Annuities–Demonstrating Your Value as a Retirement Income Expert
by Brian Grigg • The new generation of insurance income products provides more flexible tools to achieve this than ever.
Disability –Growing the Next Crop of Disability Agents
by Craig Gussin, CLU • We veteran brokers need to take the lead and do something now to keep our practice in existence in future years.
Self-Funding–Bending the Trend: Getting Back to the Basics
by David Zanze • A proven way to answer questions relative to your client’s claims data is to use what is commonly referred to as “descriptive statistics.”
Life Insurance–How Benefit Communications Can Narrow The Gender Gap
by Stephen Pontecorvo • Working men and women may have similar financial responsibilities, but research demonstrates that their life insurance ownership amounts are different.
Voluntary Benefits–The Only Things Certain In Life Are Death, Taxes And Personal Legal Needs
by Ann Dieleman • Offering a legal plan as a voluntary benefit can help employers keep benefit and operating costs in line with budgetary constraints, and that’s sure to keep clients happy in today’s uncertain economy.
Dental Survey Pt. III…You Know the Drill!
by Leila Morris • Welcome to Part III of California Broker’s 2011 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.
Healthcare–Reducing Healthcare Costs With Eligibility Audits
by Michael Smith • Employers are under tremendous pressure to reduce the cost of providing healthcare coverage amid new healthcare reform requirements including more dependents being added to the plan.
Long-Term Care–Talking to Baby Boomers About Long Term Care Insurance: Selling the planning concept rather than the product
by Steve Cain • Over the years, the sale of long-term care insurance (LTCI) has focused mainly on selling a health insurance product rather than selling the concept of long-term care (LTC) planning. LTCI has been viewed as a senior market product.

Annuities–Demonstrating Your Value as a Retirement Income Expert

by Brian Grigg

“Don’t shoot the messenger,” may be an apt motto for our industry today, as producers have to be the bearers of bad news to Baby Boomers. In addition to having low savings rates, many Baby Boomers overestimate the retirement income that their nest eggs can generate from bonds and CDs.

They also underestimate the long-term impact of inflation and taxes on their purchasing power. Fortunately, this is a major opportunity for producers to become the bearers of welcome news by providing income solutions that offer peace of mind.

In this article, we will discuss how to shift the conversation with Baby Boomer clients from an accumulation to an income perspective and how the latest generation of fixed indexed annuities can allow producers to customize solutions to a client’s financial preferences.

Retirement income is cause for concern for many Boomers. More than half are concerned about outliving their retirement savings, according to Benefit Research Institute’s 2011 Retirement Confidence Survey. Eighty-nine percent of the 77 million people born from 1946 to 1964 are not strongly convinced that they will be able to live in comfort in their later years, according to a recent Associated Press poll. About 44% of Boomers express little or no faith they will have saved enough money by retirement while one in four do not expect to retire, ever.
Helping Baby Boomers come to terms with their income prospects is not an easy role for many producers to assume. Many producers have spent virtually all their insurance career helping clients focus on accumulation; they are less comfortable discussing long-term income requirements.

Producers are aware that many Baby Boomers may be disheartened, at first, when their financial situation is examined in detail. It is never pleasant telling near-retirees that their income in retirement is likely to fall short of their expectations.

Many producers lack the training and experience to help clients select an advantageous income solution. It is crucial for producers to overcome these hurdles. Advisors who fail to add retirement income to their knowledge base risk losing clients to competitors who are well prepared to engage in income discussions. Conversely, producers who are adept at helping clients transition from their accumulation to distribution phase have a major opportunity to add business and provide advice on the entirety of their clients’ lifetime assets.

Changing the Conversation

The good news for producers is that modifying the conversation with clients from an accumulation to an income perspective is not as drastic as it may appear. In our experience, producers can often initiate this conversation using the following three questions:

1. 
What are your retirement goals and how do you envision yourself in retirement? Prompting people to discuss how they want to spend their time in retirement and what apprehensions they have about this new phase enables advisors to reinforce their personal bond with clients.

2. 
Do you have an income plan that will allow you to live the way you want for the entire span of your retirement? This question flows naturally from the preceding conversation. The answer from clients is almost always “No,” or “I’m not sure.” This gives producers an opportunity to present themselves as experts who can help the client succeed.

3 
May I schedule time with you (and your spouse or partner) to review your retirement income and discuss the various options you might have? This question is a logical counterpoint to the previous question. The producer can explain that this second discussion will focus on the five essential elements of an effective retirement plan:
1. 
Protecting against outliving assets.
2. 
Protecting purchasing power against inflation.
3. Protecting against market risk.
4. 
Providing the retiree with the ability to finance a quality lifestyle.
5. 
Ensuring that a retiree does not lose control of their money.

When the producer and client meet again, the first step is to have a thorough fact-finding session to gather information about your client’s financial position and retirement goals. This includes listing all actual and potential sources of income, such as Social Security, a pension, IRAs, an expected rollover IRA from a defined contribution plan, stock and bond portfolios, cash accounts, royalties, legal settlements and rental income. It can also be important to consider whether a client’s primary residence or other real estate that can unlock income. Once these sources are identified, they should be categorized as guaranteed or non-guaranteed and taxable or tax-deferred.

Since many people have misconceptions about Social Security, a producer can add value by helping clients understand how this benefit can fit into their total financial picture. In general, Social Security replaces only about a third of the average earner’s income. Pressure placed on our nation’s retirement system by the Baby Boom demographic suggests that Social Security may decrease in the future.

According to Social Security Administration figures, 72% of all people begin Social Security at the early-retirement age of 62. Producers can provide a real service to clients by alerting them that electing early benefits may result in a significant reduction in income received over time. The client may understand this on a superficial level, but not truly appreciate the loss that this will entail. Similarly, producers can review with clients the advantages of delaying Social Security and substantially increasing the lifetime benefit.

You can provide this information within the context of creating the client’s retirement income strategy. Once you have clarified Social Security issues, the next step is to estimate how much income other sources can be expected to contribute. This should be a simple discussion if a client’s savings and projected spending are well aligned. However, in many cases (if not most) producers find a mismatch between a client’s income sources and spending expectations, especially when potential inflation, taxes and longevity are factored in. This conversation can be especially difficult if there is a possibility of clients outliving their income or depleting it to such an extent that it threatens their quality of life. In this circumstance, producers and their clients may be prudent to consider insurance-based income benefits.

Creating A Viable Income Benefit

Regardless of how much a household has saved, a viable income plan should produce a solution that guarantees income for life and the ability to maximize payment during the accumulation phase. It should also enable clients to start and stop withdrawals at their discretion and restart withdrawals at least once. For many retirees, these features are essential to their financial well-being and not simply nice-to-have indulgences.

The original generation of income annuities possessed some, but not all of these attributes. Clients appreciated the lifetime income, but they had some resistance to the perceived lack of flexibility regarding withdrawals and opportunities to grow savings. These vehicles also were faulted for their inability to provide investors with greater control, especially the inability to reverse decisions.

Virtually all of these concerns are addressed by the latest generation of fixed indexed annuities. These products have made sizeable advances in enabling producers to customize solutions to a client’s financial preferences. In addition to accumulation elements, a growing number of FIAs offer better upside potential for interest crediting as well as access to the same guaranteed lifetime withdrawal riders that were once available only to variable annuity investors. Indeed, income riders in fixed products are prone to be more competitive than their VA counterparts because FIAs do not have to insure the downside risk.

FIAs are clearly not for all retirees, but they appear poised to capture a larger share of insurance income products. When available for purchase, the rate of election for guaranteed lifetime withdrawal benefit riders was 57.5%, according to the 1Q 2011 AnnuitySpecs.com’s Indexed Sales & Market Report. Advantage Compendium notes that FIAs have performed competitively in high and low interest rate environments as well as both rising and falling stock markets.

The Boomer generation’s need for lifetime income is a massive opportunity for producers and the new generation of insurance income products provides more flexible tools to achieve this than ever. Now is the time for advisors to present themselves as retirement income experts to their clients.
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Brian Grigg is vice President-Annuity Distribution, Fidelity & Guaranty Life insurance company.

Disability–Growing the Next Crop of Disability Agents

by Craig Gussin, CLU
Who will sell disability insurance in the next 15 years? The average disability insurance agent or broker is around 59. Within the next 15 years, these agents and brokers will be retired, close to being retired, or thinking about retiring in the near future. Already, there are fewer agents and brokers selling disability insurance than ever.

Many agents and brokers tell me that they don’t sell disability insurance because it is too hard to sell compared to the other insurance products. They will say that they tried before and had the case declined or that underwriting was too difficult. However, there is still and always will be a need and desire by the consumer to buy disability insurance. So what is the problem? I say that it’s that no one is educating these agents and brokers on how to sell disability insurance, like the insurance companies did in past years. Many insurance companies have left the agency system and have gone to brokerage. The insurance companies say they cannot afford to hire, train and provide a base salary to a new agent as they did in the past.

People are thinking twice before coming into the insurance business. Since they won’t have a salary or base pay for a period of time, why would they want to enter the insurance business when other industries will hire them, train them, and pay them a salary without the stress of having to perform, starting on day one?

Yes, our business gives them the freedom to make as much money as they like and work as much or little as they like, but a new agent or broker needs money now to live on. A veteran broker will tell you that the insurance carriers make a lot of money on the agents they train. So they should hire new agents and teach them how to sell disability insurance and other products.

Some say that GAs should train brokers or new agents to sell disability insurance since they are the ones who will help agents and brokers sell the case. Others say that veteran brokers should mentor new agents and brokers. So far, none of these ideas have worked.

So how will the disability insurance industry solve this problem when none of the other insurance industries have been able to? Every insurance company and insurance industry association has realized this problem, regardless of the insurance product they are selling.

Is there an answer? I say yes there is and so does The International Disability Insurance Society (IDIS), which was started six years ago to address this exact problem. They have developed many educational courses along with the American College to provide brokers and new agents a way to learn about disability insurance and learn how to sell it.

I believe that the answer starts with all veteran brokers. You need to think about this in two ways: one from a way to continue to grow your business income and one from a business owner point of view. Why not work with a new agent or broker who does not sell disability insurance? You get referred as the disability insurance specialist and split commissions and future renewals with the broker who referred you? You increase your income while helping a new agent or broker learn how to sell disability insurance. If the agent or broker does not want to sell disability insurance, you will have an ongoing and easy way to increase your disabiliy insurance practice and, of course, your income.

The second way is to think about who will take care of your clients and your practice when you retire, semi retire, or just slow down a bit. I believe that all brokers need to plan for this near future event. You should look for someone to come into the business or maybe the new agent or broker whom you are splitting business with. Do they share your values and work ethic? If so, bring them in as an employee or an associate. Teach them how you do business and how to sell disability insurance and the other products your firm offers. Have them work with your clients and learn how your practice runs.

The goal is for them to ultimately run your practice one day. The longer they are with you, have them do more and more of the work, get to know your clients, get them licensed if they are not already licensed, and take them with you on appointments. This will solve the two issues that most brokers have. First, it will make sure your clients are being taken care of as you begin to go into retirement mode. Second, you won’t have to sell your practice or let it run on automatic pilot mode and see your renewals decrease over time.

You can then have your income stream continue to grow while you have someone servicing your clients. You will receive commissions from new business being written on your clients and continue to receive renewals as part of an agreement you will have with the broker servicing your clients.

