Examining Dental Plans
Checking up On Carriers with Our Annual Survey
Welcome to Part I of California Broker's 2007 Dental Survey. We've asked the top dental providers in California to answer 28 crucial questions to better help you, the agent, understand their benefits, features, and services. Look for Part II in the August issue. Read the responses and sell accordingly.
1. What types of plans do you offer?

Aetna: DMO, FOC, PPO, indemnity, and Vital Savings.

Ameritas: PPO, indemnity, voluntary, non-voluntary, groups from two lives and up, individual, dental CDHP, and cost-containment plans.

BEST Life: Employer-sponsored PPO and indemnity dental plans are offered to groups enrolling two or more employees. All plans are available on a voluntary basis to groups enrolling five or more. Term-life and vision coverage is also available.

Blue Cross: Blue Cross of California offers a comprehensive line-up of plans and products that include PPOs and DHMOs for individuals, small groups, large groups, and national accounts. We also offer voluntary plans for small groups and large groups. Under our PPO products, Blue Cross of California has recently launched Dental Blue, a new, expansive, three-tier PPO network to balance access and affordability at multiple price points. Employees have access to providers in all three Dental Blue networks, with one of the largest dental PPO networks in California and the nation. Employers that add Dental Blue to their portfolio of Blue Cross of California products enjoy the convenience of one contract, one bill, and one comprehensive benefits solution.

Blue Shield of California Dental Plan: Group dental HMO and PPO plans are offered on a contributory or voluntary basis. These plans can be sold as riders to health plans or on a stand-alone basis. Individual and family plans (IFP), DHMO and DPPO plans are available to our IFP medical members as riders to health plans.

CIGNA Dental: DPPO, DEPO, dental indemnity, DHMO, CIGNAFlex Advantage (monthly switch feature between a DHMO and DPPO or dental indemnity plans), CIGNAPlus Savings, a dental discount card program, CIGNA Dental Care Value Plans (includes four flexible plan options with alternative treatment provisions). Some DHMO plans include split co-pays for general dentists and specialty providers. All plans are available on a stand-alone basis. CIGNA has three WellnessPlus Modules, which can be paired with DPPO, DEPO, or dental indemnity products. Members who get any preventive care in one plan year qualify for increased benefits in the following plan year.

Delta Dental: Managed fee-for-service, PPO and DHMO group dental programs, individual DHMO dental programs, and group HMO vision programs.

Dental Health Services: Prepaid dental benefit solutions for individuals and groups. We also offer PPO, EPO, and indemnity (reimbursement) products for groups, and ASO for self-funded groups.

Golden West: Group PPO, indemnity, and DHMO, as well as individual DHMO plans.

GroupLink: Stand-alone group dental and vision plans. Indemnity/PPO, voluntary, and employer paid. Self-funded administration services are also available. We also offer voluntary worksite products and HR administration services, small group and individual major medical and short-term medical. We also offer one-life dental plans for individuals and families.

Guardian: Guardian offers traditional PPO, network access, indemnity, and dual choice (in partnership with the DHMO plans offered by our wholly owned subsidiary, Managed DentalCare of California). Guardian also offers an administrative services only plan. In addition to the dental plans, we also offer vision products. Our plans are available to large and small groups. They are offered as self-funded, employer-paid, contributory, and voluntary, and on a stand-alone basis, subject to certain restrictions.

Health Net Dental: DHMO, PPO, and indemnity.

HumanaDental: PPO, Prepaid/DHMO, traditional, and traditional preferred and preventive plus fee-for-service plans are available on a voluntary or an employer-sponsored basis. Administrative-services only plans are also available.

MetLife: MetLife uses a consultative approach to help employers select just the right plan for their company and its employees. Because our plan designs are research-based and flexible, employers can offer employees dental benefit plans that are designed to meet their needs. PPO and indemnity plans include flexible plan design options, such as deductibles, plan maximums, coinsurance, and optional contract provisions. Co-pay plans offer competitive monthly premiums, flexible plan design options, and defined out-of-pocket expenses for participants using a Preferred Dentist Program Dentist. (Only available to groups with 500 or more eligible employees. MetLife's PDP Co-pay plans are available in California, but are not available for insured cases in Texas, including plans in Texas or covering Texas residents.) Flexible program designs enable greater employee choice with single, dual, and multi-option offerings.
Flexible funding arrangements include fully insured or self-funded and a full range of contribution options.

Principal Financial Group: We offer employer paid and voluntary plans, including indemnity, PPO, EPO, and POS. We also offer a choice between our plans and dental HMO plans through marketing alliances.

SafeGuard: DHMO, DPPO, indemnity, scheduled benefits, and ASO, all on a voluntary or employer-paid basis.

United Concordia: United Concordia offer flexible FFS, PPO, and DHMO dental plans, and a hybrid PPO/discount plan, Concordia Access. Fully insured and ASO funding arrangements are available based on group size. Most plans can be offered on an employer-sponsored or voluntary basis.

Western Dental DMO: A relationship with Ameritas and the Principal allows us to offer our DMO plans alongside PPO and EPO plans. Securian Dental offers plans for groups of two or more employees with the choice of PPO, indemnity, consumer driven, voluntary, employer-paid, pooled (two to 249 employees), custom (100 or more) benefit designs, fully insured (two to 249), or self-insured (100 or more) funding options.

2. How do plans you offer for the individual and\or small group compare in rates and benefits to the large-group plans?

Aetna: Vital Savings is a discount dental plan for individuals. Members get services at the negotiated discount from the Access network, which has almost 74,000 dentists throughout the country. We offer standard DMO, PPO, and FOC plans for groups with two or more employees. Aetna Dental has eliminated dental waiting periods for our standard small group takeover dental plans. This means that new hires will no longer have to verify prior creditable coverage.
Aetna Dental now offers voluntary plans in Calif. for small group customers (three to 50). The voluntary dental options provide a solution to meet the individual needs of members in the face of rising health care costs. Administration is easy. Members benefit from low group rates and the convenience of payroll deductions. Employers choose how the plan is funded. It can be entirely member paid, or employers can contribute up to 50%.

Ameritas: Small group and one life group plans are rated by industry and are pooled in full or part. The large groupÕs experience is rated. It includes lower rates in most cases. Plans vary in design and are more restrictive to offset risk.

BEST Life: All of our plan options, including orthodontia, are available to two or more enrolling. We offer custom plans for large groups.

Blue Cross: Blue Cross of California uses the same provider network for individual, small group, large group, and national accounts. There are different underwriting considerations (for example, waiting periods) for the individual, small, and voluntary group products. Our larger groups (over 50 members) can customize benefits to meet employeesÕ needs. Employers can control costs by purchasing the Dental Blue PPO network that best suits their needs, instead of reducing their dental benefits like traditional PPO plans.

Blue Shield: Rates for our large group dental HMO and PPO plans are typically lower than our small group and IFP plans. However, rates may vary depending on the plan design. Dental plans can be customized for large groups of 300 or more employees.

CIGNA Dental: Plan designs and rates for small groups are similar to those of large groups. There is a series of standard DHMO plan designs: flexible with PPO/indemnity plan designs. CIGNA Dental does not offer plans to individuals.

Delta Dental: Benefits offered to smaller groups are comparable to those offered to larger groups. However, larger groups have more options in terms of plan designs. Rates can be slightly higher for smaller clients, but are competitive within the marketplace and commensurate with the amount of risk. We offer two different programs with individual DHMO plan benefits: one for individuals and families and one customized for seniors. The individual and family plan offers a wide range of covered services. The senior plan is designed to offer services most utilized by this particular population, which enables us to keep the rates low.

Dental Health Services: All plans and premiums are developed based on specific individual and group needs. Co-payments and treatment options vary by plan, from very low levels of coverage to plans that provide member care at zero out-of-pocket cost. Customized plan designs are always available.

Golden West: Individual DHMO plan rates are slightly higher than standard group DHMO rates. We offer a variety of plans with variable co-payment schedules to individual and small groups. Small-group PPO and indemnity plans are book rated. Large-group plans can be customized and are underwritten individually based on claims experience.

GroupLink: Small-group plans are typically brochure designed and rated. Larger groups are custom designed and custom rated. We do have a voluntary plan, which is brochure-rated and requires only five people to be enrolled. There are no participation requirements. Our rates are generally competitive with similarly designed plans from other carriers.

Guardian: We offer the same PPO provider panel to small groups as to large groups, but with slightly fewer plan design options than those available to large groups. We offer an array of cost-reducing options, such as waiting periods, deferral of services, and tie-ins to Guardian vision or Guardian medical products. Rates are based on group size and participation requirements. We do not offer dental coverage to individuals.

Health Net Dental: A full range of benefits is offered to groups of all sizes. But, benefit plans for the small-group market are more economical and pricing of products are pooled. Plans for large groups have richer benefits including higher annual maximums. For employers with 251 or more employees, pricing is rated by zip code, SIC and actual utilization of the group.

HumanaDental: We offer flexible plan designs with a range of deductibles, co-payments and out-of-pocket expense limits for small to large groups. Customers who visit dentists participating in the HumanaDental PPO Network get deep discounts. All plans provide employee incentives for preventive dental care. A free vision discount program is included.

MetLife: We do not offer individual plans. We offer appropriate flexibility for groups of all sizes.

Principal Financial Group: The only significant rating difference pertains to experience rating, which is used on groups with 100 or more employees. There are also a few benefit limitations on very small cases, which apply to groups under 10 lives.

SafeGuard: Plans offered to individuals and small groups generally have a higher level of cost sharing for the member than those offered to larger groups. Risk evaluation is taken into consideration when underwriting larger groups. Individual plans and small groups are quoted using shelf rates.

Securian Dental: Broad benefit options and competitive pricing make Securian DentalÕs pooled plans one of the fastest-growing group dental lines in the country. Our large group plans (100 or more employees) offer more customization of benefits, pricing, and funding options. The primary difference in pricing is that for large self-insured (ASO) clients, we offer extremely competitive fees for our full-service package. We do not offer individual plans.

United Concordia: Primary factors that affect our group rates are location, experience, and credibility. Larger groups have more flexibility in customizing benefit options than do smaller groups. However, United Concordia strives to offer an array of standard group products and options to provide cost effective, quality choices for small businesses.

