2018 Dental Survey l
California Broker is pleased to offer readers the next installment in our series of surveys. The Dental Survey is an opportunity to hear it straight from the carrier’s mouth – so to speak.
We’d also love to hear from you, though. Readers: Let us know what you find valuable – or not- in the dental survey. And if you have questions you’d like answered for the next dental survey, please let us know! Email firstname.lastname@example.org
Question 1: What types of plans do you offer?
Anthem Blue Cross: Anthem Blue Cross, the trade name of Blue Cross of California, and Anthem Blue Cross Life and Health Insurance Company, independent licensees of the Blue Cross Association, offer a comprehensive line-up of dental plans and products that include Dental PPOs and Dental HMOs for individuals, small groups, large groups and national accounts. We offer voluntary dental plans for small, large, and national groups. We also offer our large customers the added flexibility to select custom fully-insured and/or administrative services only (ASO) plans.
Beam: Beam offers a wide range of fully customizable PPO options from preventive plans to benefits rich Ultra plans. Each plan comes with access to our nationwide network of over 290,000+ access points and includes Beam Perks, our smart electric toothbrush, paste and floss, delivered to each member’s door every 6 months.
Blue Shield: We provides a wide range of affordable and comprehensive dental products to meet our clients’ needs. Our Dental PPO and HMO plans offer members a wide variety of plan designs and networks that fit their budget.
- For individuals/families, we offer a unique dental PPO plan that provides member copayments instead of the usual coinsurance percentages. Our dental HMO plan offers comprehensive benefits with pre-determined member copayments. Finally, our Duo plan offers members dental and vision coverage at a single price. Our plans can be sold with medical plans or on a standalone basis.
- For senior members, we offer two comprehensive dental PPO plans for Medicare supplement plan members. There is also a dental plus vision plan package option for Medicare supplement plan members.
- For groups, some of our dental PPO and HMO plans are available on a contributory or voluntary basis, most can be sold with or without Blue Shield medical plans and are UCR- or MAC-based.
Delta: Delta Dental offers managed fee-for service, PPO and DHMO dental plans for individuals and groups of all sizes. Our group plans are available for both employer-paid and voluntary premium contributions, and with a choice of fully-insured or ASO funding options for fee-for service plans. We also offer ACA-compliant small group and individual DHMO and PPO plans, and provide coverage to additional groups and individuals through our partnerships with 36 health plans across the country.
Guardian: Guardian offers an array of plan options to meet the needs of employers and their employees. Dental PPO, 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. We also offer dental plans for individuals/families, both on and off Covered California, the state’s insurance exchange. Consumers can purchase Guardian’s dental plans directly from www.mydental.guardianlife.com.
Humana: In California, Humana offers dental PPO, prepaid/DHMO, Traditional Preferred, and Preventive Plus plans. These plans are available on a voluntary or employer-sponsored basis.
National General: We offer fixed indemnity dental plans. These plans provide a set cash reimbursement to the member for specific services rendered. An optional additional benefit is a dental/vision savings card to take those insurance dollars even further and get member pricing from retail to wholesale rates within the participating providers.
Premier Access: We offer a wide selection of plans to meet the needs of employers and their employees. Dental PPO, Dental HMO, and Indemnity plans are available on an employer-sponsored or voluntary basis. Dual and triple choice, monthly switch (between a DPPO and a DHM), and Administrative Services Only plans are available as well. We specialize in customized plans for groups of all sizes based on the needs and price points of the employers and employees.
Question 2: How do plans you offer for the individual and/or small group compare in rates and benefits to the large-group plans?
Anthem Blue Cross: Anthem is focused on providing high quality, affordable coverage that meets the dental benefit needs of our customers through competitive plan designs with a range of market-based premiums and deductibles, annual maximums, and optional benefits. With an array of popular benefit options, we deliver affordable, quality coverage that individual and small group customers expect and provide our large group customers with additional flexibility to select custom fully-insured and/or administrative services only (ASO) plans.
Beam: We specialize in pricing for small to mid-size businesses and offer unique savings opportunities for all of our clients. Each one of our dental plans comes with Beam Perks (our smart electric toothbrush, paste and floss) included automatically. Members use our brush and app together, and then clients can save up to 15% at renewal—just for brushing their teeth.