We veteran brokers need to take the lead and do something now to keep our practice in existence in future years. I know brokers will say that they have tried it and can’t find someone to hire or the person they hire did not stay. So why stop looking? Since when has a veteran broker ever stopped selling because of a rejection? Keep looking and you will find the right person for you and your practice. Of course, there is no easy way to find someone, but you have to remember that most people who would like to join our industry can’t afford to start working without a steady income, so be sure to pay your staff well, give them the skills they need, train them well, and treat them more like your team and not just your employees. Take them to association meetings and send them to educational meetings. Have them belong to the association you belong to and do what I do: pay their association dues. Make them feel like they are part of your practice. This is how you will be able to attract and retain people who want to be with you long term, with the ultimate goal of having them continue your practice when you retire.

The right person will realize what a great opportunity they have. I know this, since this is how I found mine. It was not an easy process; it took me many years until I found the right person. As a veteran broker, I would like to see other brokers bring in new agents and brokers in the business or mentor a new agent on how to sell disability insurance. We brokers need to help be part of fixing this problem along with the insurance industry so your clients stay with you and you continue to see your income grow and you are allowed to retire with renewals. This is just one broker’s thought, what are yours?
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Craig Gussin, CLU is with Auerbach & Gussin Insurance and Financial Services, Inc. in San Diego. (Lic 0E24650, 0268933). He is 2009 to 2010 Board Member and first vice president for the International Disability Insurance Society (IDIS). For more information, call 858-546-4101 or visit www.auerbachandgussin.com.

Self-Funding–Bending the Trend: Getting Back to the Basics

by David Zanze
It’s easy in the realm of self-funding to be overwhelmed with too much information. Where do you turn to get answers to seemingly simple questions? A client might ask what their claims costs are and what’s driving these costs. They might want to know the percentage of claims that are emergency room visits and how frequently they occur.

From claims frequency to utilization, do you know where to turn to get answers? You might think a sophisticated reporting mechanism will provide the information you need only to find that, in most cases, what you’re given is overkill. Sure, reporting tools are helpful. They provide a lot of useful data and even offer predictive modeling, risk profiling, forecasting and benchmarking. However, a proven way to answer questions relative to your client’s claims data is to use what is commonly referred to as “descriptive statistics.”

With healthcare costs continually on the rise, self-insured employers need to be more cost savvy than ever, even if that means coming in a hair below the charted norm. Where will your client be in the next three years? If self-insured employers have no grasp on their healthcare costs, does it even make sense in this environment for an employer to self-manage their health insurance costs? Yes, it does. By learning and applying the value of a simple set of statistic principals, you can help offset your client’s claims cost and dramatically reduce their spending. You don’t need to be a mathematician or depend on sophisticated reporting functions to attain an overall digest of what’s happening within a given employee population. You just need an understanding of the basics. Using what is known as descriptive statistics, brokers can help clients evaluate claims information, identify recurring claims expenses, and put clients on the right track to create and implement cost-effective plan designs and effective cost-containment programs.

Mathematically speaking, descriptive statistics quantify a data sample and summarize the essential elements within that data set. As a broker, this means that just a few formulas can provide a solid summary of a client’s health benefit data, allowing you to survey and perform a fundamental evaluation of their claims cost and utilization. The methods outlined below can provide your clients with a clear window into the complex world of claims data. To get started, here’s what you need to know:

Distribution

Distribution is most often used to identify the frequency of a value or range of values for a specific variable. A variable is another way of saying that a category can change. Distribution can answer any number of questions about a client’s employee population, such as what is the relationship of male to female employees? What percentage of employees falls into different age groups? Who are my client’s top 10 providers? An easy way to find the distribution would be to list each value for a variable (for example, list out the price for each claim) and the number of items that had that value (for example add the number of claims that were priced between $1 to $500; $501 to $999; and so on).

For example, you can identify the percentage of claims in each paid amount if you list the price of each claim and add the number of claims that had the same price or were between a set price range. As distribution is commonly displayed using graphs, percentages or both, the below model illustrates this example:

The above bar graph identifies the volume of claims for each price range. This data can answer any number of questions, but most importantly, it focuses the client’s attention on the obvious 45% of their claims fall between $1,000 and $5,000. The next step is to ask why. This information presents not only what future claims costs may be, but also helps the client to identify reasons for this lot of claims. Is it an anomaly that a majority of the claims are in this cost range or is there a common diagnosis driving these costs? Is there a wellness or disease management program the client could implement? Are the employees using in-network providers? If not, why? Although the client would need more detail to answer these questions, the above table helps the client to focus their attention on potential issues and to apply the appropriate resources to reduce costs.

Central Tendency (Mean, Median and Mode)

When evaluating your client’s data, you might need to identify the most common occurrence of a given variable. Your client might ask, “What is the average claim cost?” “What prescription, provider or network is being utilized the most?” “What is the frequency of office visits?” All of these questions can be answered by finding the central tendency.

The term, “central tendency” helps to get an idea of the middle values in your data. There are three major types of central tendency: mean, median, and mode. It’s important when finding the central tendency to use all three functions to develop a broad picture of the middle values. This will help to identify outliers, a value or a set of values in the data sample that is widely separated from the rest, which may be distorting your analysis.

Finding the central tendency is useful for several reasons: you can observe the central tendency against a benchmark to draw comparisons, identify problem areas to target, and reduce claims expense, or budget for future claims costs.

To find central tendency, you should first find the mean. You can find the mean, or average, by adding your values together and dividing by the total number of values in your data. For example, the mean of claims cost is determined by adding the cost of all the claims and dividing by the number of claims in your sample. But be wary of using just the mean to analyze your data. One outlier could skew the results. Does the mean include one extremely high or low dollar claim? If you’re not scanning the claims for this detail, the mean won’t tell you. It’s in this example in which the median, or middle value, might point out irregularities. If you find that the mean, median, and mode are all about the same, there is not a lot of variance in the data and the central tendency is a fair estimation.

The median determines where the data sits relative to the middle or 50th percentile. You can find the median in the example above by listing the claims in numerical order by cost and finding the midpoint. The median helps to determine whether your mean is near the true central tendency. Is the middle claim in this list close to the average claim cost? If not, and your middle claim is off by more than just a few (+/- 10) dollars, check your data for atypical costs.

Much like distribution, the mode determines frequency in your data set. For example, your mean and median is indicating that the average claim cost is $450. How often does that cost occur? And what is it? You can find the mode by listing the costs in numeric order and adding each specific cost occurrence. The highest number of occurrences indicates the most frequent cost. It turns out the employees are frequenting an emergency room rather than a standard provider’s office, which explains the cost. In this example, you might suggest a higher co-pay on emergency room visits to encourage standard office visits to significantly reduce the frequency of this cost and save your client a lot of money.

Dispersion

Dispersion is the spread of values around the middle or central tendency and is commonly measured by either “range” or “standard deviation.” The range is the difference between the highest value and the lowest value in a data set. Using the example above, if the highest claim cost was $100,000 and the lowest claim cost was $150, the range of claims dollars would be $99,850. The importance of knowing the range is that it can show you the most extreme values in either direction, high or low. While this is useful information, it could be affected by outliers. Therefore, understanding the concept of dispersion is important.

Another useful measurement of dispersion is the complicated standard deviation. The standard deviation can be a more accurate measurement of variation around the mean. It identifies whether values are concentrated around a mean or if they are spread out.

In scatter plot A, the data points are centered on the mean or diagonal line, indicating less variance around the mean. In scatter plot B, the coordinates are widely dispersed, meaning the data is skewed with extreme values around the mean. It should be noted that although standard deviation is a formula for calculating variance, the formula itself is complex and rarely done by hand. The easiest method to calculate standard deviation would be to highlight the data sample in Microsoft Excel and to apply the standard deviation function (STDEV) to it.

The information is only a summary and limited in detail. So reporting tools may be used in concert with your efforts to help drill down and evaluate date. However, analysis obtained through reporting mechanisms, alone, can be too cumbersome to analyze if you don’t first have a jumping off point. Having descriptive statistics is an important first step in cost containment efforts. Thus, reporting tools should not be the first place you turn to find answers. Blending reporting tools with descriptive statistics can guide your self-funded employers to cost-savings by allowing you to provide appropriate, cost-effective benefit plan recommendations.

Of course, these statistics don’t need to be computed by hand; using simple software solutions on your computer such as Microsoft Excel can be an excellent resource for sorting or calculating sets of data. Or you can always reach out to your TPA to help with this kind of analysis.
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David Zanze joined Pinnacle Claims Management, Inc., a TPA licensed in several states, as President, in 1996. He has spearheaded a variety of new technology services for providers, employers, and their employees and also worked to develop and institute cost containment and health management programs. For more information regarding our TPA’s services, please call (866) 930-7264 or visit us online at www.pinnacletpa.com.

Life Insurance–How Benefit Communications Can Narrow the Gender Gap

by Stephen Pontecorvo
In large part, you can measure the success of a group life insurance program by employee participation rates. Not only do you need to consider how many employees participate, but also what amounts of supplemental coverage they buy. Working men and women may have similar financial responsibilities, but research demonstrates that their life insurance ownership amounts are different. This phenomenon isn’t readily explained simply because job positions and incomes may differ because women are even more underinsured than men. Working women who have life insurance are generally insured for only twice their household income compared to men who are generally insured for almost three times their household income, according to MetLife’s 9th Annual Employee Benefits Trends Study. To compound the issue, women are even more concerned about the financial impact of their premature death to their families. The study found that 53% of women and 49% of men are very concerned about this impact.

So what explains the gender gap? One likely contributing factor is that benefit communications simply aren’t very effective. The study revealed that women have unique preferences about employee benefit communications. In preparation for open enrollment season, consider discussing with clients whether their communication strategy for female employees is robust enough to engage them in the group life offering.

The Employees’ View of Benefit Communications

Efforts to improve benefit communications do have a return-on-investment. Improved communications help ensure that employees understand and value their benefits. In addition, the study found that 65% of those who work for organizations that had improved their benefit communications during the past year felt their employer was loyal to them compared to 33% of employees overall. However, the study also found that a third of employers said that changing employee communications is simply not a current priority.

Most employees are somewhat underwhelmed by their benefit communications. Fifty-five percent of employees do not find their benefit materials to be clear and comprehensive. In addition, only 34% of working women surveyed strongly agree that their employers’ benefit communications educate them effectively on their benefit options, underscoring the opportunity for improvement.

Gender Differences Regarding Purchase Drivers

Some gender differences may be worth factoring into the communications equation. Messaging research conducted by MetLife last year shows some marked differences. For example, strong purchasing drivers among women are statements about the ease of obtaining life insurance and affordability/cost benefit statements, along with having premiums deducted from the paycheck. Certain emotional benefits are also important like having pride in taking care of their families and having the relief of knowing that their families are taken care of.

Higher income women (earning $50,000 per year or more) are not as confident in their life insurance decision-making as are higher income men, according to research commissioned by MetLife from Nielsen/Claritas. This has implications for communicating strongly about decision support tools to help guide women during the enrollment process. Consider these findings:

• 
44% of higher income women believe that life insurance costs more than they can afford compared to 32% of higher income men.
• 
67% of higher income women believe that selecting life insurance products is a complicated process compared to 59% of higher income men.
• 
59% of higher income women believe that selecting the amount of life insurance you need is a complicated process compared to 50% of higher income men.
Given the opportunity to improve communications and the increased need to help women close the underinsurance gap, there are several ways to help clients improve upcoming open enrollment communications.