Western Dental: Our group plans start at two lives. The group plans for small and large employers are more comprehensive in coverage than our individual plans. Rates are generally more competitive for large groups than for small groups.

3. Is your plan better than previous incarnations? If so, how?

Aetna: By offering lower-price plans that cover cleanings and fluoride treatments, Aetna makes it more affordable for members to seek preventive dental care for themselves and their children. Aetna Dental now offers the Aetna Dental Preventive Care plan. This low cost dental plan covers preventive and diagnostic procedures from 70% to 100%. Members also get reduced fees from Aetna's PPO dentists on non-covered services like fillings, adult orthodontia, and cosmetic tooth whitening.

Ameritas: Plans are updated constantly to meet market needs. We have released several industry firsts, including a rollover maximum product and fully insured Lasik eye benefits in our dental plans.

BEST Life: We offer increased affordability and a full range of benefit options down to two lives, which makes our plans very competitive in the California market. Plan choices now include reimbursement levels at 80th/90th percentile, the option to move endo/perio into basic, and voluntary options for groups enrolling five or more. Significant rate discounts are also offered when adding vision, life coverage or both.

Blue Cross: Dental Blue offers 60% greater access in California than does our Prudent Buyer network. This increases the likelihood that employees will have access to their own dentist, increasing their satisfaction with their dental plan. Dental Blue has three networks that offer flexibility in plan options and rates. Dental Blue specialists participate in all three Dental Blue networks. Additionally, when members meet calendar year maximums, they have access to discounts on non-covered services, such as teeth whitening, implants, and orthodontia. We have eliminated waiting periods for our small group dental plans. Blue Cross of California's large group DHMO plans (the Dental Net 2000 series) are more cost-effective and consumer-friendly, with increased flexibility and choice. The new plans include enhanced benefits for services that were not previously offered and are not often offered by other plans. Our Tonik plan is an individual plan designed for younger, individual members. It offers choice and affordability as a dental plan that's embedded within a medical product.

Blue Shield: We recently added enhanced dental services for pregnant women. Pregnant women get one additional routine adult prophylaxis, one course (up to four quadrants) of periodontal scaling and root planing, and periodontal maintenance if warranted by a history of periodontal treatment. Treatment is payable at 100% of the allowable amount for both in and up to the allowable amount out of network. We also added new dental PPO plans for small groups and groups with 51 members or more. These plans give employers more flexibility in choosing a dental plan that meets their financial and benefit needs.

CIGNA Dental: CIGNA Dental plans include several procedures and enhancements not generally covered by competitor plans. Most recently, we started covering oral cancer screening procedures, such as brush biopsy and VizilitePlus to aid in early detection of oral cancer. In addition, members no longer need a referral to seek dental care from a pediatric dentist for dependent children under seven. Members can visit network orthodontists without referral. Additionally, the age limit on sealants has been removed. We can offer added coverage for a third cleaning per 12-month period and benefit designs with general anesthesia/IV sedation coverage. We can also adjust the percentile of UCR that claims are paid out-of-network and the ability to class-shift certain procedures (as found often in the industry). CIGNA Dental's plans are among the most versatile. Our WellnessPlus plans reward members for getting preventive care by increasing their benefits in the following plan year.

Delta Dental: This year, for its California fee-for-service group clients, Delta Dental has added enhanced cleaning and periodontal benefits for pregnant women and implant coverage at no additional cost to the purchaser. Programs are customized within basic parameters. We strive to incorporate changes in treatment and technology as they evolve. Over the past few years, we've also introduced a voluntary PPO product and dual choice with monthly switch program, both of which are tailored to niche small group markets.

Dental Health Services: Our plan benefits evolve to keep pace with changes in dental technology and to respond to unique market needs. Today's plans include a wide range of treatment options that were not offered in the past, including many cosmetic procedures. In addition, monthly premium rates and co-payments for services are frequently evaluated to ensure that they are appropriate and competitive.

Golden West: We continually update plans and launch new products to remain competitive in the market.

GroupLink: Our newest offering, FLEXIDENT, is the most up-to-date dental benefit plan on the market. We offer many unique benefit options and fully customized options for groups of 10 or more. We can tailor a plan to satisfy nearly any dental benefit need that brokers and their customers could request.

Guardian: We constantly strive to provide more flexibility in benefit design, so we can customize benefit plans to meet client needs. We can vary deductibles, annual and lifetime maximums, and service frequencies; include deferrals of services; move services or groups of service to different service groups; and offer exclusion options. We also offer incentive coinsurance, incentive maximum, preventive-only, and preventive-plus plans. We can tailor a plan to meet almost any clientÕs requirements exactly, while providing the prompt case implementation and rapid claim processing that our systems have always provided.

Health Net Dental: The Health Net Advantage DHMO plans now offer more covered benefits. The PPO network has more than 14,000 providers including specialists.

HumanaDental: Yes, we continually explore ways to offer more choices and flexibility for our customers. Please see next response.

MetLife: We are continually improving our program contracts, plan-design flexibility, claims-processing guidelines, customer service, and quality programs based on available and emerging research. MetLife has expanded our plan design flexibility for our dual option offerings in the small (two-500 employee) market. This gives customers more choices to help them meet cost objectives without sacrificing quality and have flexibility on features, such as allocation of services, multiple coinsurance, deductible, annual maximum, and frequency and age limitations. Effective July 1, MetLife includes implants as a standard Type C covered procedure for all new business with 10 or more eligible lives. Implant coverage adds value to the dental benefit plan because implants are rising in popularity among patients and dentists. In some clinical situations, implants may be the only appropriate treatment to replace missing teeth.

Principal Financial Group: Our plan offers significant flexibility in plan design, movement of provisions between service units, options coverage for cosmetic services, TMJ treatment dental implant coverage, accident coverage, employee choice options, and multiple price points. Employers can design any combination of plan options to meet their needs.

SafeGuard DHMO: SafeGuard's SGX series is a vast improvement over previous plans. This new series covers more than 330 procedures covering wants dentistry (for example, teeth whitening) and needs dentistry (for example, four cleanings per year).

SafeGuard DPPO: PPO/indemnity plan and underwriting flexibility allow employers to choose a plan that matches their benefit strategy and budget.

Securian Dental: Securian DentalÕs product family offers a consumer-driven, tiered dental plan (Informed Patient Options). It helps employees select the dentists that deliver the greatest economic value. This plan is a better option for groups that want the lowest rates today and more price stability over time.

United Concordia: Our PPO products were enhanced recently to include coverage for single implant crowns for new and existing members whose dental PPO benefit plans include standard crown coverage. Dental implants typically have two parts: a post that is attached to the jawbone and a crown that is placed on top of the post. The new benefit provides coverage for the implant crown. United Concordia also recently introduced the Smile for Health program, which focuses on the relationship between oral and overall health. The program includes a maternity dental benefit and a Smile for Health enhanced dental benefit. The maternity dental benefit provides an additional dental cleaning to women during pregnancy to reduce the likelihood of periodontal disease, which has been linked to premature and low birth-weight babies. The additional cleaning also helps reduce the chances of pregnancy gingivitis, which can cause tender, swollen gums. The Smile for Health enhanced dental benefit provides coverage for certain diagnostic, preventive, and periodontal services that help dentists identify and treat the chronic oral infections that research has linked to medical conditions, such as heart disease, stroke, diabetes, premature births, and respiratory disease. The benefit options are available to ASO clients nationally as of July 1, 2007.

Western Dental: Our new benefit plans cover more detailed dental procedures. Co-payment levels have been changed to a more acceptable level of reimbursement to attract and maintain a larger provider panel.

4. What have been the most recent changes in your plan?

Aetna: In keeping up with the emerging science, we are proud to offer the Aetna Dental/Medical Integration (DMI) program to all plan sponsors who have dental and medical plans with Aetna. This program is now part of our standard benefits package for these plan sponsors. The DMI program includes enhanced benefits for pregnant women and those with diabetes, and coronary artery disease/Cerebrovascular disease. These benefits are covered at 100% with no deductibles or coinsurance.

Ameritas: We have continued to create new benefit and contribution options to meet market needs. Our rollover maximum product, Dental Rewards, continues to set Ameritas sales records. A new fully insured Lasik eye benefit in our dental is being viewed very favorably.

BEST Life: We recently reduced our employee/child and family rates by 5% for new California groups. All plans are now available on a voluntary basis to groups of five or more as well.

Blue Cross: Dental Blue PPO offers a three-tier PPO network to help control costs, while offering one of the largest dental PPO networks in the country. Also, Dental Blue specialists participate in all three networks. Several of the Dental Blue features include discounts on non-covered services, discounts after maximum plan amounts have been reached, and discounts during the benefit waiting period (if applicable). The Dental Blue network is nearly 60% larger than our Prudent Buyer network, with nearly 20,000 provider locations in California.

Blue Shield: We recently added four new small group dental PPO portfolio plans providing a wider range of plan options with up to a $2,000 annual benefit maximum. For large groups, weÕve added options to allow more customization of plan designs including higher annual plan maximums, orthodontic coverage, and out-of-network reimbursement levels. Two new IFP medical plans include an embedded dental benefit that covers diagnostic, preventive, and minor restorative services.

CIGNA Dental: CIGNA Dental recently introduced several benefit enhancements that address emerging research on the connection between a personÕs oral health and overall health. CIGNA DentalÕs Oral Health Integration Program aims to remove the cost barrier by reimbursing co-pay/coinsurance for certain members who are pregnant or enrolled in disease management programs for diabetes or cardiovascular disease. CIGNA Dental also covers VizilitePlus and brush biopsy, procedures used to help diagnose oral cancer at its earliest stages when treatment is most likely to be successful. In addition, members no longer need a referral to seek dental care from a pediatric dentist for dependent children under seven. Members can visit network orthodontists without referral. The age limit on sealants has been removed. CIGNA now offers a complete package of very competitive plan designs with one of the largest national provider networks. CIGNA Dental also enhanced its dental treatment cost estimator. This comprehensive Web-based service allows CIGNA Dental members to select the procedure or treatment they are considering and estimate what their out-of-pocket cost would be prior to seeking care. Estimates are based on their individual plan information and are adjusted for geographic location.