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 PPO plans come in a wide range of deductibles and annual benefit maximums.
- Our individual, family and Medicare Supplement dental PPO plans may vary in waiting periods, deductibles, and annual benefit maximums based 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.
Delta: We offer small businesses a very wide range of dental benefits plans, many of which are often available only to larger groups. The majority of our small business plans are offered through a special program that evaluates risk on a pooled basis, helping to keep both rates and plan designs extremely competitive when compared to large group plans. Attractive features available through our small business plans include missing tooth coverage, composite (white) fillings on posterior teeth and coverage for all three phases of orthodontics for adults and children. While large groups often have the most flexibility in customizing plan options and obtaining rates that balance their experience and cost effectiveness, the range of benefits available through our Small Business Program make our plans particularly attractive to small group purchasers.
We have both DHMO and PPO off-exchange plans for individuals and families. Rates are especially affordable for plans that emphasize preventive care, and we offer richer plans at slightly higher price points as well. We also market plans designed to meet the needs of seniors, offering benefits most utilized by this particular population. The small business plans and individual plans that are available through the state and federal exchanges emphasize preventive care and coverage for the most commonly used services.
Guardian: Guardian offers nearly the same plan options to small group employers as to large employers, plus an array of cost-reducing options. We also offer dental benefits through the California state exchange (through Premier Access) and through our direct-to-consumer website at www.mydental.guardianlife.com.
Humana: 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. All our dental plans provide employees with incentives for preventive dental care, which promotes their overall health. Customers who see dentists participating in our dental networks receive deep discounts.
For individuals, Humana offers its Complete Dental plan, a comprehensive plan that offers broad preventive, basic and major services coverage. This plan works well for those who may be recently retired or are moving off of a group dental plan. Complete Dental is a PPO plan, allowing members the flexibility to have coverage with in-network and out-of-network dentists.
National General: The rates for the dental indemnity product are comparable if not slightly lower than a traditional plan offered through a group chassis. The ‘cash dental’ plan- as ours is -also takes a less traditional approach but the net effect of the benefits tends to work out the same. Plans range in cost from $15.50 to $145.10 per month.
Premier Access: Our standardized and customized plans for small group employers are the same as the ones that we offer for large group employers.
Question 3: What have been the most recent changes in your plan(s)?
Anthem Blue Cross: In 2018, Anthem Blue Cross launched two new PPO products, Anthem Dental Essential and Consumer Choice PPO, that offer modernized benefit designs, lower premiums, and a broad, but competitive dentist network locally and nationally. These plans include benefit options such as dental implants and composite (tooth-colored) fillings, annual maximum carryover including a carry-in feature, an unlimited annual maximum, and cosmetic dentistry including teeth-whitening. The plans also offer additional options for out-of-network reimbursement, including the 95th percentile of FAIR Health, and benefit enhancements including accidental dental injury coverage, extension of benefits, and enhanced preventative care, including two routine and four periodontal maintenance procedures.
Each dental plan also includes access to our industry-leading clinical integration solution, Anthem Whole Health Connection®, an innovative program that leverages Anthem’s broad capabilities to provide a holistic approach to care. Through this program, our care management staff can access member medical, pharmacy, dental, vision and disability claim and clinical data, which can help them better identify and correct gaps in patient care based on a complete health profile. In addition, consumers with chronic health conditions become eligible for additional dental services including cleanings, fluoride treatments, and even sealants—all covered at 100% with no deductible, coinsurance or waiting period.
Beam: We recently launched our Ultra plans to our SmartPremiums products. Ultra plans offer 100/100/100 coinsurance levels and annual maxes up to $5000. Clients can add $0 deductibles and adult orthodontic coverage as well. This is the perfect product for companies looking to build market leading benefits programs.
Blue Shield: We are always looking to enhance our plans and provide valuable benefits to our members.
- In 2019, for Large groups, we are introducing 4 new dental PPO and 1 new DHMO plan. We are also adding 1 Diagnostic and Preventative Only and 1 Duo (dental and vision) Diagnostic and Preventative plans that will be 100% employer paid. The new Diagnostic and Preventative plans will offer a lower price alternative to our traditional dental PPO and DHMO plans. There will be no annual maximums on these plans although all standard exclusion and limitations will apply.