Address Women’s Purchase Barriers

More effective communications can help address women’s concerns by emphasizing the ease of purchasing and choosing life insurance, the fact that coverage through the workplace is generally offered at competitive group rates, and the peace of mind that can be obtained for the family’s financial security.
Communicate the Affordability of Life Insurance to Women

The reality is that life insurance may be more affordable than some employees think due to competitive group rates.

Communicate the Broad Purpose and Intent of Life Insurance

Women are more likely to view life insurance as a product to cover burial expenses versus for financial security overall, according to the Nielsen/Claritas research. Emphasize the importance of life insurance as an income replacement means and as a way to secure more financial security for family members.

Communicate in the Channels and Frequency That Women Prefer

Working women participating in the study said the following would be helpful for improving communications:
• 
43% access to benefit information on the Internet.
• 
39% information tailored to their life events and life stages.
• 
39% access to a person who can tell them about their benefits.
• 
30% more frequent communication about their benefits.
Open enrollment season should be one of several opportunities to communicate about employee benefits. Use communication opportunities at different times of the year to reinforce ongoing messages in order to keep your clients’ employees more engaged – men and women alike.

Provide Tools and Guidance

Emphasize that choosing the right type and amount of life insurance can be a simple process and that the right tools can help employees select the appropriate type and amount. Only 30% of women in the study feel very confident that they are making the right financial decisions for their families compared to 42% of men. Offering a variety of in-depth assessment and educational tools can help your female employees understand their need for coverage, assess the right coverage amount, and enroll easily. To make the right decisions during open enrollment, encourage your clients to connect their employees to in depth decision support tools. They should also remind employees that certain life events may trigger the need to take action to re-evaluate coverage levels.

Incorporate Features With Added Value

You can also help increase the value of your client’s life insurance plan by promoting services like face-to-face will preparation and estate resolution services. These services can help men and women feel more secure about their families’ preparedness in the event of a premature death. The help offered by meeting with an attorney can help diminish considerable anxiety around legal planning.

Impact on Loyalty

According to the study, employees who say that their company has effective benefit communications or who recognize that their employer has improved communications, are more than twice as likely to say they are loyal to their employer. They are also more likely to be satisfied with their benefits and jobs.

If benefit communications do not address the needs of female employees, employers can miss an opportunity to fully leverage the value women get from their benefits at work and miss an opportunity to improve loyalty among workers. The study found that only 37% of employers say non-medical benefits, such as life, disability and dental insurance are very important factors in influencing employee loyalty. However, 63% of working women say that these benefits are very important factors. These statistics reinforce the importance of highlighting the value of the group life program with more effective communications.
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Stephen Pontecorvo is vice president, Group Life Products for MetLife. MetLife is a subsidiary of MetLife, Inc. (NYSE: MET), a leading global provider of insurance, annuities and employee benefit programs, serving 90 million customers in over 60 countries. For more information, visit www.metlife.com.

Our Annual Dental Survey–You Know the Drill!

by Leila Morris
Welcome to Part I of California Broker’s 2011 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. If you’d like to see the survey in it’s entirety, please click here.

1. What types of plans do you offer?

Aetna: We offer the following dental plans:
• 
Aetna Dental Maintenance Organization (DMO) plan, PPO, PPO Max,
• 
Freedom-of-Choice Plan Design (offering members their choice of two dental plans),
• 
Aetna Dental Preventive Care, Aetna DMO Access, Aetna Dental Care Reward, Aetna
• 
DentalFund (our consumer-directed dental plan), Indemnity, Vital Savings by Aetna, a dental discount program.
Aflac: Voluntary Individual Table of Allowances plans.
Ameritas: has the following types of dental plans available nationwide: PPO, indemnity, voluntary, non-voluntary, groups from two lives and up, individual, consumer driven and cost containment plans.
Anthem Blue Cross: Anthem Blue Cross and 
Anthem Blue Cross Life and Health Insurance Company offer a comprehensive line-up of dental plans and products that include: PPOs and DHMOs for individuals, small groups, large groups and national accounts. We offer voluntary dental plans for small and large groups.
BEN-E-LECT: BEN-E-LECT offers Fully-Insured PPO, High Deductible, Pre-Paid and Self-Insured Dental Plans for the group market. Employer Paid and Voluntary down to 2 lives, with multiple network and out of network options down to the employee level.
BEST Life: In California, we offer employer-contributory PPO, and 
Indemnity dental plans to groups with 2 or more employees enrolling. Voluntary PPO/Indemnity dental plans are available to groups with 5 or more employees enrolling. Custom dental plans can be offered for groups with 100 or more employees enrolling. Group term life and vision PPO/indemnity plans are also available.
Blue Shield: Blue Shield provides a wide range of affordable and comprehensive dental PPO and HMO plans to meet your clients’ needs, whether they’re large or small groups or individuals and families. We offer dental PPO plans with MAC, UCR, and fee-for-service schedules. Our group dental PPO and HMO plans are offered on a contributory or voluntary basis. These plans can be sold with or without Blue Shield medical plans.
Individual and family plans (IFP) dental PPO and HMO plans are available to our IFP medical members as well as on a stand-alone basis for dental PPO plans. We also offer two comprehensive dental PPO plans developed specifically for Medicare Supplement plan members.
CIGNA: We offer the following dental plans:
• DPPO
• DEPO
• CIGNA Traditional – dental indemnity
• 
DHMO Standard plans and split copays for general dentists and specialists
• 
DHMO Value Plans – including flexible plan options with alternative treatment provisions.
• 
DHMO Preventive Plans
• 
CIGNAFlex Advantage (monthly switch feature between a DHMO and DPPO or Dental indemnity plans)
• 
CIGNA Dental WellnessPlus
• 
CIGNAPlus Savings, a dental discount card program (not an insurance product) which helps meet the needs of employers looking to offer an extra benefit to part-time employees, seasonal employees, or retirees. This is an affordable alternative to offering traditional dental insurance that provides access to dental care services at discounted rates.
• 
Dental Shared Administration — provides qualified Funds and clients the administrative flexibility to pay their own dental claims and still take advantage of CIGNA Dental DPPO negotiated discounts and utilization management tools.
• 
All plans are available on a stand-alone basis. All plans except the discount card are also available alongside medical and/or vision plans. CIGNA also has three WellnessPlus features, which can be paired with DPPO, DEPO, or dental indemnity products. Individuals who get any preventive care in one plan year qualify for increased benefits in the following plan year. All plans are available on a contributory or voluntary basis.
Dearborn National: Dearborn National offers nationally both a 
flexible portfolio of dental plan options as well as custom options for larger groups. With the proprietary claims adjudication system, employers are offered flexibility in designing their custom dental plan needs as well. Funding options include fully insured, self insured and voluntary plans. Dental plans are offered for groups as small as 2 employees to national accounts exceeding 40,000 employees. In addition, with our partnership with California Dental Network (CDN), we offer both PPO plans and DHMO plan options in the state of California.
Delta Dental: Managed fee-for-service, PPO and DHMO group dental
plans; individual DHMO dental plans and group HMO vision plans.
Dental Health Services: Prepaid dental benefit solutions for groups and individuals. We also offer PPO, EPO, and indemnity (reimbursement) products for groups of all sizes and ASO services for self-funded groups.
Guardian: Dental PPO (active or passive), Prepaid/DHMO, and 
Indemnity plans are available on a voluntary or employer-sponsored basis. Dual and Triple Choice, Monthly Switch (between a DHMO and PPO), and Administrative Services Only plans are also available. Guardian specializes in customized plans based on the needs and price points of the employers and employees.
Health Net Dental: Health Net Dental HMO (DHMO) plans and dental PPO plans offer robust benefits covering most dental procedures. Dental plans may be purchased in conjunction with a Health Net medical plan or on a stand-alone basis. In addition, the dental plans may be purchased as dual choice. Contributory and voluntary plans are available.
HumanaDental: PPO, prepaid/DHMO, traditional preferred, and preventive plus plans available on a voluntary or employer-sponsored basis. Humana also has a robust ASO dental plan available in California.
MetLife: Dental PPO, Dental PPO-Copay, Dental HMO and Indemnity 
plans, with flexible designs and funding arrangements available to accommodate employer plan requirements – single or multi options, fully insured or self-funded as well as a full range of contribution options. Group dental insurance policies featuring the Preferred Dentist Program are underwritten by Metropolitan Life Insurance Company, New York, NY 10166. Dental HMO plans are available in CA, FL and TX only, through a domestic company in the applicable state named SafeGuard Health Plans, Inc. The SafeGuard companies are part of the MetLife family of companies. “Dental HMO” is used to refer to products that may differ by state of residence of enrollee, including but not limited to: “Specialized Health Care Service Plans” in California.
Principal Financial Group: We offer both employer paid and voluntary plans, including PPO, EPO, and POS. We also offer a choice between our plans and dental HMO plans through marketing alliances.
Securian Dental: Group dental PPO and indemnity.
United Concordia Dental: United Concordia Dental offers flexible fully insured PPO and DHMO plans as well as an individual product, iDental. ASO funding arrangements are available based on group size. Most plans can be offered on an employer-sponsored or voluntary basis.
Western Dental: Western Dental offers DHMO mixed-model provider panel comprised of (a) contracted independent, general dentist and specialists, along with (b) Western Dental employee dentist and specialists, who work in the company-owned Western Dental Centers. Western Dental currently operates over general dentistry and orthodontic offices throughout Calif., Ariz., and Nevada.

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

Aetna: The key difference between Aetna small group plans and 
larger group plans is that small group plans are pre-packaged plan designs. While larger groups can select from an array of benefits, the packaged small group plans are comprehensive yet price sensitive and make it easy for our customers to choose from plans that are competitive in the market.
Aflac: Our rates and benefits do not vary based upon the size of the 
account. However, when replacing existing dental coverage in larger accounts, waiting periods may be significantly reduced.
Ameritas: Ameritas’ small group and one life group plans are rated 
by industry and are pooled in full or in part. Large groups: Experience is rated and includes lower rates in most cases. Ameritas offers a wide variety of plan designs, regardless of group size, to meet the needs of our customers. The pricing of our non-group individual plans will be higher than group individual because of the nature of the risk.
Anthem Blue Cross: Anthem Blue Cross normally uses the same provider network for individual, small group, and large group. There are different underwriting considerations for each business segment depending on the product offered. Our larger groups can customize benefits to meet their employees’ needs.
BEN-E-LECT: The majority of our plans compete very well in the large group market. The benefit design and structure of our plans remain consistent across the small and large group markets.
BEST Life: Rates vary by plan design, group size, and employer contribution. Typically the larger the group, the lower the rates.
However, we offer a lot of plan design flexibility for groups with 10 or more enrolling. Waiting periods for Major and Orthodontic services are waived for groups with 10 or more employees enrolling regardless of employer contribution. Some benefits are standard regardless of size. We offer a dental supplemental accident benefit on all our dental plans, and a children’s vision benefit is also standard on plans with orthodontic coverage. Other benefits vary by group size: Adult orthodontic benefits are available to employer-contributory plans with 25 or more enrolling. Groups with 100 or more enrolling can customize benefits.
Bundling discounts are available if vision and/or life coverage is sold with a BEST Life dental plan.
Blue Shield: There are different underwriting considerations for each business segment.
Our ability to customize offerings for groups with more than 300 employees typically results in lower rates and more choices to meet the employer’s needs. Group plans come in a range of deductibles and annual benefit maximums. Our Individual, Family and Medicare Supplement dental plans may vary in waiting periods, deductibles, and annual benefit maximums depending on the plan selection. All dental plans include generous benefits, competitive premiums, and strong California and national provider networks that are available to all members; we don’t differentiate our provider network for small groups or individual or family markets.
CIGNA: Dental plan designs and rates for small groups are similar 
to those of large groups. There are a series of standard DHMO plan designs and DPPO/indemnity plan designs. CIGNA does not currently offer dental plans to individuals. Larger groups generally want more robust and flexible plans, while smaller groups gravitate toward standard offerings. We can custom-fit DPPO plans to offer a variety of cost-savings options for employers that want to keep claims costs low, such as missing tooth limitations, class shifting, low maximums, varying coinsurance, deductibles, waiting periods, etc. Our DHMO plans start with basic coverage, specialty discount, split copays, and other cost savings mechanisms and go up to very rich, low-copay plans at the higher end of the cost spectrum. Through recent acquisitions, CIGNA can also deliver solutions for the smaller employer segment through the CIGNA Voluntary limited benefit dental plan as well as leveraging the small segment capabilities of the former Great West distribution channel. We provide the full spectrum of products, each with varying price points based on product, funding type, and voluntary vs. contributory.
Dearborn National: Dearborn National offers nationally dental plans for groups as small as two employees to large-group plans. There is an extensive portfolio of standard plan design options for small group to choose from, and large-group plans can customize their plan designs to fit their needs. Pricing is determined by demographics, group size and the region the employees are in.
Delta Dental: While benefits offered to smaller groups are compara