Delta Dental: The enhanced benefits for pregnant women and implant coverage for California fee-for-service group clients (see above).

Dental Health Services: Our plans now feature coverage for composites on posterior teeth, re-treatment on root canals, fixed fees for precious metals and porcelain on molars, titanium crowns, teeth whitening, and other cosmetic procedures.

Golden West: PPO: We have increased our panel size to over 13,000 in California and over 55,000 nationally.

GroupLink: We are now giving full waiting period credit to all employees on the prior plan bill at time of takeover. We are covering implants as a standard benefit in major services. We are offering groups multiple plan options down to five lives. We are offering a new broker bonus program for brokers who have never written a case with us and other incentives through IHC, such as a trip to Tahiti and a stock bonus program for GAs and producers. We are also introducing online quoting and administrative access to brokers and groups starting in May 2007.

Guardian: We recently implemented value-added discount programs that are free with our dental plans for new and in-force business. The dental discount programs use Guardians DentalGuard preferred PPO network and offer guaranteed discounts on services and supplies not covered by a member's dental PPO plan. This includes implants or orthodontia when not covered by a plan or services not covered due to plan limitations and exclusions that are on the PPO fee schedule. In addition, we introduced a discount vision program with the network of Vision Service Plan (VSP) to all our new business dental plans. Guardian's dental members will have access to VSPs network discounts on vision exams, glasses, contact lens professional services, and laser surgery.

Health Net Dental: Our new Advantage plans offer more covered benefits, including additional cleanings beyond the two cleanings per year. Cosmetic procedures, teeth whitening, material upgrades, adult fluoride, and general anesthesia are covered at additional co-payments under the DHMO plans. Voluntary dental PPO products have been introduced for groups of 51 or more employees. Non-voluntary PPO plans offer periodontics, oral surgery, and endodontics under basic services. There are no waiting periods for major services, which results in lower out-of-pocket costs for members. Also, orthodontia is available for adults and children.

HumanaDental: Plans in our new generation of products are available as voluntary plans and to groups with as few as two employees. We offer higher annual maximums, adult orthodontia, higher orthodontia lifetime maximums and orthodontia discounts, allow benefit payments for orthodontic services when treatment began before the group's or member's effective date with HumanaDental without prior orthodontia benefits, and reimburse out-of-network claims at a higher level. Due to the connection between oral health and overall health, we have added, free of charge, two additional periodontal exams to all of our marketed products, excluding DHMO/prepaid plans. Our new plans will also offer a reimbursement option for out-of-network reimbursement: either maximum allowable fee or based on in-network fee schedules. Updates also include additional deductible choices, implant coverage, and acrylic filling coverage.

MetLife: MetLife launched a new voluntary dental product (Full Service Dental for Retirees). This product allows customers to enrich their retiree benefits programs with no benefit expense and minimal administration. Plan participants pay the entire premium. MetLife handles the marketing, enrollment, customer service, recordkeeping, billing, and collection of premiums. Full service dental for retirees has all the features of a traditional dental offering with a brand name that employers and consumers know and trust. Additionally, MetLife put together a dental plan that follows the concepts of consumerism. It rewards good choices and reimburses services that treat the initiation and progression of disease at higher levels. The new consumer-driven plan design is an innovative way to reduce plan cost, and while providing value for employees. This dental plan design places a greater focus on benefiting services that are essential to achieving oral health, rather than those that are more elective Ð supported by research and standards of care.

Principal Financial Group: We recently announced our consumer driven dental offerings and an entirely new dental product (Principal Dental Series II).

SafeGuard: DHMO: The new SGX series includes expanded wellness and preventive procedures as well as coverage for IV sedation, nitrous oxide, and general anesthesia. All non-listed procedures are covered at a reduced fee.

SafeGuard PPO/indemnity: Offerings of custom plan options, scheduled benefit plans, and high in-network incentive plans, supported by over 14,000 network dentists and specialists.

Securian Dental: Last year, Securian Dental introduced the dental industryÕs first true consumer-driven, tiered dental product, which gives consumers easy-to-use rankings of dentists based on the economic value they deliver. This plan has lower premiums immediately and provides more long-term cost stability. We have also reduced our fees for self-insured (ASO) groups significantly.

United Concordia: The most recent changes include the addition of single implant crown coverage to plans that already include standard crown coverage and the Smile for Health program benefit options.

Western Dental: We now offer a Western Centers-only plan with more than 200 dental offices. In addition, we offer extended office hours and finance co-payments at 0% interest at this new option. We are also open six days a week.

5. Can an insured use their own dentist even if they are not on your participation list?

Aetna: PPO and indemnity members can use any licensed dentist.

Ameritas: Insureds can use any provider, but they may incur additional out-of-pocket expenses.

BEST Life: PPO and IndemnityPlus plans allow members to visit any dentist and get coverage for services. Our members can also access the First Dental Health Network (FDH) for excellent in-network savings.

Blue Cross: Yes, Dental Blue PPO members who choose a provider within the 100/200/300 network get the most savings. However, no matter which specific network employees choose, they will have access to all three Dental Blue networks and can still take advantage of the dentistÕs negotiated rates. Members have access to all Dental Blue providers and even to dentists outside of the DB network. However, they usually save the most by choosing a Dental Blue dentist. A Dental Net DHMO member must choose a participating network dentist.

Blue Shield: Yes, for dental PPO plan members.

CIGNA Dental: Insureds can use their own dentist in the DPPO and dental indemnity plans. However, there are no out-of-network benefits with DHMO, CIGNAPlus Savings dental discount plans, or with DEPO. Members can nominate their dentists to join our plan. If the dentist wants to participate and meets our criteria, they will be credentialed and join the network.

Delta Dental: Fee-for-service enrollees can visit any licensed dentist for care, although there are advantages to visiting one of the more than 20,300 Delta Dental dentists in California. Enrollees may go to any dentist, but they are only guaranteed to get in-network benefits and avoid balance billing when visiting a Delta Dental dentist. PPO patients also have complete freedom of choice in selecting a dentist. The PPO program provides access to two Delta Dental dentist networks (PPO plus Premier) with different levels of savings. DHMO enrollees must use a participating general dentist or approved specialist except for emergency care.

Dental Health Services: Our PPO and reimbursement plans allow members to get treatment from any dentist. Members of Dental Health ServicesÕ prepaid and EPO plans choose their dentist from our extensive network of participating dentists.

Golden West: Yes, members covered under our PPO and indemnity plans can get services from a non-panel provider.

GroupLink: Yes, all of our indemnity plans offer freedom of choice. However, our true PPO plans do have in-network versus out-of-network benefits for seeking care from a network dentist. Covered insureds get a higher benefit for doing so.

Guardian: Yes, members covered under our DentalGuard Preferred PPO plans can go to any dentist. Benefits are paid usually at a lower coinsurance rate for non-participating dentists.

Health Net Dental: Yes, they can for PPO and indemnity plans, but not for DHMO, unless there is an emergency.

HumanaDental: Indemnity and PPO members can visit the dentists of their choice. Out-of-pocket savings are greater when members visit participating network dentists.

Managed Dental Care: On a PPO plan, yes. On a DHMO plan, no.

MetLife: All MetLife dental plans allow participants to get services from any dentist they choose. For PPO plans, participants can save more by getting services from a participating PPO dentist.

Principal Financial Group: Yes, the insured can see any dentist even if the dentist is not on the participation list.

SafeGuard: PPO: There are in- and out-of-network options for all plans. By using the in-network option, the member and client will reduce claims costs through negotiated-fee schedules. Also, there is a higher in-network coverage level with many plans, reducing the enrolleeÕs costs out-of-pocket.

Securian Dental: Yes, Securian Dental members are free to see any dentist with no need for pre-selection or a referral.

United Concordia: Our FFS and PPO plans allow insureds to visit any dentist and still get payment toward covered services. DHMO members must use network providers.

Western Dental: Through the DMO plans, the member must use a dentist that participates in our network in order to have coverage.

6. If the dentist bill exceeds UCR, can the dentist bill the patient for the difference?

Aetna: Network dentists are contractually prevented from balance billing.

Ameritas/FDH Network: Ameritas PPO dentists and FDH PPO dentists are bound by contract not to balance bill the difference between their normal charge and PPO maximum allowable charges. Members are financially responsible for non-covered procedures.

BEST Life: When visiting an FDH provider, members will not be balance billed for amounts that exceed their plans UCR. Those who visit a non-participating dentist may be balanced billed. Our 90% UCR choice is a great cost-effective option for groups that have limited network access.

Blue Cross: Blue Cross of CaliforniaÕs Dental Blue participating provider contracts include negotiated fee agreements. A dentist may not balance-bill members for amounts that exceed the negotiated and contractually agreed upon fee. Members are not responsible for amounts in excess of negotiated rates. With the Dental Net DHMO, the patient is only responsible for co-payments and/or uncovered services.

Blue Shield: No, in-network providers cannot bill members for fees that exceed the negotiated rate. Yes, out of network providers can bill for charges that exceed the plans' allowed amount.

CIGNA Dental: In-network DPPO and DHMO dentists are not allowed to balance bill members. The only time dentists are allowed to balance bill the patient is with the out-of-network DPPO and, of course, with the dental indemnity plans. We cannot prevent non-network dentists from balance billing.

Delta Dental: Enrollees can go to any dentist, but they are only guaranteed to get in-network benefits and avoid balance billing when visiting a Delta Dental dentist.

Dental Health Services: No, members of our prepaid and PPO plans are protected from paying unexpected, additional fees from their dentist.

Golden West: Non-panel dentists can balance bill a PPO or indemnity member the difference of the billed fee and the average fee charged for the geographic area. PPO panel dentists cannot balance bill members. They must agree to bill the contracted fee.

GroupLink: Yes.

Guardian: DentalGuard Preferred PPO dentists are prohibited from billing members for any difference between the billed fee and the contracted fee schedule amount, less applicable deductibles and coinsurance. Non-participating dentists who charge more than our UCR amount can bill the patient for the difference.

Health Net Dental: Yes, for indemnity and out-of-network PPO plans. No, if members are enrolled under DHMO or are seeking care from in-network PPO providers.