- For Small groups, we are introducing 11 new dental PPO plans and 1 new DHMO plan to our small group portfolio designed to fill in gaps in the benefit spectrum. We are also removing the Rollover Rewards from all plans and adding a 2- year rate guarantee.
In addition to new plan designs, all BSC plans include oral cancer screening coverage as a value-added benefit, which comes at no out-of-pocket cost to the member. We also 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 four 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 in and out of network
Delta: Most recently, we have expanded our PPO and DHMO plan offerings to individuals and families to make them available in more areas across the country. These plans allow purchasers to choose from exceptionally affordable coverage that focuses most on preventive care and basic services, or richer plans that provide coverage for more services at a lower cost per procedure for the enrollee share.
We’ve also improved our dentist search capabilities to include Yelp reviews, click-to-call phone numbers, links to dentist web pages and Google Maps interface. All of these improvements place the customer first by providing them with richer information to make an informed provider choice.
Guardian: Guardian constantly develops new, innovative ideas in order to meet our customers’ needs by helping keep their teeth healthy and saving them money. Guardian offers the College Tuition Benefit®, a value-added benefit that helps Guardian dental members pay for college. Employees covered by a Guardian dental plan that includes the College Tuition Benefit® earn Tuition Rewards® that can be used to pay up to one year’s tuition at one of more than 375 private colleges and universities across the nation. Guardian is the only dental carrier to offer the College Tuition Benefit®. In addition, this year we introduced enhanced PPO plan designs that offer employers and employees more flexibility and control over savings.
Humana: Humana is the only specialty carrier in the market to offer a plan with an unlimited annual maximum. For the first time, employers can provide a true dental insurance plan for their employees. Plans in our new generation of products are available as voluntary plans, and to groups with as few as two employees.
All our plans offer an extended maximum benefit where members receive 30 percent coinsurance on services rendered after they reach their annual maximum (implants and orthodontia excluded). It’s important to note that because benefits never reach a maximum, network providers must continue to honor the network discounts, which are among the deepest in the market. This results in members paying as little as 30 percent of retail, depending upon the area of the state where they reside.
In addition, we offer open enrollment assistance, orthodontia benefits, and no waiting periods for major services for voluntary groups with 10 or more enrolled. Additional deductible choices, implant coverage, and acrylic filling coverage are also offered. Due to the connection between oral health and overall health, we have added – at no additional cost – oral cancer screenings to all of our products, excluding DHMO/prepaid plans, as well as four periodontal cleanings per year in addition to the two regular cleanings.
National General: Based on valued feedback, we have provided an option to add on a $3 Network Savings Card at point of sale. This enhancement creates the ability for a member to maximize savings by using a PPO dentist, in addition, includes access to vision benefits.
Premier Access: Our enhanced PPO plan designs offer brokers and employers more flexibility and control over their plan design and provide opportunities for savings using our unique tiered network combined with our tiered benefit design. Members also have the option to enroll in a monthly election plan that allows them to switch between the DPPO and the DHMO.
Question 4: Can an insured use their own dentist even if they are not on your participation list?
Anthem Blue Cross: Yes, Anthem Dental Essential and Consumer Choice PPO plan members can choose their own dentist even if they are not in our network, but their out-of-pocket costs may be higher. Members who choose a provider within Anthem’s Dental Prime or Dental Complete PPO network will save the most on their dental costs. Members insured by the Dental Net DHMO plans are restricted to only in-network dentists, excluding emergency care.
Beam: Yes, every Beam plan comes with great out-of-network coverage. Our plans come standard with 90th percentile UCR and is customizable based on the out-of-network coverage needs of an employer.
Blue Shield: Yes, both 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.
Delta: Yes. Delta Dental PPOTM and Delta Dental Premier® enrollees may visit the dentist of their choice. However, PPO enrollees will enjoy the most cost protections by visiting a PPO network dentist. Likewise, enrollees in a Premier plan can maximize their savings when visiting a Delta Dental dentist. Enrollees of these two plans can utilize any licensed dentist anywhere, and are not subject to service area restrictions.