ble to those offered to larger groups, larger groups have more options in terms of plan designs. Rates can be slightly higher for smaller clients and individuals, but Delta Dental strives to be competitive while balancing our financial risk. With individual DHMO plan benefits, we offer three different plan options — two for individuals and families and one customized for seniors. The individual and family plans offer a wide range of covered services. The senior plan is designed to offer services most utilized by this particular population.
Dental Health Services: All plans and premiums are developed 
based on individual and group needs. Co-payments and treatment options vary by plan, from very low levels of coverage all the way up to plans that provide member care at zero out-of-pocket cost. We have products starting at only $6.25, ranging to very high benefit plans. Customized plan designs are always available.
Guardian: Guardian offers nearly the same plan options to small group employers as to large employers. We offer an array of cost-reducing options, such as waiting periods, deferral of services, and tie-ins to Guardian vision products.
Health Net Dental: DHMO plans offered to individuals provide a comprehensive schedule of benefits at a monthly fee that is slightly higher than rates quoted for groups. Small groups (2–50 employees) have two comprehensive Health Net Plus DHMO and 13 DPPO plans from which to choose. Mid-market groups (51–250 employees) may choose from five DHMO plans and 15 new DPPO plans. Mid-market rates are based on location, benefit plan chosen, employer contributions and participation. Individual and small group rates are based on book rates. Risk evaluation is taken into consideration when underwriting larger groups (over 250 eligible employees).
HumanaDental: We offer flexible plan designs with a range of deductibles, co-payments, and out-of-pocket expense limits to meet the needs of small to large groups. We also offer large groups the additional flexibility to customize plan options. Customers who see dentists participating in the HumanaDental PPO Network receive deep discounts. In Calif., our negotiated discounts average 34% off billed charges. All our dental plans provide employees with incentives for preventive dental care, which promotes their overall health. A free vision discount program is included.
MetLife: MetLife offers individual plans in CA, FL and TX though SafeGuard, a MetLife company. Dental HMO plans offered to individuals provide a mid-range level of benefits at a monthly fee that is slightly higher than rates quoted for groups.
Small groups (2-50 eligible lives) have a broad range of options within the Dental PPO and Dental HMO benefit plans. Rates are based on location, plan chosen and participation. Risk evaluation is taken into consideration when underwriting larger groups; individual plans are quoted using shelf rates.
Principal Financial Group: The only significant rating difference pertains to experience rating, which is used on groups with 150+ employees.
Securian Dental: Small group rates are developed on a pooled basis. Large group rates are developed on a custom basis.
United Concordia Dental: While larger groups have more flexibility 
in customizing benefit options than smaller groups, United Concordia Dental offers an array of standard group products and options that provide small businesses and individual consumers with cost-effective, quality choices. To control the risk associated with individual insurance, waiting periods for selected types of procedures are used. To keep the small group premiums comparable to those found in larger groups, slightly higher deductibles, lower coinsurance percentages and lower maximums are more commonplace within this market segment.
Western Dental: Our individual and small group rates are a little higher for standard benefit plans. Customized benefits plans are available for large groups.

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

Aetna: We continuously review which services should be covered based on major dental studies, new clinical advances, recommendations from the leading health and dental organizations, consultations with academic leaders on the latest technology and techniques now taught in dental schools. We offer the following:
• 
Freedom-of-Choice Plan Design — Packages our DMO plan with one of our Indemnity or PPO plan options. Members pay one rate and can switch between the plans as often as monthly. It can be a lower cost alternative to a PPO plan.
• 
Aetna Dental Preventive Care – A low-cost PPO or Indemnity plan covers preventive and diagnostic procedures from 70% to 100%. Members may also get reduced fees from dentists who participate in Aetna’s PPO network for non-covered services like fillings, adult orthodontia, and cosmetic tooth whitening.
• 
Aetna DMO Access – A fixed-co-pay DMO plan offers broader network access at a lower cost. There are no out-of-pocket deductibles for the member to pay and no claim forms to file. It also includes the Aetna Dental Access discount network, which gives members access to more dentists and discounts of 15% to 50% for non-covered services like bleaching.
• 
Aetna Dental Care Reward – By going to the dentist for preventive services in one plan year, Aetna will cover a greater percentage of coinsurance and/or annual maximum next plan year.
Ameritas: Ameritas is known for our flexibility and expertise in dental. We talk to employers all over the country for input on their needs. Our plans are updated constantly to meet those needs. We have released several industry firsts including a rollover maximum product; fully insured Lasik eye benefits; dollar reimbursement plans; combined dental/vision deductible, frequency and maximum plans; shared family maximum plans; $5000 maximum plans, and stand-alone hearing care benefits. Our newest individual plan release is very popular across the nation.
Aflac: We have not had any plan changes since the latest plan was 
introduced in 2004.
Anthem Blue Cross: With the Dental Blue PPO plans from Anthem Blue Cross Life and Health Insurance Company; there is greater access to more dentists in more locations. This increases the likelihood that members will have access to their own current dentist, increasing their satisfaction with their dental plan. The three networks offer flexibility in plan options and Dental Blue specialists participate in all three networks. Additionally, members have access to our negotiated discounts on non-covered services, such as veneers, implants, temporal mandibular joint dysfunction (TMD), and orthodontia, negotiated discounts after the annual maximum has been reached and negotiated discounts during waiting periods (if applicable).
We have eliminated waiting periods for small group dental plans. The Anthem Blue Cross large group DHMO plans – the Dental Net 2000 Series Plans – are more cost-effective and consumer-friendly, with increased flexibility and choice. The plans include enhanced benefits for services not previously offered and often not offered by other plans. Our Tonik and Enhanced Tonik individual plans, designed for younger members, offer choice and affordability with a dental plan that’s embedded within a medical product.
We have also introduced a new International Emergency Dental Program for all of our dental members, and we offer extra cleanings and periodontal maintenance procedures for our Dental Blue members, which does not count toward the annual maximum. In addition, we just launched new large group Dental Blue plans in California, which offer more flexibility and various out-of-network options, along with five additional new riders.
BEN-E-LECT: Our plans offer more employer and employee options 
than any other dental plan in the market. They can be written stand-alone or the employer may combine our plans for a complete package offering PPO, DHMO and fully self funded options.
BEST Life: Our current dental plans offer a lot more options com
pared to the dental plans we’ve offered in the past. All of our dental plans can be tailored to offer rich or lean benefits, depending on a company’s needs. We now include an EyeMed Vision Discount program (not an insurance product) to all dental groups. We continually evaluate our dental plans to ensure the competitiveness of the benefits, and our underwriting guidelines.
Blue Shield: Yes, we are always looking to enhance our plans and 
provide richer benefits. An oral cancer screening coverage is not only a value-added benefit, but comes at no out-of-pocket cost to the member. We offer enhanced dental services for pregnant women to all dental PPO plans. Pregnant women receive one additional routine adult prophylaxis, and/or one course (up to 4 quadrants) of periodontal scaling and root planing, and/or periodontal maintenance if warranted by a history of periodontal treatment. Treatment is payable at 100% of the allowable amount for both in and out of network.
CIGNA: Yes, our DHMO 07 Series provides access to four cleanings per year, two at $0 copay and another two available at a minimal copay, when recommended by the network dentist; expanded fluoride treatment options; and a variety of schedules and copay structures. Teeth whitening (take-home trays with bleaching gel) is also available on most of the 07 schedules.
We’ve also added Identity Theft resolution services free of charge exclusively with this Series. For clients who thought they couldn’t afford dental coverage, CIGNA added the D Series with preventive and diagnostic coverage only and access to network discounts for services that aren’t covered.
CIGNA’s dental plans include several enhancements in recent years, such as coverage for oral cancer screening including brush biopsy and VizilitePlus. In addition, we removed the age limit on sealants for DHMO plans. And on most schedules, individuals don’t need a referral to a pediatric dentist for dependent children under seven. Individuals can visit network orthodontists without a referral.
Our WellnessPlus features increases benefits in the following plan year for individuals who get preventive care. CIGNA Healthy Rewards Program offers discounts on health and wellness products and services items, such as xylitol products and health management programs and more.
CIGNA DPPO offers employers more choice. The CIGNA Dental Core Network offers balance between network access and discounts. The CIGNA Dental Radius Network offers the greatest nationwide access to dentists at all discount levels and is appropriate for employers for which network size is the primary driver.
Those enrolled in the CIGNA Dental PPO (DPPO) or Dental EPO (DEPO) plan get discounts on non-covered services (where allowed by law). The discounts also apply to covered services that exceed the annual maximum or other plan limitations. Most of our DPPO network dentists have agreed to offer negotiated contracted fees for most non-covered services.
Targeting availability for Jan. 1, 2011, the Dental Network Savings Program (DNSP) will become a standard cost-containment feature for DPPO (except MAC and Scheduled benefit plans) and Indemnity clients. It provides access to a network of dentists who provide out-of-network care at a discounted rate. In addition to our DPPO Core and Radius networks, the DNSP allows us to provide an additional tier of discounted access points and incremental savings for clients and customers.
Finally, we have added both Identity Theft and Will Preparation enhancements to the CIGNAPlus Savings discount card (not an insurance product). The Identity Theft Program is identical to that which is offered with our DHMO 07 Series while the Will Preparation service provides online tools to build a simple will and provides other standard legal documents for download.
Dearborn National: When Dearborn National first entered the PPO dental marketplace, we filled the niche on voluntary dental plan needs. We have since expanded to offer fully insured employer paid and self-funded dental benefits. In addition, due to the flexible proprietary claims system, the custom benefit plan design options are extremely robust. In addition to offering excellent discounts, and customer service to create a convenient and accommodating dental program, Dearborn National also offers the largest PPO network of dental access points, with now over 180,000.
Regarding our DHMO product offered, new products were created to cover additional cleanings (beyond the standard 2 times per year), alternative name brand crowns and many other services typically used to up-sell patients.
Delta Dental: We’ve recently added additional cleanings as optional 
benefits to self-funded clients. Employers who are interested in enhancing their dental coverage can offer their employees an additional third or fourth cleaning per year. This benefit is available to all enrollees, including those with certain dental or medical conditions who might benefit the most. This optional benefit is available to self-funded clients at a minimal additional charge. Our standard plans include two cleanings per year.
Dental Health Services: We offer a number of cosmetic procedures as standard benefits in our plans. In addition, monthly premium rates and co-payments for services are evaluated frequently to ensure that they are appropriate and competitive.
Guardian: The key is flexibility, especially in today’s market as 
employers and employees are under more pressure than ever to balance costs with benefits. Guardian offers customized options to fit each employer’s needs and budget. Our recent focus has been on innovative plan designs with flexible solutions, including dual choice plans, “tiered” PPO plans offering two networks and voluntary options for employers to sponsor coverage without breaking the bank.
Health Net Dental: Health Net is pleased to introduce new DPPO plans for small and mid-market groups. All of our new DPPO plans include extra services for pregnant women in their second and third trimesters, including extra cleanings, scaling, and debridement covered at 100% in and out of network and not subject to the plan’s deductible. Our new Classic Plus DPPO Plans include MaxAdvantage, our rewards program that allows members to carry over a portion of their calendar year maximum into the next calendar year. Our new Basic DPPO is a unique plan offering in- and out-of-network coverage for preventive, diagnostic, and restorative procedures (oral surgery, endodontics, periodontics, major services and orthodontia not covered).
For new groups purchasing a dental PPO plan with coverage for orthodontia, the orthodontic lifetime maximum starts over, even for members who have previously started treatment. We do not require the prior carrier’s PPO orthodontic paid claims and there is no reduction of the member’s lifetime orthodontia maximum for treatment already in progress.
The Health Net Dental Plus DHMO plans offer more than 340 covered benefits, including oral cancer screenings, additional teeth cleanings, teeth whitening and veneers. In addition, members have access to one of the largest DHMO networks in the state.
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 upon clinical research, consumer-value approaches, and dental industry trends.
MetLife continues to expand our product offerings and plan design flexibility in the small (<500 employee) market – providing customers with more choices to help them meet cost objectives without sacrificing quality.
Principal Financial Group: Our current plan offers significant flex
ibility in plan design, optional 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. In addition to our Maximum Accumulation feature, which allows members to carry over a portion of their unused annual maximum for use in future years, we also rolled out a new Preventive Passport feature. This allows for preventive charges to not count/reduce the annual maximum.
Securian Dental: We have added greater flexibility.
United Concordia Dental: In recent years we have done the following: 
Introduced more voluntary plan options and added optional coverage for posterior composite restorations and implants to groups with 10 or more enrollees.
• 
With our DHMO plan in Calif., we added more than 70 procedures, now covering over 300 in total.
• 
We launched Preventive Incentive, which covers diagnostic and preventive services without counting them toward the member’s annual maximum.
• 
Enhanced our employee oral health educational offerings.
• 
Introduced the Smile for Health program in 2007, which includes a maternity dental benefit that provides an additional cleaning during pregnancy. An enhanced dental benefit provides coverage for certain diagnostic, preventive and periodontal services that help dentists to identify and treat chronic oral infections.
• 
Launched a series of plan designs through iDental, our dental product for individuals and families without coverage elsewhere.
Western Dental: Western Dental Benefits Division recently launched 
the DHMO Series 7 dental plans. Our new plans offer an increase of covered procedures to include the availability of cosmetic alternatives and more orthodontic options for children and adults.