HumanaDental: A dentist participating in our PPO network may not balance bill patients.

MetLife: When getting services from a participating PPO dentist, eligible employees and dependents cannot be billed any charge in excess of our maximum allowable fee (minus any plan benefits). If the patient goes to a non-network dentist or is in a non-PPO program, the dentist can bill the patient for the difference between the plan benefit and the dentistÕs submitted charge.

Principal Financial Group: Dentists that are part of our PPO or EPO network cannot bill over the UCR amount. A dentist who is not a part of one of our networks can bill the amount over UCR.

SafeGuard: Dentists participating in DHMO plans have agreed to charge our members only the specified plan co-payment. There is no balance billing. PPO dentists have agreed to accept SafeGuardÕs fee schedules as payment in full. There is no balance billing when getting treatment from a PPO dentist. Non-network dentists may balance bill.

Securian Dental: With Securian Dental PPO plans, a participating dentist cannot bill the patient for the difference. With our other plans, the dentist can bill for the difference.

United Concordia: United Concordia participating providers agree to accept our allowances as payment in full for covered services (less any deductibles and coinsurances or co-payments).

Western Dental: Since this is a capitation plan, members pay only the applicable co-payment listed on their benefit schedule. Members are financially responsible for non-covered procedures at a discount.

7. How does the dental plan protect against overbilling or waiver of co-payments?

Aetna: Quality assurance programs are designed to protect members and providers.

Ameritas: The explanation of benefits automatically calculates the insureds' portion of the bill to prevent these kinds of problems.

BEST Life: Pre-determination services are available to inform members what their charges will be before getting service. We provide easy to understand explanations of benefits, which clearly illustrate network savings of utilizing an FDH provider.

Blue Cross: Blue Cross of California's extensive contracts with participating Dental Blue providers address these issues to avoid over-billing and co-payment waivers.

Blue Shield: Our contract with in-network providers stipulates that they cannot bill members for fees that exceed the negotiated rate. Any complaints from members about balance billing by providers are forwarded to our Provider Relations department for review and resolution.

CIGNA Dental: We review encounter data and utilization patterns compared to normative data by geographical area. We would then counsel any providers who were found to have patterns outside the norms.

Delta Dental: Our compliance department and a staff of dental consultants monitor utilization data and investigate anomalies. Proprietary software identifies over utilization trends and patterns. Enrollees, dentists, and clients are educated on the dangers of fraud and how to prevent it. Delta Dental also performs audits of randomly selected dental offices to protect against over billing. Advertising and promotions of co-payment waivers are monitored and reported to Delta Dental. In addition, our DHMO dentists must complete encounter forms that document all services performed and co-payments collected as dictated by plan design. The DHMO dentist contract does not allow waiver of co-payment or over billing for services that require a patient co-payment.

Dental Health Services: Participating dentists are audited on-site on an ongoing basis to ensure treatment is rendered in accordance with Dental Health Services' policies.

Golden West: The compliance department and dental consultants monitor utilization. Additionally, a proprietary claims system identifies over-utilization trends and patterns.

GroupLink: Claims are paid on a percentage of UCR.

Guardian: DentalGuard Preferred PPO dentists are prohibited from billing members for any amount for covered charges other than the deductible or coinsurance that may apply to the discounted fee schedule amount. Explanation of benefits statements sent to members identifies the discounts taken and the member's responsibility.

Health Net Dental: Quality management procedures include a fraud and abuse identification and investigation process. There is an on-site review of grievances, if necessary.

HumanaDental: The dentist and the patient get an explanation of benefits to ensure that the dentist does not overcharge or omit fees. The claims-processing system adjudicates the claim based on the contracted fee schedule. Waiving co-payments does not apply under a PPO.

MetLife: Our explanation of benefits is the first protection for the patient against over-billing. It clearly identifies the charges for services that the patient has a responsibility to pay. In addition, our customer service area is responsive to patient inquiries about questionable billing items. This area gathers information from the patient and investigates the issue fully. A response with our findings is provided to the patient. Waiver of co-payments can also be identified from calls to our customer service center and our auditing unit, which looks for atypical billing patterns.

Principal Financial Group: Provider utilization patterns are studied and issues are addressed as they are uncovered.

SafeGuard: DHMO: The dentist's agreement prohibits billing a member above the specified co-payment. The plan conducts a thorough orientation with each dental office. The Quality Management department reviews member complaints that relate to charges. The Office of Quality Assessment reviewer notes any apparent overcharges during the patient-record audit and works with the dentist's office to correct the issues.

Securian Dental: Securian Dental reviews all claims to ensure appropriate billing and tracks dentists' practice patterns for trends that may indicate more subtle forms of abuse.

United Concordia: Thousands of claims are reviewed each year regarding the acceptability of treatment and quality of services. Advisors and consultants also review dental providers' fees and practice patterns.

Western Dental: Providers are bound by contract to accept the memberÕs schedule of benefits.

8. How many provider locations do you have?

Aetna: Aetna has more 5,000 DMO dentist locations and 19,500 PPO provider locations in California. There are more than 35,900 DMO provider locations and 91,000 PPO provider locations nationally.

Ameritas PPO: 8,567 provider locations. 15,375 providers in California.

Ameritas/FDH Network: 11,518 provider locations.

BEST Life: We contract with one of the largest networks in California, First Dental Health, which has more than 14,834 participating dentists.

Blue Cross: California Dental Blue PPO locations: Dental Blue 100 14,296 Dental Blue 200 18,629, and Dental Blue 300 19,337, National PPO: 11,945. DHMO locations: 4,500 in California.

Blue Shield: We have more than 70,000 nationwide (including 17,500 in California) dental PPO directory entries. We have more than 8,600 dental HMO provider directory entries in California. These are two of the largest statewide provider networks in the industry.

CIGNA Dental: Nationally, we have more than 33,000 DHMO dentists and more than 85,000 DPPO contracted access points. In California, we have more than 5,300 DHMO dentists and more than 19,000 DPPO contracted access points.

Delta Dental: In California, fee-for-service, 27,183, DHMO, 5,618.

Dental Health Services: Our network of participating dentists includes more than 2,900 prepaid dentists and more than 13,000 PPO dentists throughout California.

Golden West: There are about 55,000 PPO providers nationally and 4,200 DHMO dentists and specialists in California.

GroupLink: This number is always changing as the networks continue to recruit providers and we add new states monthly. We use five different provider networks, depending on the strength and service ability within a certain area.

Guardian: We have more than 99,000 DentalGuard Preferred PPO dentist locations across the country and more than 27,300 DGP PPO dentist locations in California.

Health Net Dental: Nearly 4,000 DHMO providers, including specialists. There are more than 14,000 dental PPO providers, including specialists.

HumanaDental: We have more than 25,013 network dentist locations in California.

MetLife: As of March 2007, in California, MetLife has 17,895 participating dentist locations within our PPO, the Preferred Dentist Program. Nationally, MetLife has more than 99,000 participating dentist locations representing a 43.2% penetration.

Principal Financial Group: We have about 15,200 PPO provider locations and 7,900 EPO provider locations.

SafeGuard: DHMO: 3,949 general dentists and specialists, PPO: 14.117 general dentists and specialists.

Securian Dental: More than 21,000 in California, with more than 73,000 nationwide. Additionally, Securian Dental members automatically get access to our emergency dental network in 137 foreign countries.

United Concordia: Advantage Plus PPO network: 13,115 dentists, 11,926 offices, 18,089 practice locations, and 28,619 total locations. Also, 1,352 DHMO primary dental offices (PDO).

Western Dental: Our network consists of 1,572 facilities with 3,252 dentists.

9. Can the insured easily change providers if they are unhappy?

Aetna: Yes.

Ameritas PPO and the FDH Networks: Insureds can choose any provider at any time for procedures.

BEST Life: Members can choose any dentist they want while also using FDH for network savings.

Blue Cross: Dental Blue PPO members can visit any licensed dentist. They save more when services are completed by a Dental Blue 100, Dental Blue 200, or Dental Blue 300 network provider. The dental DHMO members can change providers once a month. Blue Cross of California still has a choice program in which the members can change between a PPO and a DHMO provider on a monthly basis.

Blue Shield: Yes, DHMO members can change in-network dentists on a monthly basis. Requests must be made by the 10th of the month in order to be effective the first of the following month. DPPO members may see in-network or out-of-network providers.

CIGNA Dental: The DPPO/DEPO/indemnity plans allow members to change dentists whenever they want. No call is necessary. DHMO members can easily change their primary-care dentist online via myCIGNA.com. They can also use our automated Quick Transfer option or simply call customer service. The change is effective on the first day of the month following the date they make the change. On CIGNAFlex Advantage plans, members can switch monthly between DHMO and DPPO or indemnity plans, depending on the plan design the employer has chosen.

Delta Dental: Fee-for-service enrollees can change dentists any time without notifying us. DHMO enrollees can change their contract dentist by contacting the customer service department by phone, in writing, or through "Visit Delta Dental's HMO affiliate" link on the Delta Dental Website at www.deltadentalca.org. The change is effective the first of the month after the request is received, provided the request is received before the 20th of the month.

Dental Health Services: Members can change their dentist any time by contacting their member service specialist at 800-63-SMILE or online at www.dentalhealthservices.com.

Golden West: Yes, DHMO members can change their providers once a month by calling our Member Services department and requesting the change.

GroupLink: Yes, they can change providers any time.

Guardian: Members covered under Guardian's PPO plans can change dentists at will, regardless of whether the dentists are participating or non-participating. The PPO plans do not require members to select primary care dentists. PPO members can see any in-network or out-of-network dentist they want at any time.

Health Net Dental: Yes, member services representatives are available 5:00 A.M. to 6:00 P.M. Monday through Friday (PST). They can make the change over the phone for our members who are enrolled in the DHMO.

HumanaDental: With the PPO option, the member can change dentists without notifying the dental plan.

MetLife: There is no need to select a primary dentist or get referrals for specialty care with our PPO plan design. Plans typically provide an opportunity for more cost savings if an employee chooses to get services from a participating Preferred Dentist Program dentist, but benefits are still provided for covered services provided through a non-network dentist.