DeltaCare® USA (DHMO) enrollees must visit their selected general dentist or approved specialist to receive benefits, with the exception of emergency out-of-area care.
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.
Humana: PPO members can visit the dentists of their choice. Out-of-pocket savings are greater when members visit participating network dentists. DHMO members must select a participating dentist.
National General: Yes. Since this is a fixed indemnity dental plan, there are no networks. However, to maximize savings during a wait period, a member might consider using an in-network provider if they selected our Network Savings Card. This provides an average savings of 43 percent on dental care — on top of the cash benefits from our plan.
Premier Access: Members covered under our PPO plans can visit any dentist they choose; however, benefits may be paid at a lower co-insurance rate for non-participating dentists. DHMO members must choose and use a participating primary care dentist.
Question 5: How many provider locations do you have?
Anthem Blue Cross: We have doubled the size of our network nationwide since 2011. Our Dental Complete PPO network includes more than 18,000 unique dentists and nearly 45,000 access points in California alone — and nearly 127,000 unique dentists and 386,000 access points nationwide. Anthem’s Dental Net HMO network includes nearly 17,000 provider locations in California to choose from both general dentists as well as specialists. Additionally, all Anthem dental members have access to our international emergency dentist network, with 24/7 assistance locating an English-speaking provider for dental emergencies in approximately 100 countries worldwide. Services received through this program do not count toward the member’s plan annual maximum. We also offer an expanded network of participating providers in Mexico with more than 74 dental locations, with 62 general dentists and 22 dental specialists.
Beam: 290,000+ nationwide
Blue Shield: Members have network access to over 23,900 dental HMO and 52,300 dental PPO providers in California, and more than 445,000 providers nationwide. These are two of the largest statewide provider networks in the industry.
Delta: Delta Dental PPO offers nearly 44,000 participating provider locations in California and nearly 301,000 locations nationally. Premier dentists offer nearly 53,000 locations in California and nearly 372,000 locations nationally. Currently there are nearly 6,400 participating DeltaCare USA facilities in California to choose from.
Guardian: There are over 369,602 PPO access points across the country and more than 41,924 in California. We are one of the largest PPO networks in the state based on dentists. The DentalGuard Alliance network tier, a smaller group of dentists offering greater discounts, has over 6,523 dentist access points in California. For the DHMO, there are 50,024 dentist access points across the country and 15,057 in California. Guardian’s PPO network also includes dental offices in Mexico. International Assist, a value-added service available, provides dental members with access to dental care if needed while traveling outside of the U.S.
Humana: Nationally, Humana has more than 290,000 dental PPO provider locations. In California, we have approximately 30,000 dental PPO and more than 18,000 DHMO provider locations.
National General: We are a hybrid of sorts due to the platform of fixed indemnity and optional access to our Careington Maximum Care Dental Network — a national network of more than 200,000 dental practices.
Premier Access: Our Dental PPO networks offer access to more than 56,000 dentist locations nationwide, with more than 12,000 in California. Our DHMO network in California has more than 3,300 dental locations, including specialists.
Question 6: What percentage of your network is closed to new enrollment? How many offices does this represent?
Anthem Blue Cross: Our Dental Prime and Dental Complete PPO network model is open-access. Dental Net HMO participation status is monitored to ensure network access and adequacy, and we actively work with members and providers to ensure new enrollees have options for offices that may be closed to new enrollment.
Blue Shield: In 2017, approximately 7% of dental HMO plan network providers maintained closed practices; this represents approximately 145 offices out of 2,195 unique locations.
Delta: Zero percent of Delta Dental PPO and Delta Dental Premier offices are closed to new enrollment. Our fee-for-service providers may close their practice, but while in operation, they must accept patients without discrimination, regardless of age, gender, ethnicity or being new to the practice. Of our DeltaCare USA facilities, 6,382 are open to new enrollment; only 208 DeltaCare USA facilities, representing 3.26% of all DHMO facilities, are closed to new enrollment.
Guardian: In California, only 0.03% of our PPO network and 2.73% of our DHMO network are closed to new patients.