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

Aetna: Full mouth debridement will be covered as a major service and will be a standard on all new DMO, dental PPO and indemnity plans with effective dates of October 1, 2010 and later. This procedure is part of our Dental/Medical Integration program enhanced benefits.
Aflac: Since our current plan was introduced in 2004, it continues 
to provide a simple, no direct cost option for employers to enhance employee benefits offerings. Our plan provides the ease of administration without the hassle of network restrictions, deductibles, precertification for treatment, or annual premium reviews.
Ameritas: Individual dental, dental/eye care and a $5000 maximum option for dental.
BEST Life: Last year we expanded our in-network access by con
tracting with an additional national PPO network. All our dental PPO plans now offer a regional and national PPO network. Our California network is one of the largest, with 17,920 provider locations throughout the State. Our national PPO network offers 122,00 provider locations in the country. By expanding our PPO network access, BEST Life members can access their in-network benefits anywhere in the country and receive excellent in-network savings.
Anthem Blue Cross: We recently introduced a new International 
Emergency Dental Program for all of our dental members, and we offer extra cleanings and periodontal maintenance procedures for our Dental Blue members, which does not count toward the annual maximum.
In addition, we just launched new large group Dental Blue plans in California, which offer more flexibility and various out-of-network options, along with five additional new riders.
BEN-E-LECT: Our Freedom PPO Plans have added the option to waive the waiting period for groups with no prior coverage. The addition of our new Freedom Pre-Paid Dental Plans(tm) made available by Western Dental exclusively for BEN-E-LECT has been a well-received addition.
Blue Shield: In response to market demand, Blue Shield developed 
two stand-alone dental plans for the IFP market – one comprehensive Smile PPO dental plan and one affordable Value Smile PPO dental plan. Now brokers can sell Blue Shield dental coverage to individuals and families with or without Blue Shield medical coverage.
For our Medicare Supplement plan members, a third teeth cleaning per year is covered at 100% when using a network provider for dental PPO plans. In addition, all Blue Shield dental PPO plans now cover oral cancer screenings at 100% as a preventive and diagnostic benefit for the member. Additionally, we’ve expanded our dental PPO network of providers from 110,000 to more than 144,000 nationwide.
CIGNA: CIGNA’s dental plans address emerging research on the 
connection between oral health and overall health. CIGNA pioneered the introduction of integrated benefits between medical and dental in 2006 with our Oral Health Integration Program, which offers enhanced dental coverage to address populations at risk, such as those with diabetes, heart disease, or those who are pregnant. In addition, CIGNA’s dental plans cover oral cancer screening procedures such as brush biopsy and VizilitePlus to aid in the early detection of oral cancer. We also don’t have an age limit on sealants for DHMO plans. CIGNA offers a complete package of very competitive dental plan designs with some of the largest national dental networks. CIGNA enhanced our dental treatment cost estimator and launched our Periodontal Risk Assessment and Cavity Risk Assessment Tools, designed to help individuals identify factors that increase the risk of gum disease and cavities. Both assessment tools are available in English and Spanish. CIGNA also developed an Oral Cancer Awareness quiz and an online toolkit to help parents care for their children’s teeth.
Dearborn National: Dearborn National recently announced enhance
ments to their dental PPO plan, such as availability to cover implants, and the option for groups to have annual open enrollment without waiting periods.
Delta Dental: We recently introduced a new dental wellness program for our enrollees, the SmileWay Wellness Program: SmileWay provides an array of wellness resources, including plan designs that emphasize preventive care, enhanced oral health communications and an expanded online presence that promotes oral health through social media channels such as Facebook and Twitter. New features on our website include a three-part SmileWay Challenge. Our SmileWay Wellness Program is self-managed, enabling enrollees to determine their level of participation, and encourages users to review their habits and take our free cavity and periodontal risk quizzes that will indicate their risk level based on oral health habits and lifestyle choices. In the risk assessment results, we encourage users to stay connected with us by signing up for customized communications based on their results. Our extensive dental health article and video library contains more than 100 articles and videos.
Dental Health Services: Our plans provide 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.
Guardian: Guardian constantly develops new, innovative ideas in order to meet our customers’ needs by keeping their teeth healthy and saving them money. Guardian Freedom, our newest plan, allows members to choose dentists in Guardian’s broad DentalGuard Preferred network or in Guardian’s new DentalGuard Alliance PPO, which offers even greater claims savings through a select pool of dentists. Members are still free to see out-of-network dentists. Guardian Choice, another new plan design, allows employees to choose between a MAC or UCR PPO plan using one blended rate and the ability to switch at annual open enrollment.
Health Net Dental: All of our Classic Plus, Classic, Essential and Ba
sic DPPO plans include extra benefits for pregnant members in their second and third trimesters.
HumanaDental: Plans in our new generation of products are available as voluntary plans, and to groups with as few as two employees. Our new plans offer an extended maximum benefit, in which members get 30% coinsurance on services rendered after they reach their annual maximum. In addition, no waiting periods for major services for voluntary groups with 10 or more enrolled, open enrollment options, and orthodontia benefits. Updates include reimbursement options for out-of- network reimbursement: maximum allowable fee, or based on in-network fee schedules. Additional deductible choices, implant coverage, and acrylic filling coverage have also been added. Due to the connection between oral health and overall health, we have added, free of charge, oral cancer screenings to all of our products, excluding DHMO/prepaid plans.
MetLife:
• 
New MET Series of DHMO plans, provided through SafeGuard Health Plans, Inc, a MetLife company, offering both Copay and Coinsurance options. Our objective is to continue offering DHMO plans that provide greater satisfaction for members and providers, and better align with our DPPO offering. These new plans provide more comprehensive coverage — more than 400 covered dental services addressing current market trends, clinical research and treatment protocols – and aligning coverage with the MetLife DPPO. Additionally, we’ve enhanced the plans to clarify plan language to promote understanding and network stability — protecting the plan and our members as well as ensuring dentists are appropriately and adequately reimbursed
MetLife Dental Health Manager — This proprietary dental disease management program provides participants with relevant educational content and personalized report cards that graphically illustrate their risk for oral disease and general dental health, helping them understand and track their progress to achieve and/or maintain their oral health. The new program is available to new and existing MetLife customers with 500 or more employees, at no additional cost as a standalone program. Employers also have the option to coordinate the program with a disease management vendor, which requires a one-time set-up fee.
• 
Enhanced Oral Health Library — MetLife is continually adding to the educational articles, tools and resources available on the MetLife Oral Health Library at www.metllife.com/dental. Some of the latest additions are within the new Kid’s Dental Health Center. It’s designed to engage and help kids and their parents learn about the importance of oral health and its impact on overall health in an effort to provide value beyond dental benefits. Every article and tool available in the MetLife Oral Health Library has been reviewed and approved by the MetLife Dental Advisory Council (DAC) – an esteemed group of academic and practicing dentists as well as corporate benefits representatives. In addition to MetLife-produced material, the library contains articles and information from recognized sources, including the American Dental Association, the American Academy of Periodontology, and the National Institute of Dental and Craniofacial Research.
Principal Financial Group: Our newest feature to our dental plans is 
the option of Preventive Passport. This feature excludes preventive services/charges from counting towards the annual maximum.
Securian Dental: More flexible participation guidelines. Escalating annual maximum and lifetime deductible options.
United Concordia Dental: United Concordia Dental introduced an 
individual product line, iDental, designed to meet the varying needs of anyone that does not have access to quality dental care at an affordable price through their workplace.
Western Dental: Our Series 7 plans cover more procedures and now 
include Implants, veneers and external bleaching.