Principal Financial Group: Yes.

SafeGuard DHMO: A member can change providers by calling Member Services or by touch-tone phone 24 hours a day and online through our Website.

SafeGuard PPO/indemnity: There are no assigned dentists when using a PPO/indemnity plan. An insured can choose any dentist in the network at anytime or get treatment from a non-network dentist.

Securian Dental: Yes, Securian Dental plan members are free to choose a new dentist any time.

United Concordia: Members can change PPO providers any time without notice. The DHMO insured can change dentists by writing or calling customer service and requesting a new DHMO provider as long as there is no existing balance due to the dentist or treatment in progress. If the request is received before the 10th of the month, the transfer to the new provider is effective on the first of the following month.

Western Dental: Yes, our membership can change providers by phone or in writing on a monthly basis.

10. How do you ensure that your dentists are aware of the benefits of your plan? Do you have a way of knowing if dentists are soliciting or recommending services that are not compensated for by your plan?

Aetna: All participating dental offices get a dental office guide, which includes information on plan designs, policies, and procedures. We also offer a Website designed for dentists, which includes real-time eligibility and benefits information, Aetna Voice Advantage (24/7 speech recognition technology), and a Dentist Solutions Team located in our Dental Service Centers.

Ameritas PPO and the FDH Networks: Dentists can access individual plan information using the toll-free voice response system, the fax-back system, or our online benefit Website. In-house consultants and dental claim systems can catch many procedures that are substituted for covered procedures.

BEST Life: Dentists can contact BEST Life for information about member benefits by calling 800-433-0088. We also have a fax-back line dentists can use to get benefit information.

Blue Cross: Dentists can access updated information on our Website, through our interactive voice response system, from our provider relations and customer service representatives, and through occasional mailings. Practice patterns of participating providers are routinely monitored and reported through monthly utilization reports and claims experience. A network representative and the dental director are contacted when suspected over utilization or under utilization patterns are identified. In such cases, the dentist is contacted and we discuss findings along with a plan to bring the practice within the standard.

Blue Shield: Each provider gets a Provider Manual upon acceptance into the plan. It outlines requirements of participation and details on plan administration. Providers can get in-person training with their staff, if requested.

CIGNA Dental: A large staff of network managers, based in specific field locations and in operational offices, meets continuously with providers on our administrative and quality policies. Any offices that are found not to be in compliance are counseled by our network teams and remediation plans are put into place to ensure compliance.

Delta Dental: Each dentist gets a regularly updated dentists' handbook, which explains policies, procedures, and programs. Detailed program information for all enrollees, including deductibles, maximums, and benefit levels, is available through a secure area of the company Website and through a toll-free number. Delta Dental publishes a quarterly dentist newsletter and holds seminars to keep dentists up-to-date on news and innovations. Regular enrollee surveys seek information on various quality issues, such as services rendered that are not covered by the program, services delivered as claimed, office cleanliness and appearance, and customer service.

Dental Health Services: We regularly provide on-site training, auditing, and service visits for our participating prepaid dentists. Additionally, each office gets a comprehensive manual, and we monitor all services and treatments received by our members through monthly utilization reports.

Golden West: Network-area managers keep panel offices apprised of plan-design enhancements. Provider guides, which are kept in the dental offices, reflect the various plan designs and co-payment schedules. The guides are updated and reviewed regularly with the dental office staff.

GroupLink: The 24-hour, seven-day-a-week automated-eligibility system is accessed via an 800 number. Benefit information is faxed back automatically.

Guardian: All PPO dentists get information about Guardians' plans. Our claim system tracks and monitors each dentists' practice patterns for bundling, over utilization, etc. PPO dentists whose patterns are flagged are counseled. They may be terminated from the DGP PPO network if they show no improvement. We recommend that members get a voluntary pre-determination of benefits before proceeding with any treatment that will cost $300 or more. But we do not reduce or deny benefits if the member does not submit the treatment plan for predetermination. The member will be advised if the treatment plan includes services that are not covered under their plan.

Health Net Dental: Provider manuals are updated and distributed whenever there is a plan benefit modification. In addition, the Provider Relations team conducts on-site office visits for auditing and provider education. Facility audits, chart reviews, and utilization reviews are part of our quality-management process.

HumanaDental: We recommend to members and dentists that a pretreatment plan be submitted for approval if services are expected to exceed $300. If a procedure is not covered under the memberÕs benefit plan, we notify the dentist and member at that time. Also, the claims system would reimburse only for the covered services.

MetLife: MetLife has developed a multi-channel technology platform for employers, participants, and dental offices. It provides access to information via Internet, fax, or phone. At the time of service, dental offices can access eligibility, plan, and other information through dedicated real-time channels.

Once dentists are selected to participate in MetLife's PPO network, their treatment patterns are monitored to help ensure maintenance of appropriate practice patterns. If a dentist's treatment patterns become unacceptable, the dentist is educated and monitored via MetLife's claims review processes. If it is warranted, the dentist is removed from the network. With MetLife, participants get value every time they go to a participating MetLife dentist as our negotiated dental fees extend to all in-network services, even to non-covered services such as orthodontia, cosmetics, and implants, and services provided after the annual benefit maximum is exceeded. If a participant has a complaint about charges for services that are covered or not covered by a MetLife plan, our trained customer service representatives will review the issue with the participant and generate a response and follow-up investigation, if necessary.

Principal Financial Group: We provide on-line and telephone service options for providers to verify benefits and eligibility. We encourage pre-determination to be performed for inlays, onlays, single crowns, prosthetics, periodontics, and oral surgery.

SafeGuard DHMO: Each dental office gets a facility reference guide with a section on the plans. A provider relations representative conducts a thorough orientation with the dental office staff to help them fully understand the plans. Quality Management reviews member concerns and conducts regular chart audits.

SafeGuard PPO/indemnity: PPO dentists get fee schedules with each covered procedure listed along with the associated fee.

Securian Dental: Dentists can access the member's benefit information with one toll-free call to the phone number listed on the member's ID card. We monitor all submitted claims for evidence of practice patterns that may indicate abuse. But, we do not attempt to limit or interfere in the dentist-patient relationship. Dentists should recommend treatment based on the patient's needs, regardless of coverage

United Concordia: United Concordia's provider relations representatives conduct periodic visits and phone calls. We also offer benefit and eligibility information 24/7 online or on the phone, quarterly provider newsletters, special mailings, office manuals, dental office seminars, and continuing education courses to ensure dentists are aware of how to access information regarding member plans. In addition, thousands of claims are reviewed each year regarding the acceptability of treatment and quality of services.

Western Dental: We give each dentist a provider handbook, which explains Western Dentals' policies, procedures, and programs. Also, Western Dental performs periodic audits of each dental facility to ensure that it adheres to co-payment schedules. Additionally, Western DentalÕs Utilization Management Committee reviews provider encounter data on a quarterly basis.

11. How many provider offices have you lost over the past 12 months? If asked, will you provide the names and phone numbers of at least three of these offices?

Aetna: Annual provider turnover is about 5%. We have experienced an overall net growth in participating dental offices.

Ameritas PPO: 578 provider offices were lost. Yes, we would provide names if requested.

Ameritas/FDH Network: 1,050 provider offices were lost. Yes, we would provide names, if requested.

BEST Life: Fewer than 5% of providers have left the FDH network over the past 12 months. Reasons for leaving include retirement, relocation of practice, changes within group practices, and voluntary terminations. For the sake of privacy, our network does not share such information for the purpose of a general interview.

Blue Cross: Our retention of network dentists is exceptionally high due to Blue Cross of California's ability to administer individually negotiated fee schedules with our PPO participating dentists. We only lost 3% of our offices in the past 12-month period.

Blue Shield: In 2005 our provider turnover in both our DPPO and DHMO networks was less than 3%. The net growth in our PPO network was 9.5% and the DHMO was 5.5%.

DPPO only: In 2006, there were 937 dentists who voluntarily terminated from our network. The voluntary turnover rate (excluding deaths, retirements and practice relocations) was 2.7%. In 2006, there were 2,994 dentists who involuntarily terminated from our network. The involuntary turnover rate was 8.5%.

CIGNA Dental: While NADP has not yet released their average turnover rates, our national turnover rates are lower than the most recent NADP data. Provider information can be given to customers and brokers.

Delta Dental: All of our networks increased in size: our main network, Delta Dental Premier, by .3%, Delta Dental PPO by nearly 6%, and DeltaCare USA, our DHMO network, by nearly 11%. Delta Dental does not release specific information on its contracted dentists.

Dental Health Services: Although roughly 5% of participating dentists have been lost over the past 12 months, our overall network size has made up for this loss. It has increased in size by an additional 5% over the previous year. The names and phone numbers of all offices are available upon request.

Golden West: The DHMO panel-retention rate average is 93%, including dental offices that have closed their practices. Yes.

GroupLink: N/A. We are not a network administrator. We do offer PPO options with our plans. Information could be obtained from them upon request.

Guardian: Over the past 12 months, turnover has been about 6%, terminating for voluntary (retirement, moving from area, closing the practice) and involuntary (terminated by network) reasons. We will provide names and phone numbers of terminated offices, subject to permission from the offices.

Health Net Dental: There is a 3% to 4% termination rate from the DHMO network, while there is net growth in specialist and PPO networks. Provider information is privileged, but provider contacts can be provided based on discretion and provider approval.

HumanaDental: 81 California dentists terminated their agreements during the past 12 months. Yes, we will provide the requested information on at least three offices.

MetLife: Our turnover rate was 1.34% nationally, 1.06% of which was voluntary. In California, the network turnover rate was 1.3%. It's important to note that these numbers include turnover that's voluntary (dentists requesting to drop out of our network) and involuntary (MetLife terminating the dentist's participation).

Principal Financial Group: For our PPO network, we've lost 770 providers. For our EPO network, we've lost 960 providers.

SafeGuard: DHMO: Fewer than 4% to 3% of contracted dentists left the network in the past 12 months. They have been replaced based on area population studies. Terminated providers' names are not provided due to contractual constraints.

SafeGuard PPO/indemnity: The PPO office turnover is less than 1% and usually occurs when a dentist moves out of our network area or sells his or her practice.

