental Insurance Companies Blue Cross of California About the insurer: As an independent licensee of Blue Cross Association, Blue Cross is a major U.S. health insurance company, with more policyholders in California than any other insurer. Network : 2,274 general 1,007 specialists Website: Phone: of California About the insurer: As a California-based not-for-profit health plan, of California is driven by a single mission: to ensure all Californians have access to high quality care at an affordable price. We are offering a dental preferred provider organization () plan and a dental health maintenance organization () plan that gives Covered California customers a choice of high-quality dentists at an affordable price. We ve been serving California for more than 70 years and have consistently been a leader in developing new and better ways of delivering dental care. Network : 2,061 general 6,780 specialists : 10,237 general 3,689 specialists Website: Phone: updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

27 Participating Dental Insurance Companies Participating Dental Insurance Companies Dental of California About the insurer: Dental of California, headquartered in San Francisco, is the state s largest dental health plan. Together with its affiliate companies, we cover approximately 26 million people. Dental of California is part of the national Dental Plans Association, whose member companies collectively cover over 59 million people in the U.S. Dental of California is committed to advance dental health and access through exceptional dental benefits service, technology and professional support. Network : 32,830 general 15,658 specialists : 2,623 general 2,501 specialists Website: Phone: : : Dental Plan of California About the insurer: Dental Plan of California, Inc. is a privately held dental insurance corporation that specializes in providing dental benefits administration. Licensed and headquartered in California, was established in 2001 and has experienced consistent growth both in membership and industry reputation due to a philosophy centered on customer service. Network : 6,375 general 3,748 specialists DEPO: 5,469 general 3,748 specialists Website: Phone: updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

28 Participating Dental Insurance Companies Dental and Vision About the insurer: Dental and Vision was founded by a practicing dentist in 1989 in an effort to make quality dental care available at an affordable cost. In less than 25 years, the organization has grown to include multiple companies, all of which are related to promoting good oral health. Network : 2,280 general 1,006 specialists : 8,218 general 1,274 specialists Website: Phone: updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

29 Glossary Actuarial Value A health insurance plan s actuarial value is the percentage of total average costs for benefits that a health insurance plan covers. These expenses are usually incurred at the point of receiving health care services when you visit the doctor or the emergency room, for example. Dental plans come in two actuarial value options: 85 percent, which features higher premiums but lower average out-of-pocket costs; and a 70 percent value plan with lower premiums and higher average out-of-pocket costs. An actuarial value is the percentage of total average costs for benefits that a dental plan will cover. Coinsurance Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service, is called coinsurance. You pay coinsurance plus any deductible you may owe. For example, if the health insurance plan s allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health insurance plan pays the rest of the allowed amount. The allowed amount is the amount the doctor or hospital has agreed to accept for the care provided. Dental Health Maintenance Organization () A type of dental plan product that delivers dental services by requiring assignment to a primary dental care provider who is paid a capitated fee for providing all required dental services to the enrollee unless specialty care is needed. DMHOs require referral to specialty dental providers. These products do not include coverage of services provided by dental care providers outside the dental plan. Out-of-Pocket Maximum The most you pay during a policy period (a calendar year) before your health insurance plan begins to pay 100 percent of the cost of covered services. This limit never includes your premium, balance-billed charges or health care your health insurance plan doesn t cover. Some health insurance plans don t count all out-ofnetwork payments toward this limit. Copayment A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Dental Exclusive Provider Organization (DEPO) A DEPO works like a but does not provide coverage for services provided by dentists outside the network of participating providers. Dental Preferred Provider Organization () A type of dental plan product that delivers dental services to members through a network of contracted dental care providers and includes limited coverage of out-ofnetwork services. 54 updated Sept. 6, 2013 Covered California Children s Dental Insurance Plan Rates Covered California Children s Dental Insurance Plan Rates updated Sept. 6,

30 CoveredCA.com