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

Aetna: PPO – We offer a national network of dentists. Each covered 
family member can visit any licensed dentist for covered services. When members visit dentists who participate in our network, their out-of-pocket costs are generally lower. Indemnity – Members can visit any licensed dentist. Aetna: DMO – Members must seek care from a participating DMO provider unless a state allows a member to seek out of network care. We make this easy by consistently offering the largest DMO network in the industry.
Aflac: Policyholders may use any dentist they choose, as we do not have network requirements.
Ameritas: Insureds can use any provider, but they may incur additional out-of-pocket expenses.
Anthem Blue Cross: Yes, they can with all of our PPO plans. Mem
bers who choose a provider, within the Dental Blue network, get the most savings in their dental costs. However, members can choose a non-Dental Blue dentist, but their out-of-pocket costs may be higher. The same is true for our traditional Prudent Buyer PPO dental plans. The DHMO plans are in-network only.
BEN-E-LECT: Yes, our plans offer both in and out of network coverage with multiple options for coverage and benefits. The member maintains complete control over the dentist they choose to utilize.
BEST Life: Yes. Both PPO and IndemnityPlus plans allow members to 
visit any dentist of their choice and receive coverage for services.
Blue Shield: Yes, dental PPO plan members can choose to go to any 
dentist, although their benefits will be covered at a higher percentage when choosing a network dentist, with less out-of-pocket expense.
CIGNA: 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 (not insurance) or with DEPO. Individuals can nominate their dentist to join our plan and if the dentist wants to participate and meets our criteria, he/she will be credentialed and added to the network. Additionally, DPPO and DEPO plans may include savings on most non-covered services. Most of our DPPO network dentists offer their negotiated contracted fees to customers and their covered dependents for most non-covered services. And the savings also apply to covered services when an individual exceeds his or her annual maximum or other plan limitations, such as frequency, age or missing tooth.
Dearborn National: Yes, in the PPO dental plan, members can utilize either an in-network or out-of-network dentist. However greater savings are gained by utilizing network dentists. In the DHMO plan, members must select a dentist that is in the network.
Delta Dental:Delta Dental Premier enrollees can visit any licensed dentist for care, although there are advantages to visiting one of more than 36,000 Delta Dental Premier dentists in California. 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. Delta Dental PPO enrollees also have freedom of choice, but can benefit from the protections associated with selecting one of more than 22,000 Delta Dental PPO dentists in California. PPO enrollees have access to both Delta Dental PPO and Premier dentist networks with different levels of savings.
DHMO enrollees must use a participating general dentist or approved specialist, except for emergency care. There are more than 4,500 dentist facilities for DeltaCare USA in California.
Dental Health Services: Our PPO and reimbursement plans allow members to get treatment from any dentist. Members of Dental Health Services’ prepaid and EPO plans choose their dentist from our extensive network of participating dentists.
Guardian: Members covered under our PPO plans can visit any dentist; however, benefits may be paid at a lower coinsurance rate for non-participating dentists. DHMO members must choose a participating primary care dentist.
Health Net Dental: Our dental PPO plans offer members freedom 
of choice; members may receive services from any licensed dentist, but we will reduce their out-of-pocket costs by receiving services from a participating PPO dentist. Under Health Net Dental DHMO plan, members must use a participating dentist to receive benefits.
HumanaDental: PPO members can visit the dentists of their choice. Out-of-pocket savings are great when members visit participating network dentists.
MetLife: For Dental PPO plans, plan participants can visit any dentist and receive benefits. Participants may realize additional expense savings by receiving services from a participating dentist. For Dental HMO, members must use a participating dentist to utilize their benefits.
Principal Financial Group: Yes, our members can see any if they are enrolled in either our PPO or POS design. If a member is enrolled in our EPO design, however, they must see network dentists for services in order to receive coverage.
Securian Dental: Yes.
United Concordia Dental: Our FFS and PPO plans allow members to visit any dentist. However, out-of-pocket costs will be lower when visiting a participating network provider. DHMO members must use network dentists.
Western Dental: Through the DMO plans, the member must use a 
dentist who 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: For covered services, network dentists are contractually pre
vented from balance billing above the negotiated rate. Non-covered services are also available for a discount in most states. Dentists who are not in our networks may balance bill members.
Aflac: We pay benefits based on a Table of Allowances and not UCR. 
If the dentist’s charge exceeds the benefit amount paid, the dentist may balance-bill the patient.
Ameritas PPO/First Dental Health (FDH) Networks: 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.
Anthem Blue Cross: No, not when visiting an Anthem Blue Cross dental PPO provider. Anthem Blue Cross participating provider contracts include negotiated fee agreements that prohibit balance billing. A participating dentist may not balance-bill members for amounts that exceed the negotiated and contractually agreed on fee. Members are not responsible for amounts in excess of negotiated rates. However, if a member visits an out-of-network provider, there is no contract and the provider can bill the patient for the difference. With our DHMO plans, the patient is only responsible for co-payments and non-covered services when accessing services through their participating dental provider
BEN-E-LECT: The member does have the option to choose this 
method upon enrollment.
BEST Life: Members will not be balanced billed if they receive treatment from a contracted PPO provider. All our dental PPO plans offer a regional and national PPO network. On a BEST Life PPO plan, members can access their in-network benefits anywhere in the country and will not be balanced billed.
Those who choose to visit a non-participating dentist may be balanced billed. Our 90th percentile UCR choice is a great cost-effective option for groups that have limited network access.
Blue Shield: No, in-network providers cannot bill members for fees that exceed the negotiated rate. Non-network providers, however, may bill for charges that exceed the plan’s allowed amount.
Dearborn National: If a member sees an in-network dentist, per our contract, dentists are not allowed to balance bill. However if a member opts to see an out-of-network dentist, then that provider could balance bill the member.
Delta Dental: Delta Dental Premier enrollees can visit any licensed dentist for care, although there are advantages to visiting one of more than 36,000 Delta Dental Premier dentists in California. 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. Delta Dental PPO enrollees also have freedom of choice, but can benefit from the protections associated with selecting one of more than 22,000 Delta Dental PPO dentists in California. PPO enrollees have access to both Delta Dental PPO and Premier dentist networks with different levels of savings.
DHMO enrollees must use a participating general dentist or approved specialist, except for emergency care. There are more than 4,500 dentist facilities for DeltaCare USA in California.
Dental Health Services: No, members utilizing in-network benefits on our prepaid and PPO plans are protected from paying unexpected, additional fees from their dentist.
Guardian: Guardian’s 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.
Health Net Dental: When receiving services from a participating 
PPO dentist, members cannot be billed any charge in excess of the maximum allowable charge established by the plan. If the member goes to a non-participating dentist, the dentist can bill the patient for the difference between the allowed amount for the plan benefit and the dentist’s submitted charge.
HumanaDental: PPO members can visit the dentists of their choice. 
Out-of-pocket savings are great when members visit participating network dentists.
MetLife: When receiving services from a participating Dental 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, the dentist can bill the patient for the difference between the plan benefit and the dentist’s submitted charge.
When receiving services from a participating Dental HMO dentist, members cannot be billed any charge in excess of the specified plan co-payments, listed in the Schedule of Benefits for their plan.*
* 
Members are responsible for the participating dentist’s full fee for procedures specifically excluded from coverage.
Principal Financial Group: Dentists cannot bill over the UCR amount 
if they are part of our PPO or EPO networks. If the dentist is not a part of one of our networks, he/she can bill the amount over UCR.
Securian Dental: If the dentist is part of our network – no. If the dentist is not part of our network – yes.
United Concordia Dental: Contractually, United Concordia Dental 
participating dentists 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 managed care 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 over billing or waiver of co-payments?

Aetna: Our explanation of benefits (EOBs) shows the member’s out of-pocket responsibility. A copy is sent to both member and provider. If necessary, the provider relations area helps to resolve any issues whether related to over billing, waiver of co-payments, or other issues.
Ameritas: The explanation of benefits automatically calculates the insured’s portion of the bill to prevent these kinds of problems.
Anthem Blue Cross: Anthem Blue Cross’ extensive contracts with 
participating Dental Blue providers address these issues to avoid over billing and co-payment waivers. The same is true for our traditional Prudent Buyer PPO dental plans. Additionally, our quality assurance teams assess claims and providers regularly to ensure our DHMO members are getting the highest level of service and satisfaction. For the PPO product, the service and satisfaction monitoring would be through the grievance and appeal process.
BEST Life: We do this in several ways: 1) We automatically apply 
any provider network discounts at the time a claim is processed; 2) Pre-determination services are available to inform members what their charges will be prior to receiving service, 3) We provide easy to understand EOBs that clearly illustrate network savings. 4) We have educational flyers that inform members on how their dental plan works and why they should go to a network provider.
Blue Shield: Our contract with our in-network providers stipulates that they cannot bill members for fees that exceed the negotiated rate. Any complaints from members regarding ‘balance billing’ by providers are forwarded to our Provider Relations Department for review and resolution.
CIGNA: alance billing for covered procedures is strictly prohibited. We counsel network dentists who do not comply. Continued balance billing may be referred to our Credentialing Committee for review of future participation in the network. CIGNA monitors allegations of overcharging through enrollee feedback, surveys, and the dental network management staff. For DHMO plans, the collection of copays is between the patient and the dentist. We encourage dentists to collect copays at the time treatment is rendered. For DPPO/Indemnity plans, it is illegal in some states for dentists to routinely waive deductibles. Since our group contracts indicate that CIGNA is not responsible for any charge the patient is not required to pay, we may reduce our claim payment by the copay amount waived by the dentist. Our Investigations Unit may also contact the dentist and the patient for further information and has the ability to review claims on an ongoing basis.
Delta Dental: Delta Dental Premier and PPO dentists contract with us to establish acceptable fees as well as formally agree to certain protections for Delta Dental enrollees. Protections include: no balance billing — contracted dentists cannot charge enrollees for the difference between their contracted Delta Dental fee and their submitted charge for a service; they may only collect the patient portion (copayment plus any deductible and/or amount over the annual maximum) at the time of service. Delta Dental dentists also agree not to unbundle a procedure that is on file with Delta Dental as one procedure. Waiver of plan copayments and deductibles is considered fraudulent and is handled by notifying the dentist of the violation and possible network termination.
DHMO network dentists agree to be paid by Delta Dental on a guaranteed capitation basis. They also contractually agree to accept enrollee copayments as payment in full for covered dental procedures and not to seek additional fees. If a dentist consistently demonstrates a disregard for their contractual obligations with Delta Dental their participation may be restricted or terminated.
Dental Health Services: Participating dentists’ charts are audited on-site on an ongoing basis to ensure treatment is rendered in accordance with Dental Health Services’ policies. In addition, plan members get extensive patient education and tools to help them understand their plan benefits so they can question charges that may not be in compliance with plan benefits. Members are encouraged to contact the plan for assistance if they feel they are being overcharged.
Guardian: Guardian’s PPO dentists may only charge members for any 
covered charges other than the deductible or coinsurance that may apply to the discounted fee schedule amount. Explanation of benefits statements sent to members specifically identify the discounts taken and the member’s responsibility.
Health Net Dental: Under our DPPO and DHMO plans, participating dentists are contractually prohibited from balance billing a member more than the maximum allowable charge or the contracted copayment amount. Practices are in place to discipline network dentists who attempt to bill members more than these contracted amounts.
If it is determined that a participating dentist has overcharged a member, our Customer Service team will contact the provider on behalf of the member to confirm benefits and re-educate the office about proper plan collection from a member. If the provider refuses to comply with the plan design, the issue is escalated to the Professional Relations Department for follow-up with the provider. Depending on the circumstances, the issue could be escalated to our Quality Management Team, which follows state mandates for a full investigation, including the request for patient records from the office and a review by a dental professional. These investigations must be completed within 30 days and written communications are sent to both the member and provider. If the provider still refuses to comply, our Legal Department would be contacted and steps may be taken to terminate our relationship with the provider. In these rare instances, it might become necessary for the plan to reimburse the member or provider depending on the circumstances and to ensure a positive member experience.
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 systems adjudicates the claim based on the contracted fee schedule. Waiving co-payments does not apply under a PPO.
MetLife: For Dental PPO, our first protection for the patient against over-billing is our explanation-of-benefits, which 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.
For Dental HMO, 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 Quality Assessment reviewer notes any apparent overcharges during the patient-record audit and works with the dentist’s office to correct the issues.
Principal Financial Group: Provider utilization patterns are studied 
and issues are addressed as they are uncovered.
Securian Dental: We systematically check every submitted claim.
United Concordia Dental: United Concordia Dental participating 
dentists contractually agree to only bill members for applicable deductibles, coinsurance, or amounts exceeding the plan maximums. In addition, members get explanations of benefits that clearly describe the services received and their financial responsibility.
Members can also access the My Dental Benefits tool on our website (www.UnitedConcordia.com) to view their benefits and eligibility information, claim details, procedure history, maximum and deductible accumulations, and more. Plus, United Concordia Dental’s responsive customer service representatives are available to assist members with questions regarding their benefits. Our Utilization Review area also analyzes thousands of claims each year to ensure the acceptability of treatment and quality of services. And, our Dental Advisors and consultants continuously review dentists’ fees and practice patterns for statistical variation from their peers. Dentists who fall outside of the norm are targeted for education and additional monitoring.
Western Dental: Providers are bound by contract to accept the member’s schedule of benefits.