Securian Dental: Each year, fewer than 2% of the network dentists discontinue participation with the network serving Securian Dental. The majority of these terminations are because a provider retired, did, or moved or closed a practice.

United Concordia: There have been 74 DHMO facility terminations from May 1, 2006 to April 30, 2007. The turnover rate is 5.5%. The names and phone numbers of these offices are confidential.

Western Dental: Our turnover is about 1% for the past year. Yes.

Dental Survey Part II

12. What percentage of your network is closed to new enrollment? How many offices does this represent?

Aetna: About 6% of DMO GP locations are closed to new enrollment.

Ameritas PPO: 117 Offices (1% of the panel) are closed to new enrollment.

Ameritas/FDH Network: None.

BEST Life: All participating PPO dentists are accepting new patients.

Blue Cross: All our dental PPO providers are accepting new patients.

Blue Shield: 4.9% of the locations in our DHMO network are closed to new enrollment and 4% of our DPPO network providers maintain closed practices.

CIGNA Dental: In California, the total number of network locations is 1,480. Of those, 1,314 are open to new membership. The DPPO network offices do not close to new membership.

Delta Dental: Our fee-for-service dentists do not close to new enrollment. The number of DHMO dental offices closed to new enrollment varies, but is generally less than 10%.

Dental Health Services: About 5% of network dentists are closed to new enrollment.

Golden West: About 4% of our DHMO panel offices are closed to new members. This represents about 168 offices.

GroupLink: N/A

Guardian: In California, 10 participating dentist offices are closed to new PPO patients, which represents .04% of our network.

Health Net Dental: DHMO: Fewer than 10% of general dentist offices are closed to new enrollment. The PPO network is accepting all new Health Net Dental members.

HumanaDental: Under HumanaDental's provider contract, participating dentists must schedule and treat members without discrimination, including benefit or payer differentials. Closed practices are not common because this is a fee-for-service reimbursement program.

MetLife: Nationally, 1% of our participating PPO dentists have requested that their names be removed from our PPO provider listing for purposes of not accepting new MetLife-eligible patients.

Principal Financial Group: Fewer than 1% of the offices participating in our network are closed to new enrollment.

SafeGuard: DHMO: Fewer than 10% of SafeGuard's general dentist offices are closed to new enrollment.

Securian Dental: Providers in the network serving Securian Dental are open to new patients.

United Concordia: 62 DHMO offices are closed to new enrollment. 95.4% of facilities are open to new patients.

Western Dental: Fewer than 2% of our network providers are closed to new enrollments, which is about 32 offices.

13. Do all of your contracted offices accept every benefit level that your company sells or can they to choose the programs with co-payments?

Aetna: All DMO offices accept all of our coinsurance and fixed co-payment plan designs.

Ameritas PPO: All offices accept all coverages, except if sold with the FDH PPO. The FDH PPO plans only can use the FDH panel.

BEST Life: All contracted offices accept every benefit level that BEST sells. Furthermore, by contract, all providers will honor the PPO discounts on all procedures, including non-covered services. They must also honor a discount for members who are within a waiting period or who have exceeded their annual maximum.

Blue Cross: Blue Cross of California encourages all Dental Blue providers to accept all plans offered.

Blue Shield: Offices are not allowed to choose which plan designs they accept.

CIGNA Dental: All of our contracted offices are required to accept every benefit level as part of our network contracts.

Delta Dental: Delta Dental dentists contract for the programs they want to accept. All contracted fee-for-service dentists are required to accept all benefit programs sold by Delta Dental to group purchasers. While not all Premier dentists participate in PPO, PPO enrollees can visit any Delta Dental dentist and pay the co-payment appropriate to the dentistÕs level of participation. However, not all fee-for service dentists (Premier and PPO) contract with the DHMO (DeltaCare USA) plan. Contracted DHMO offices are required to accept all DHMO benefit levels.

Dental Health Services: All new dentists are contracted for all plans offered by Dental Health Services.

Golden West: Most of our DHMO panel offices accept all of our plans. However, they can choose plans in which to participate.

GroupLink: Our leased networks would track this.

Guardian: All contracted PPO offices accept all of our plan designs.

Health Net Dental: PPO and DHMO providers accept all plans.

HumanaDental: The PPO contract is for all network-based programs, excluding DHMO, which requires a separate agreement.

MetLife: All participating MetLife PPO dentists accept all of our plan designs..

Principal Financial Group: Providers can choose to participate in our PPO and EPO networks. Within each option, providers are obligated to accept all benefit levels sold by our company.

SafeGuard: When SafeGuard contracts with a dental-care provider, it is understood that the dentist will accept all DHMO plans. A few contracted dentists do not participate in some of the older custom plans. All SafeGuard-contracted offices accept all PPO/indemnity plans.

Securian Dental: Securian Dental's network dentists accept all of our benefit designs

United Concordia: An office that is open to new enrollment accepts all plans.

Western Dental: All our plans are accepted by the large majority of contacted providers.

14. Do monitor how long a patient waits in the doctor's office?

Aetna: A Semi-annual written survey is collected from all Calif. DMO GP's and specialists.

Ameritas PPO: Yes, each dentist gets an office evaluation worksheet along with the initial application. The office-wait time is questioned at that point. In addition, surveys are performed to address insureds' satisfaction with office wait times.

BEST Life: FDH monitors accessibility and wait times through its Customer Service and Provider Relations departments.

Blue Cross: Yes, we monitor this metric in our member satisfaction surveys. Issues such as wait times are logged and monitored through our complaint tracking process. We also monitor appointment wait times and emergency wait times through surveys conducted by our organization.

Blue Shield: Yes, we document member complaints on this issue in our customer service workbench and track them electronically until they are resolved. Our annual member satisfaction survey includes questions about wait times with our network offices.

CIGNA Dental: The network management team monitors wait times in our DHMO general dentist facilities via monthly telephone calls. We can also identify lengthy wait times through our patient-satisfaction surveys.

Delta Dental: Delta Dental conducts random enrollee surveys each quarter, which include questions about how long it takes the enrollee to schedule dentist appointments and other customer satisfaction issues. The appointment availability at DHMO offices is also monitored via regular office visits from a Delta Dental representative.

Dental Health Services: Yes, we conduct frequent member surveys and regular on-site dental office visits.

Golden West: Yes, access is measured through member-satisfaction surveys in addition to on-site reviews and word-of-mouth from our members.

GroupLink: Our leased networks would track it.

Guardian: We do not monitor appointment scheduling or wait times for the PPO plan. However, we send member satisfaction surveys every month to randomly chosen PPO members who have been to a network dentist within the previous 90 days. Surveys include questions about wait times.

Health Net Dental: Yes, wait times are monitored through random provider office surveys, member surveys, and call data collected from Member Services. Deficiencies are noted in the audit summary letter sent to the provider.

HumanaDental: We rely on member calls to keep us apprised of scheduling issues. Sometimes, the member is limiting their own options (for example, after 5:00 p.m.), which is discovered through discussion with our customer-relations representatives. If the issue becomes chronic, the information is forwarded to our National Dental Network department because additional providers may be needed in the area.

MetLife: We monitor patient impressions of wait time through monthly satisfaction surveys. For 2006, 98% of surveyed plan participants were satisfied with wait time.

Principal Financial Group: We do not monitor this.

SafeGuard: For the DHMO, SafeGuard monitors time that patients wait in the reception area and the operatory through the quarterly accessibility survey and service visit reports by provider-relations representatives. We also track wait times through a monthly report and member-satisfaction survey. For the PPO, there is no monitoring of wait times for PPO dentists, but insureds get help if they are experiencing excessive wait times in any of our contracted offices.

Securian Dental: Securian Dental measures members' satisfaction with the network, but does not monitor office-wait times.

United Concordia: Yes, it is monitored through member surveys, a customer service grievance process, and periodic phone audits of the offices.

Western Dental: Western Dental monitors patient's wait time by onsite reviews, surveys, and questionnaires. In addition, our staff model offices use the Quality Assurance Management System. The state-of-the-art proprietary software tracks measurable items, such as wait times.

15. Are there plenty of providers who stay open late and are open on Saturdays?

Aetna: Each dental office sets office hours.

Ameritas PPO: Yes.

Ameritas/FDH Network: Yes.

BEST Life: Yes, with more than 14,834 providers in the state, many have extended and flexible hours.

Blue Cross: Blue Cross of California offers the option of dental offices with varying hours of operation, but this is the choice of the individual dental practice.

Blue Shield: This varies by provider, but some do stay open late and are open on Saturdays.

CIGNA Dental: Yes, many offices offer evening and Saturday appointments.

Delta Dental: Our online dentist directory contains information on hours and access, including maps and languages spoken. Enrollees can call a toll-free number to request a list of dentists in their area with extended and Saturday hours. In addition to posting hours and access, DHMO network dentists are required to provide 24-hour emergency services to DeltaCare USA enrollees.

Dental Health Services: Many participating dental offices offer extended hours, including weekend hours.

Golden West: Yes, many of our providers offer evening and Saturday appointments. Our Member Services Department can help members with details.

GroupLink: Our leased networks would need to advise on such schedules.

Guardian: Yes, many PPO provider locations have extended or weekend hours.

Health Net Dental: Yes, most providers offer extended service hours.

HumanaDental: Office hours are not tracked.

MetLife: As part of MetLife's credentialing criteria, all participating MetLife PPO dentists must provide acceptable hours of service and have established emergency care and off-hour protocols.

Principal Financial Group: Members can see any provider of their choice, which can include those who have extended hours.

SafeGuard: For the DMHO, SafeGuard contracts with dental practitioners, many who have evening and Saturday hours. For the PPO/indemnity. The plan contracts with individual dental practitioners, many of whom have evening and Saturday hours.

Securian Dental: Yes, Securian Dental's network includes more than 73,000 dentist locations and plenty are open late and on Saturdays.

United Concordia: Providers in every market have extended hours.

Western Dental: Yes, many of our IPA providers have evening and Saturday hours. Most Western Dental Staff Model Offices are open from 9:00 a.m. to 8:00 p.m., Monday through Friday and 8:00 a.m. to 4:00 p.m. on Saturdays.