8. How many provider locations do you have?

Aetna: As of 6/1/11: DMO – 55.6k dentist locations nationally and 9.6k in California, PPO: 147k and 26.4k in California.
Aflac: We do not have network requirements. Policyholders may visit 
any provider they choose.
Ameritas/FDH Network: 40,354 California provider access points, 
(25,980 Ameritas; 14,374 FDH); 16,942 California locations, (11,042 Ameritas; 5,900 FDH)
BEN-E-LECT: Our dental plans utilize the Smart Health (Interplan), First Dental Health, Dentemax, PPO USA and Western Dental networks which contain thousands of offices statewide.
BEST Life: We offer access to a regional and a national PPO network. Our California network has over 17,920 access points throughout the state of California. Our national network has 122,000 provider locations, which offers our members network access when they are outside of California.
Blue Shield: Members have network access to more than 9,000 dental HMO and 21,000 dental PPO providers in California, and more than 144,000 providers nationwide. These are two of the largest statewide provider networks in the industry.
CIGNA: Nationally we have more than 47,000 DHMO contracted access points and more than 167,400 DPPO Radius Network contracted access points. In California we have more than 10,200 DHMO contracted access points and more than 31,200 DPPO Radius Network contracted access points. CIGNAPlus Savings (dental discount card, not insurance) includes more than 121,500 of our DPPO contracted access points.
Dearborn National: has the largest PPO network of dental access points nationwide offering over 180,000 access points for our members to chose from.
Delta Dental: In California, Delta Dental Premier, more than 36,000; Delta Dental PPO, more than 22,000; and DeltaCare USA (DHMO), more than 4,500. We also give our enrollees access to the national Delta Dental networks.
Guardian: There are over 141,000 PPO dentist-locations across the country and more than 23,600 in California. We are one of the largest PPO networks in the state based on unique dentists. The DentalGuard Alliance PPO network has over 2,500 dentist-locations in Southern California. For the DHMO, there are 11,860 locations across the country and 5,738 in California.
Health Net Dental: As of May 2011, our California PPO network in
cludes 30,566 access points in 375 locations. Our California DHMO network includes 1,996 locations.
MetLife: s of May 2011, our Dental PPO network includes over 155,000 participating dentist locations nationwide (15% growth from 2010), including over 24,800 in California. And, the Dental HMO network includes more than 15,600 participating dentist locations in California, Florida and Texas (20% growth from 2010), including over 8,400 in California, over 4,600 in Florida and over 2,400 in Texas.
Principal Financial Group: We have approximately 27,700 PPO pro
vider locations and 15,300 EPO provider locations.
Securian Dental: 122,000 dentist access points.
United Concordia Dental: We have more than 73,000 dentists at 
164,294 access points nationwide in our Advantage Plus PPO network. In Calif. alone, we have more than 13,400 dentists at 32,489 access points. Our DHMO network includes more than 2,600 primary dental offices and 1,500 specialists nationwide, with over 1,671 primary dental offices and 730 specialists in Calif.
Western Dental: Our Provider network is unique among DMO carries because it has over 240 Western Dental Centers (staff model) in addition to more than 2, 500 provider locations.

9. 
Can Insureds change providers easily if they are unhappy?

Aetna: Yes, members in our PPO/indemnity plan can change any 
time and do not need to notify us. Members in our DMO plan can choose a new provider as often as once per month through Navigator, our online web tool for members, or by calling the toll-free telephone number on the back of their ID card.
Aflac: Yes. Policyholders can change providers at any time.
Ameritas PPO and the FDH Networks: Insureds can choose any provider at any time for procedures.
Anthem Blue Cross: Dental Blue PPO members can visit any 
licensed dentist and will normally have more cost-savings when services are completed by a Dental Blue provider. There is no gatekeeper for the dental Blue PPO dental plans. The same is true for our traditional Prudent Buyer dental PPO plans. The DHMO members can change providers once a month.
BEN-E-LECT: Yes. Members may change providers at any time by selecting to use another provider. No further documentation or process in necessary. Freedom Pre-Paid Dental is the only plan in which a member would select a specific provider.
BEST Life: Members may choose any dentist they desire without 
calling BEST Life to switch providers. We also provide immediate access to Customer Service, who can assist members with selecting a provider.
Blue Shield: Yes. Dental PPO plan members may change providers 
at any time without notice; dental PPO plan members have the flexibility to see in-network or non-network providers. Dental HMO plan members may change their primary care dentist as needed; changes will be effective the first of the following month.
CIGNA: Yes. The DPPO/DEPO/indemnity plans allow individuals to change dentists whenever they want. No call is necessary. DHMO enrollees can easily change their primary-care dentist online via myCIGNA.com – our secure website. 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. The CIGNAFlex Advantage feature provides individuals the flexibility to switch monthly between DHMO and DPPO or indemnity plans, depending on the plan design options chosen by the employer.
Dearborn National: In our PPO dental plan, members can see any dentist they like, whether in-network or out-of-network. However greater savings are gained by utilizing network dentists.
In the DHMO plan, members must select a dentist that is in the network.
Delta Dental: Fee-for-service enrollees can change dentists any time without notifying us. DHMO enrollees can change their contract dentist by contacting customer service or online at deltadentalins.com. Requests submitted prior to the 21st of each month are effective the first of the following month.
Dental Health Services: Members can change their dentist at any 
time by contacting their Member Service Specialist by calling 800-637-6453 or online at www.dentalhealthservices.com.
Guardian: Members covered under Guardian’s PPO plans can change dentists at will, regardless of whether the dentists are participating or non-participating. Members covered under our DHMO plan may change dentists by using our online Web tool, GuardianAnytime.com, or by calling our toll-fee number. Requests made by the 20th of the month are effective the first of the following month. We also offer a dual choice monthly switch plan, which enables members to switch between the DHMO and PPO as often as desired on a monthly basis.
Health Net Dental: With our PPO plan design, there is no need to select a primary care dentist or to obtain referrals for specialty care. Under our DHMO plans, members may change their primary care dentists once a month by calling Health Net Dental Member Services or via our online Web portal. The change is effective the first of the month, provided that the request is made by the 20th of the previous month.
HumanaDental: With the PPO plan design, the member can change 
dentists without notifying the dental plan.
MetLife: With our Dental PPO benefit plans, there is no need to 
select a primary care dentist or get referrals for specialty care. For the Dental HMO, a member can easily change their selected dentist online or by calling customer service.
Principal Financial Group: Yes.
Securian Dental: Yes.
United Concordia Dental: Yes, members can change PPO providers at any time without notice. DHMO participants may 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 current dentist or treatment in progress.
Western Dental: Our membership can change providers, on a 
monthly basis, by phone or in writing.

Voluntary Benefits–The Only Things Certain in Life are Death, Taxes and Personal Legal Needs

by Ann Dieleman
As Benjamin Franklin once said, “In this world nothing can be said to be certain, except death and taxes.” But, other life events seem to be inevitable as well. Personal legal issues can happen to anyone at anytime – affecting quality of life, relationships and careers.

In national studies, seven out of 10 Americans said they had been dealing with legal issues during the previous year. As a result, they were less productive on the job, took time off and spent the equivalent of seven business days on personal legal needs while at work, according to a study commissioned by Arag. In our complex society, no one is immune from legal issues and Californians are no exception.

The Need For Legal Services

People generally recognize the importance of professional services for everyday concerns, such as taxes or medical issues, but they don’t always know where to turn for help with legal matters. Access to legal services can help employees with many types of legal needs including the following:
• 
A will or living will.
• 
Durable power of attorney.
• 
A healthcare directive to make sure loved ones are protected.
• 
Trust and estate planning documents.
• 
Review of property agreements.
• 
Advice on adoption or divorce.
• 
Dispute resolution or family law matters.
Certainly, not all legal needs are negative or necessarily stressful, but some life events such as bankruptcy, foreclosure, divorce, or child custody issues can have a detrimental effect on private lives and careers. Your clients are understandably concerned about the occurrence and severity of employees’ legal needs and how they can affect employee engagement, productivity, and operating costs. Fortunately, cost-effective resources are available in the benefit market to help your clients’ employees get their lives and careers back on track.

In fact, many progressive organizations in California and across the country have adopted an employee benefit that offers easy access to affordable legal services to prevent or resolve legal issues, create personal safety nets, and achieve legal wellness. They have chosen to offer group legal plans as part of a competitive benefit program for their workforce. Employees gain access to professional services and valuable resources to address personal or family needs.

Why You Should Recommend Legal Plans

Human resource and benefit professionals rely on you for wise counsel, quality products, responsive service, and solutions to business needs. Recommending a quality legal plan to your clients is important because this product does the following:
• 
Helps solve significant workplace challenges, such as presenteeism, absenteeism, and productivity issues.
• 
Enables you to satisfy a wider range of needs for existing and new clients.
• 
Adds value and differentiates your total product portfolio.
• 
Offers a low risk and low maintenance product.
• 
Offers a straightforward, uncomplicated product that doesn’t require extensive client handholding.
• 
Is not subject to the same inflationary drivers as some other employee benefits.
• 
Strengthens your book of business.
• 
Provides a nice offset product for employers who are wrestling with higher operating costs.
Over the past few years, legal coverage has become an important benefit, especially in the ancillary or voluntary market. The following types of legal coverage range from discount and access plans to comprehensive coverage:
• 
Discount plans typically include basic covered services, such as will preparation and a discount from an attorney’s standard rate or a guaranteed hourly rate.
• 
Access plans typically provide legal advice and consultation by telephone, attorney calls and follow-up letters and document review and preparation via telephone or fax.
• 
Comprehensive legal plans typically provide a wider range of services (beyond those offered in discount and access plans) including office work and representation for various types of legal matters at no additional cost.