16. With respect to your mid-range benefit level, what amount of capitation is paid to the general dentist? Do you offer validation for these amounts?

Aetna: This is proprietary information.

Ameritas: For the PPO and the FDH Networks, no capitation is paid to PPO providers.

BEST Life: We do not compensate our providers through capitation. Our indemnity and PPO plans allow patients to utilize providers of their choice.

Blue Cross: This is proprietary information.

Blue Shield: This is proprietary information.

CIGNA Dental: This is proprietary information.

Delta Dental: Delta Dental Premier and Delta Dental PPO are fee-for-service programs and are not capitated. For the DHMO plan, amounts vary by plan design and employer contribution. Groups can validate these amounts through standard group reports if they meet minimum enrollment requirements.

Dental Health Services: This is proprietary information.

Golden West: This is proprietary information.

GroupLink: We are not a DHMO, so this is not applicable.

Guardian: It is not applicable to the PPO dental products Guardian offers in California.

Health Net Dental: The plan pays a specified flat amount of capitation per plan. Amounts are confidential. The Advantage DHMO plans augment dentistÕs compensation by paying supplemental payments on frequently utilized services in addition to standard capitation.

HumanaDental: Managed dental care capitation varies by plan schedule and geographic location.

MetLife: N/A

Principal Financial Group: N/A

SafeGuard: DHMO: This is proprietary information. Capitation for DHMO plans is set actuarially by plan design. Capitation is augmented by supplemental payments for certain procedures. In addition, the plan pays fees for each member visit. There is no capitation with PPO/indemnity plans.

Securian Dental: All Securian Dental plans are fee-for-service. Capitation does not apply.

United Concordia: This is proprietary information. Our DHMO dentists get supplemental reimbursements in addition to monthly capitation payments

Western Dental: We pay the dentist a dollar amount for each plan. The amount varies by plan.

17. Are there incentives for the provider to be thorough?

Aetna: Quality assurance programs are designed to protect members and providers.

Ameritas PPO: Yes, a utilization review is performed quarterly. If standards are not met, the provider could be terminated from the plan.

Ameritas/FDH Network: N/A

BEST Life: FDH administers comprehensive utilizations reviews for dental necessity and appropriateness of care.

Blue Cross: Dentists cannot increase their revenue through incentive programs. When deemed necessary and appropriate, supplemental payments may be made to participating dentists. However, these payments are not part of any bonus or incentive program.

Blue Shield: Appropriate care provided by dentists in our networks is measured continuously through numerous oversight mechanisms. While dentists carry out routine treatment plans without prospective review, our dental consultants evaluate more complicated treatments. They assess the proposed treatments for appropriateness and benefit determination. All dentists involved in our review process are fully licensed. Our clinicians are also involved in the annual review of dentist records. These quality-of-care audits involve the use of comprehensive guidelines established by the American Academy of Dental Group Practice, the California Dental Association, and the American Dental Association (through the University of North Carolina School of Dentistry). Our dental consultants select a random sample of each dentist's records to review. Necessary recommendations are made to any dentists who do not meet our quality standards and follow-up audits are conducted to verify that corrective action has been taken.

CIGNA Dental: Our Integrated Quality Management Program drives quality and better outcomes across our entire network. While we do not provide incentives, we expect providers in our networks to meet professionally recognized standards of care.

Delta Dental: There are no financial incentives because Delta Dental's contract requires a dentist to be thorough and to deliver quality healthcare. Delta Dental monitors dentists' performance through enrollee complaints, on-site quality assessment surveys, and dental office reviews conducted by licensed dentists. Monitoring is based on our utilization management system.

Dental Health Services: Our supplemental payments and rigorous Quality Assurance program are designed as incentives to provide appropriate and thorough care.

Golden West: Yes, referrals to plan specialists are not charged back to the general dentist. On-site visits by quality assurance and provider relation representatives help ensure that panel dental offices meet quality assurance standards.

GroupLink: This is usually asked in context of a DHMO arrangement. Providers under our programs are paid based on a fee-for-service basis or a negotiated fee schedule.

Guardian: Our PPO fee schedules and plan provisions are adequate to encourage proper care. We do not offer incentives. Guardian requires participating dentists to treat PPO members the same as they would any other patients. We investigate all quality of care complaints from members.

Health Net Dental: No

HumanaDental: Fee-for-service reimbursement encourages thorough treatment. Our Quality Assurance Department reviews member complaints through our standard grievance process.

MetLife: Our participating provider contracts require providers to furnish appropriate services. There is no payment to dentists based on the number of covered plan participants they serve (for example, reimbursement is on a fee-for-service, not a capitated basis). Claims are considered for reimbursement based on generally accepted standards of dental care.

Principal Financial Group: Being thorough is an expectation. We do not provide incentives to meet expectations. All providers in our networks or those we might recommend must meet strict credentialing requirements. This means they have all been reviewed independently and found to have proper professional credentials and a verified history of responsible billings. However, a member is free to choose any provider.

SafeGuard: There are no monetary incentives to dentists, but they are expected to perform in accordance with the high standards of competence, care, and concern for the welfare and needs of SafeGuard enrollees and in accordance with the Principles of Ethics of the American Dental Association and California law.

Securian Dental: While Securian Dental regularly monitors providersÕ practice patterns, our philosophy is that the dentist and patient are in the best position to determine a treatment plan that is best suited to the patient. The dentist does not have an incentive to under-treat since all of our plans are fee-for-service.

United Concordia: Participating DHMO primary dentists get supplemental reimbursement on most highly utilized procedures in addition to monthly capitation and member co-payments.

Western Dental: Western Dental Services Inc. may pay the dentist a bonus based exceeding minimum standards specified by Western Dental with regard to accessibility of services and quality of care.

18. Do you provide coverage for all types of specialist referrals?

Aetna: Yes.

Ameritas PPO/FDH Networks: Yes, all specialists are considered for claim reimbursement.

BEST Life: Yes, specialists are covered at full contract benefits as described in our Indemnity and PPO plan certificates. Our orthodontic plan is available for all of our PPO and Indemnity plans.

Blue Cross: Yes, specialist coverage is a benefit for the Dental Blue PPO plan, but referrals are not required. Dental Blue contracted dentists are credentialed providers. In addition, our contracted specialists, such as oral surgeons, periodontists, and endodontists participate in all three Dental Blue networks. For the Dental Net DHMO plans, Blue Cross of California provides coverage for referrals to specialists including, orthodontists, oral surgeons, endodontists, periodontists, and pedodonists (for children under 5).

Blue Shield: Yes.

CIGNA Dental: Coverage is provided for periodontic, endodontic, oral surgery, pediatric dentistry, and orthodontic specialty referrals for DHMO plans. Our DPPO/DEPO and dental indemnity plans do not require specialty referrals.

Delta Dental: Fee-for-service enrollees can visit any licensed dentist. Referrals are not required for specialty care. Enrollees are advised to confer with their general dentist to determine if specialty care is needed and if itÕs covered by their benefit plan. Delta Dental recommends that the enrollee ask the dentist to submit a predetermination request to Delta Dental if the treatment plan is complicated or expensive. This eliminates that guesswork about allowable costs and out-of-pocket expenses. For DHMO patients, referrals to specialists are not charged back against the dentistsÕ capitation payments. As a result, general dentists are not discouraged from making specialty referrals when necessary. However, while prosthodontic procedures performed by the general dentist are covered, services from a prosthodontic specialist are not covered under the DHMO plan. Group coverage levels and the groupÕs contractual agreement determine coverage for other specialist procedures.

Dental Health Services: Our plans provide specialty coverage for endodontics, periodontics, oral surgery, pedodontics, and orthodontics.

Golden West: Yes, our DHMO and PPO plans include coverage for most specialists.

GroupLink: N/A.

Guardian: Specialty care referrals are not required under GuardianÕs PPO plans. Members can get treatment from any specialist without advance approval. We provide coverage for all types of specialist dentists in the PPO network, including orthodontists if the memberÕs plan has orthodontia benefits.

Health Net Dental: Yes, all of our plans include specialty benefits.

Humana Dental: Members can be referred to in-network specialists and out-of-network specialists, depending on the accessibility of the appropriate specialist in his or her area.

MetLife: Our PPO product does not require referrals for specialist care. All claims for services by licensed dental practitioners are considered for reimbursement based on the participant's plan design.

Principal Financial Group: Generally yes.

SafeGuard: For the DHMO, plans cover endodontics, periodontics, oral surgery, pedodontics, and orthodontics. For the PPO/indemnity, insureds can self-refer to any endodontic, periodontic, oral surgery, pedodontics, or orthodontic specialist. Using the specialist listed in our directory will result in reduced fees.

Securian Dental: Securian Dental does not require referrals for any of its services. All specialists are paid based on the dental benefit contract.

United Concordia: Yes.

Western Dental: Specialty coverage is available in all group plans. Oral surgery, periodontics, endodontics, pedodontics, and orthodontics are covered specialties.

19. If covered, explain the process that allows the general dentist to refer to the specialist.

Aetna: For DMO plans, GPs may directly refer to a participating specialist based on published guidelines. Indemnity and PPO plans have direct access for specialty services.

Ameritas PPO/FDH Networks: Specialist referrals are allowed any time from our general dentists.

BEST Life: No referral is necessary. Insureds can visit a specialist at any time.

Blue Cross: Blue Cross of California PPO plans use a pre-treatment and post-treatment professional review to monitor referral activity. In-house dental consultants, who are licensed dentists, perform all professional reviews. Under the Dental Blue PPO contract, pre-treatment review is recommended for procedures in excess of $350. For the Dental Net DHMO, referrals that do not include the high-risk procedures are reviewed post-treatment. Using the Direct Referral program, the participating general dentist may refer a patient to a specialist without prior authorization. The dentistsÕ practice patterns have been scrutinized to ensure that they share in our commitment to providing quality healthcare. For the Dental Net DHMO products, the member's assigned general dentist may call the customer service hotline to get an immediate authorization for emergency services.

Blue Shield: The general dentist completes a specialty care referral form. The dentist also gives a copy to the DHMO member who brings it to the participating specialist at the time of the appointment. DPPO members may self refer to a specialist.