A Valuable Product In Today’s Market

Employees have different interests, needs and concerns, based on their life stage, life style, and life events, which makes legal plans an important resource to serve today’s multi-generational society. While some specialty products, such as identity theft plans, offer some assistance in times of need, leading group legal plans provide more robust benefits. Most comprehensive plans are designed to meet 80% to 90% of the personal legal service needs of middle-income families. Some carriers offer flexibility to customize plan design or offer dual plan designs to meet the needs specific to the client’s employee population. Members typically have access to a group of attorneys and other legal resources to meet their legal needs at an affordable premium.
The following trends have emerged in legal plan offerings:

• 
Online legal documents, such as wills, that are legally-valid and state-specific.
• 
Identity theft prevention and resolution services with certified identity theft specialists.
• 
Education and referral resources for various legal needs, such as elder care.
• 
A legal center that offers online educational resources for all employees, plus employee-pay solutions to meet budget and legal needs.
Few things are certain in life, but offering great advice, products, and service is sure to please your clients. One of the best ways is by recommending a group legal plan. Group legal coverage is definitely worth exploring before your competitors discover its potential and stake a claim to your prospects and clients.
Legal plans provide affordable solutions for personal legal matters that touch employees, families and the workplace. Offering a legal plan as a voluntary benefit can help employers keep benefit and operating costs in line with budgetary constraints, and that’s sure to keep clients happy in today’s uncertain economy.
––––––––––
Ann Dieleman is senior vice president and chief marketing & business development officer for ARAG. She has nearly two decades of experience in the employee benefit arena and leads design teams that develop products. Ann received her bachelor’s degree in business and communications from Simpson College in Indianola, Iowa and her Master’s from Drake University in Des Moines, Iowa. She holds an associate’s degree in customer service designation from the Life Office Management Association. Ann is an executive member of the Creative Good Council. She is a member and former board member of the American Marketing Association, a member of the Direct Marketing Association and a corporate member of LIMRA International.

 

Health Coverage–Reducing Healthcare Costs With Eligibility Audits

by Michael Smith
Employers are under tremendous pressure to reduce the cost of providing healthcare coverage amid new healthcare reform requirements including more dependents being added the plan. With double-digit increases in healthcare costs, senior management is pushing hard to offset these added expenses.

Amid these turbulent times, some employers have made an up-front investment in wellness programs that they hope will pay off in the long-term. Others have made the tough decision to pass the increases on to employees in the form of premium increases and higher co-pays. Still others have turned to their brokers to help design and implement high deductible plans and renegotiate rates with carriers.

Some premium increases may be unavoidable, but there are options to deliver immediate and long-term savings. These options also position the broker as a valued partner in bringing initiatives to the table that deliver proven results.

Dependent Eligibility Audits

One of the best cost containment options is the dependent eligibility verification (DEV) audit. A DEV audit ensures that only eligible dependents are enrolled under the employer’s plan. Companies can cut their annual healthcare spending by as much as 5% within the first year and often reduce their expected healthcare cost increases by up to 50% by examining eligibility criteria for each dependent and removing those who don’t meet the requirements. An efficient and thorough DEV audit typically generates a 10 to one return on investment in the first year, which is far greater than the most other cost containment programs.

Without adding a cost burden to the employees, DEV audits can save on annual healthcare expenditures and ensure continued cost savings down the road since ineligible dependents are no longer a drain on the plan’s resources. Most employers begin to see a cost savings within 60 days by removing ineligible dependents from the plan.

DEV in Action

Providence Saint Joseph Medical Center in Burbank, Calif. saved an estimated $1 million per year when it eliminated 1,200 ineligible dependents from its plan. The audit found that roughly 8% of the 16,000 members were ineligible — mostly unmarried couples and adult children of employees who were no longer eligible for the plan.

Providence even included an appeals process in the audit as well as the ability to grant exceptions, when appropriate, to align with its core Catholic values. This is a perfect example of the flexibility and customization options available with the DEV audit process. The most capable third-party can accommodate these nuances to ensure a satisfactory result for both the employer and the employee.

Performing a DEV audit with in-house staff is often daunting, especially for smaller employers. But brokers who build partnerships with qualified third-party DEV service providers can offer a valuable outsourced solution and a dramatically higher return-on-investment compared to an in-house audit. A third-party auditor alleviates nearly all of the potential burden on the internal HR department. The auditor also provides discretion that eliminates the perception of co-workers scrutinizing one another’s family situations and dependents.

Furthermore, conducting ongoing DEV audits during open enrollment, when new employees are hired or when employees change coverage options can deliver long-term cost savings and protect the employer’s investment in the initial audit. We have found that about 50% of dependents were ineligible during the prior audit cycle try to re-enroll during open enrollment – 85% of whom are still ineligible.

Other Coverage Verification

Working spouse rules, such as spousal surcharges or waiver (carve-out) programs, are making a resurgence in light of healthcare reform. This cost-containment program has gained popularity in the past year and consultants are looking for plan design specifics for groups to implement in 2012. Working spouse rules can save money by collecting additional funds through added premium charges or encouraging spouses to participate in their own employer’s plan.

How does the employer know who should be participating in the program without verifying whether other coverage is truly available? Working spouse rules can be as much as 75% ineffective if the spouse’s other coverage is not verified. With employers that don’t have a comprehensive verification of other coverage, typically only about 8% of employees with spouses actually participate. That percentage can jump by nearly 300% after conducting the other coverage verification audit. In many cases, failure to participate is the result of confusion surrounding the rules. Once this is cleared up through the audit process, it can generate significant opportunity for employers to reduce their out-of-pocket costs. Savings vary based on the program that is implemented. In general, spouse surcharges generate value by delivering direct dollar remuneration in the form of a collection from the employee each pay period. However, a waiver or carve-out program that removes a spouse with other coverage can generate far greater impact based on the savings in utilization. Often this can save an employer up to 7% on annual healthcare expenses.

Brokers are in a powerful position to offer solutions that deliver immediate savings as well as a long-term return on investment.
––––––––––
Michael Smith is president and co-founder of ConSova Corporation, the leading provider of healthcare cost containment solutions. Prior to ConSova, Michael held a variety of health and welfare benefits positions, including Vice President at Clark Consulting and Finance and Labor Relations for US Airways, and he worked with Arthur Andersen as a manager developing healthcare cost containment practices. He is a Certified Public Accountant. For more information on ConSova please visit www.consova.com

Long-Term Care–Selling the Planning Concept Rather Than the Product
Talking to Baby Boomers About Long Term Care Insurance

by Steve Cain

Over the years, the sale of long-term care insurance (LTCI) has focused mainly on selling a health insurance product rather than selling the concept of long-term care (LTC) planning. LTCI has been viewed as a senior market product and, with the industry average purchase age being 57, it has become a Baby Boomer market product.|

In order to increase market penetration of LTCI among this market, the conversation must be redefined to reach and communicate effectively with Boomers.

Baby Boomers, those born between 1946 and 1964, have characteristics that distinguish them from other demographic groups. They are, first and foremost, hard workers and many plan to continue to work after retirement, by running their own small business or by volunteering. They’re proud of the recognition and income they’ve achieved and hope to enjoy them after retirement. Though idealistic, Boomers also are pragmatic and not afraid to break with tradition to find effective solutions. Their individualism and determination to take care of themselves are expressed in a strong interest in anti-aging, wellness, healthy diet, exercise, etc. And many Boomers have already have experienced the need for long term care within their own families.
Taking all of this into account, insurance agents and brokers, financial advisors, and others in the role of retirement advisors should focus their LTCI discussion with Boomers on planning rather than on product. Essentially, the agent is convincing the Boomer to plan for longevity and address this issue like all other risks in their lives. Extended healthcare is a financial risk to their portfolios and their post-retirement lifestyles. In this vein, it is wise to assess the funding options for the financial risk; discuss the client’s healthcare options; and urge them to mitigate the risk by proactively planning for such an event.

The Risk Management Approach

LTC planning should be approached no differently than in the P&C, benefits, or financial planning businesses. Discussing the issue from a risk management perspective helps remove emotion and allows Boomers to draw parallels to other risks in their lives. With any risk, such as property, liability, portfolio, estate tax, or healthcare, there are traditionally four ways to manage them:
1. 
Avoid. We cannot avoid the aging process no matter how hard we try!
2. 
Reduce. We cannot reduce the risk of an extended healthcare event. In fact, there is an interesting inverse relationship between your good health today and the potential need for home health or facility care tomorrow. Good health generally leads to a longer life, which increases the chance of needing LTC.
3. 
Retain. Simply stated, this option means self-insurance, or Boomers taking on this risk for themselves. But managing an LTC event takes more than money. If this option is being considered, advisors should create a LTC plan document that details how the care event will be managed, taking into account the client’s financial and family situation.
4. 
Transfer. Hedge against the risk with insurance. The amount of insurance or type varies, but individuals look to insurance to protect them from risk.
For most clients, this objective conversation leads them to conclude that there are only two ways to manage this risk – retain or transfer. That leads to an analysis of each option and to the client making a decision with their advisor about how to manage the risk.

Advancing the Sale

Instead of focusing on closing the sale, advisors should advance the sale. While the difference between advancing and closing a sale may seem minor, thinking about advancing the sale can go a long way in diffusing the tension that makes clients put up their guard. Advancing the sale requires finesse, with the advisor constantly assessing the client’s sense of urgency for LTC planning. This sensitivity and a shift in language can lead to success by advancing the client relationship, even if a sale is not made.

Best practices for advancing the sale include the following:

• 
Focus on getting to an agreement that LTC planning makes sense and should play a role in your client’s retirement plan or risk management strategy. If the client agrees that planning is a good idea, then you are advancing the conversation. Positioning the conversation changes the dynamics between advisor and client. The advisor goes from sitting across the table from clients to sitting beside them. Together, they identify a healthcare exposure and plan how to mitigate the risk. The next step is to discuss what planning means. Is it with or without insurance as a funding mechanism?
• 
As consumers, we tend to be interested in what our peers are doing, as in the benefits and P&C world, where benchmarking is commonplace. In presenting LTCI, advisors might try something like this, “You know, Mr. or Mrs. Boomer, many of my clients have been asking about LTC Insurance. What do you know about long-term care?”
• 
Most professional advisors and insurance agents take their fiduciary responsibilities to clients very seriously. The duty to protect a client’s interests lends credibility to the discussion of Long-Term Care planning.
• 
Avoid statistics because they create debate. If clients hear that 70% of all Americans over 65 will need some form of long-term care, they will immediately exclude themselves from that unlucky 70%. A better approach is to tell them, “Mrs. or Mrs. Boomer, I am not going to bore you with statistics. This is a real issue that might affect your loved ones or you.”
We all know someone who has dealt with a long-term care event. There are emotional and financial implications, and we must be prepared to handle them. Our responsibility is to help clients, increasingly Baby Boomers, deal with this issue 20 years before it happens, not 20 minutes after.
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Steve Cain is executive vice president, National Sales Leader, at LTCI Partners, a brokerage general agency specializing in Long-Term Care insurance. Email him at steve.cain@ltcipartners.com