CIGNA Dental: DPPO plans do not require referrals. General dentists are not required to act as gatekeepers. For DHMO plans, general dentists act as gatekeeper for all specialty services except pediatrics (up to age seven) and orthodontic network dentists. For members under age seven, referrals are not needed for orthodontia or to visit a network pediatric dentist. General dentists refer members to network specialty care providers as deemed necessary. CIGNA Dental works directly with the specialists for preauthorization and direct payment when appropriate.

Delta Dental: Fee-for-service enrollees can self-refer. A referral by the general dentist isnÕt required. The general dentist must submit documentation for review and approval for DHMO patients. Approvals are returned to the dentist, who directs the enrollee to the appropriate specialist. In an emergency, the general dentist may call Delta Dental with the request.

Dental Health Services: The general dental office sends Dental Health Services a specialist referral authorization. Upon approval, the authorization is sent back to the general dentist, who informs the patient that they are eligible to get appropriate care from a specialist.

Golden West: The general dentist can self refer the member to a specialist without getting prior approval from the plan.

GroupLink: The general dentist can refer to any specialist.

Guardian: We do not require referrals to specialists under our dental PPO plans.

Health Net Dental: If the general dentist determines that the necessary services are out of their scope of practice, they simply submit a referral request to the plan for approval. This process is outlined in detail in the specialty referral guidelines sent to each network provider.

HumanaDental: General dentists are encouraged to refer members to participating specialists to provide the highest level of benefit to the member. The general dentist can refer out-of-network if there are no specialists within a reasonable distance.

MetLife: Our PPO product does not require referrals for specialist care.

Principal Financial Group: Patients can choose any provider in the network. Referrals are not required.

Safe Guard: For the DHMO, SafeGuard has plans with standard referral, direct referral, and self-referral. Each plan is created with a specialty process. SafeGuard standard plans include direct referral, which allows general dentists to refer directly to contracted specialists. They also include standard referral, which requires approval by SafeGuard for pedodontics and orthodontics only. Discounted specialty plans allow members to self-refer to contracted specialists. Orthodontia can be self-referred on the discounted specialty plans, but needs a referral from SafeGuard for the Preventive Plus and standard DHMO plans. For the PPO, all participants may self-refer to contracted specialists.

Securian Dental: Securian Dental members can see any specialist without prior authorization or a referral.

United Concordia: DHMO plan members must coordinate all care through their primary dental office, including referrals to specialists. However, no preauthorization on referral review is required. This allows the referral process for all specialty services to be completed immediately.

Western Dental: Once the general dentist determines that the necessary procedure is out of their scope, the office submits a written referral request to our plan. Western DentalÕs dental director determines whether the referral is medically necessary and whether the procedure is covered under the benefit plan.

20. Are any of your specialists board eligible/certified?

Aetna: Yes.

Ameritas PPO: Yes, all are board eligible or certified and are monitored during the PPO credentialing process.

Ameritas/FDH Network: Yes.

BEST Life: Our contracted network, FDH, contracts with board-certified specialists.

Blue Cross: All contracted specialists with Blue Cross California must be board certified or board eligible.

Blue Shield: Yes, it varies by specialist.

CIGNA Dental: Yes.

Delta Dental: Yes, under state law, all specialists must be board certified or eligible.

Dental Health Services: Almost all of our participating specialists are board certified or eligible.

Golden West: Yes, all contracted specialists must be board-certified or eligible.

GroupLink: Yes, but leased networks would need to advise on detail.

Guardian: Yes, many of our PPO specialists are board certified or eligible, but it is not a requirement for participation in the DentalGuard Preferred PPO network.

Health Net Dental: Yes, all contracting specialists are board board-certified or eligible.

HumanaDental: All participating specialists must provide copies of their specialty licenses or residency certificates.

MetLife: To participate in the MetLife PPO, specialists must submit and keep any certifications and other factors necessary to maintain their specialty. Specialists are listed as such in our various provider listings.

Principal Financial Group: Yes, all specialists must be board eligible, board certified or be a designated specialist by the ADA.

SafeGuard: All contracting specialists are board certified or eligible.

Securian Dental: Yes, Securian Dental's network includes board-certified or eligible specialists.

United Concordia: Yes, the majority of our specialists are board certified or eligible.

Western Dental: All contracted specialists are board certified or eligible.

21. How do you fund your specialty care?

Aetna: Specialty services are paid through the claim system on a fee-for-service basis.

Ameritas PPO/FDH Networks: Specialty care claims are paid out of the same claims reserve that is established for the groupÕs general dentist claims. All are funded out of the premium charged to each group.

BEST Life: Our PPO and indemnity plans do not require special funding arrangements for specialty care.

Blue Cross: PPO and DHMO specialty care is paid through claims processed according to the provider's fee schedule.

Blue Shield: Specialty care is paid on a fee for service basis for DHMO and DPPOs. Member and plan co-payments will vary, depending on the plan.

CIGNA Dental: DHMO and PPO specialists are compensated similarly through discounted fee-for-service, which is paid from a portion of collected premiums.

Delta Dental: Specialty care is built into the premium. Specialists are reimbursed with a combination of co-payments paid by the covered enrollee and maximum plan allowances by procedure (pre-contracted fees between Delta Dental and dentists).

Dental Health Services: Specialty care and treatment is paid for on a contracted basis. Payment varies by procedure. These costs are built into each plan's monthly premium rate.

Golden West: A percentage of sold premiums is allocated for specialty care.

GroupLink: N/A

Guardian: The plan is not required to fund the specialty care because our PPO specialists are paid on a fee-for-service basis. For the DHMO, specialty dentists are reimbursed based on a predetermined fixed fee schedule. On standard plans, the member never pays more than the applicable co-payment, if any, for any covered service provided by the member's selected provider or referred specialist. Funding of specialty care is done through the monthly fees paid on behalf of the subscriber. Specialty PPO dentists are reimbursed based on a predetermined fixed fee schedule. Funding is provided through the premium payment made on the insuredÕs behalf.

HumanaDental: Specialists are paid on a fee-for-service basis according to a contracted fee-schedule amount or by reimbursement limit.

MetLife: N/A

Principal Financial Group: Through normal plan provisions.

SafeGuard: For the DHMO, specialty dentists are reimbursed based on a predetermined fixed fee schedule. On standard plans, the member never pays more than the applicable co-payment, if any, for any covered service provided by the member's selected provider or referred specialist. SafeGuard does have plans with a discounted specialty care feature. The member gets a 25% reduction from the specialistÕs usual and customary fee. Funding of specialty care is done through the monthly fees paid on the subscriberÕs behalf. Specialty PPO dentists are reimbursed based on a predetermined fixed fee schedule.

Securian Dental: Specialty care is funded on a fee-for-service basis.

United Concordia: Specialists agree to accept an amount per procedure as payment in full. If the memberÕs co-payment is less than the guaranteed amount, the plan will reimburse the specialist the difference between the negotiated fee and the member co-payment.

Western Dental: We incorporate into our rates what we expect specialty care claims to be. We then pay the claims based on dental necessity and plan guidelines.

22. Can the member self refer or does the member have to be referred by the primary dentist to the orthodontist?

Aetna: All members may self-refer to an orthodontist. DMO and Vital Savings members must choose a participating orthodontist.

Ameritas PPO/FDH Networks: Insureds can self-refer.

BEST Life: No referral is necessary on our PPO or Indemnity plans.

Blue Cross: Members enrolled in the Blue Cross of California Dental Blue PPO program can self refer. Members can seek services from a network specialist to get the full savings advantage of their benefits. There is no paperwork since the member goes directly to the specialist. Once the specialist performs an evaluation, they may submit a pre-treatment estimate. Upon consent of the member, they may perform the needed procedures without submitting a pre-treatment estimate. Members who enroll in the Blue Cross Dental Net DHMO program must be referred by their primary dentist to an orthodontist. Using our Direct Referral program, the participating general dentist may refer the patient directly to the specialist without prior authorization.

Blue Shield: For DHMO plans, the general dentist completes a specialty care referral form and provides a copy to the member who brings this to the participating specialist at the time of the appointment. PPO plan members may self refer.

CIGNA Dental: DPPO/ DEPO and dental indemnity plans do not require referrals to visit a specialist. A new enhancement for our DHMO plans is the removal of the referral requirement for a member to see a network orthodontist.

Delta Dental: Enrollees may self-refer. For DHMO plans, the enrollee may self-refer only to a contracted DHMO orthodontist.

Dental Health Services: Members must get a referral from one of our network dentists before visiting a participating orthodontist.

Golden West: The member can self refer to the panel orthodontist office.

GroupLink: Members can self refer.

Guardian: PPO members can self-refer to all types of specialty care, including orthodontia. For the DHMO, orthodontia needs a referral from Health Net Dental PPO/indemnity: Insureds can self-refer to any contracted orthodontist.

HumanaDental: In our PPO, the member can self-refer to an orthodontist.

MetLife: Our PPO product does not require referrals for specialty or orthodontic care, so participants can self-refer.

Principal Financial Group: A member can seek services from any provider.

SafeGuard: For the DHMO, orthodontia can be self-referred on the discounted specialty plans. But a referral is required from SafeGuard for all other DHMO plans. For the PPO/indemnity, insureds can self-refer to any contracted orthodontist.

Securian Dental: Securian Dental does not require referrals for any of its covered benefits including orthodontia.

United Concordia: Under our DHMO plans, the primary dentist determines if a specialty referral is required, regardless of the specialty. Our PPO plans allow members to self-refer.

Western Dental: The member must be referred by the primary dentist to the orthodontist for our IPA Dental Plan. Our Western Centers-only plan allows the member to self-refer.

23. How long does it take to process a referral in terms of member notification and payment to the specialist?

Aetna: DMO GPs usually give the member an immediate referral. Specialty payments are made upon receipt and adjudication of the claim. Reimbursement checks are mailed weekly.

Ameritas: N/A

BEST Life: Our average claims-payment time is less than five days. Check our agent Website (www.besthealthplans.com) for weekly stats.

Blue Cross: With Blue Cross of California PPO plans, the member can self-refer, so there is no time frame. Our PPO plans do not require referrals to specialists. Members can go directly to any PPO specialist without any referrals.

Blue Shield: For DHMO plans, the gene