Humana: Under Humana’s dental provider contracts, participating dentists must schedule and treat members without discrimination, including benefit or payer differentials. Because this is a fee-for-service reimbursement program, closed practices are not common for dental PPO plans. Approximately 95 percent of practices are open to new patients in the Liberty DHMO plans.
National General: None – the core plan is ‘go anywhere’. If the dental/vision savings card is selected, those providers are all available to new participants.
Premier Access: Less than five percent of the DHMO network is closed to new patients; this figure represents about 159 general dentist locations.
Question 7: What is the time frame for processing a referral in terms of member notification and payment to the specialist?
Anthem: Anthem Blue Cross does not require a referral for consumers enrolled in our Dental PPO products to see a dental specialist. Dental specialists submit dental claims directly to the plan and are paid in the same manner as general dentists. More than 98 percent are processed within 14 days. Consumers enrolled in our dental HMO products are required to get a referral to a specialist from their primary care dentist. We provide specific guidelines for the provider to follow when submitting a referral so that it is automatically approved, with payment processing closely aligned to our Dental PPO products.
Blue Shield: For PPO members, Specialist referrals are not required, and payments to specialists are processed the same as for general dentists. For DHMO members, pre-authorizations for Specialists are normally processed within 5 business days.
Delta: For PPO and Premier, referrals and preauthorization are not required; payments to specialists are processed by the same guidelines as general dentists. Our standard turnaround for processing DeltaCare USA specialty care referrals is five days.
Guardian: Referrals are not required under our PPO plans. For our DHMO plans, payment to the specialist is within 30 days of receipt of the claim.
Humana: Humana’s dental plans including DHMO plans do not require a referral from a general dentist to a specialist. The member gets a higher benefit when seeing a participating dentist and specialist. In 2017, 97.6 percent of clean claims were processed within 10 business days (14 calendar days).
National General: This kind of transaction would be handled in the member services area in the same manner as regular treatment. So, as long as the services are deemed necessary and covered, benefits would be available as per the contract.
Premier Access: Referrals are not required under our DPPO plans. For our DHMO plans, payment to the specialists is within 30 days of receipt of the claim.
Question 8: How do you handle early termination of coverage when a member is still in the middle of orthodontic treatment?
Anthem Blue Cross: Orthodontic payments will cease if coverage is not active at the time the payment is due.
Beam: Beam will pick up orthodontic treatments in the middle of their period for new members. For an early termination, Beam will cease making payments on that coverage when it terminates.
Blue Shield: Orthodontic coverage/payments end at cancellation of coverage.
Delta: Delta Dental’s obligation to cover orthodontic treatment ceases after the date the enrollee loses eligibility or terminates coverage.
Guardian: When an orthodontic appliance is inserted prior to the PPO member’s effective date, we will cover a portion of treatment. Based on the original treatment plan, we determine the portion of charges incurred by the member prior to being covered by our plan and deduct them from the total charges. Our payment is based on the remaining charges. We limit what we consider of the proposed treatment plan to the shorter of the proposed length of treatment, or two years from the date the orthodontic
treatment started. Also, we enforce the plan’s orthodontic benefit maximum by reducing the total benefit that Guardian would pay by the amount paid by the prior carrier, if applicable.
If a member is undergoing orthodontic treatment and his or her Guardian coverage terminates, we pro-rate the benefit to cover only the period during which coverage was in force. We do not extend benefits.
Our DHMO agreement provides for the Contracted Orthodontist to complete treatment at the contracted patient charge on a number of our plans. As an additional contract rider we can allow for supplemental transfer coverage for Orthodontia under our DHMO.
Humana: For orthodontic claims, Humana will pay benefits monthly through the month that the member is termed. Orthodontia is prorated over the time of treatment depending on how long they are in treatment.
National General: Not applicable to our coverage, as our plan does not provide such benefits.
Premier Access: If a member is undergoing orthodontic treatment and Premier Access coverage terminates, we will prorate the benefit to cover only the time period during which coverage was in force. We do not extend the benefits beyond the policy termination. Our DHMO agreement provides for the contracted orthodontist to complete treatment at the contracted patient charge on a number of our plans.
Question 9: Does your plan have annual and lifetime maximums on dental coverage? If so, what are they?
Anthem: The annual maximums for our plans vary from as little as $500 to as much as $10,000 with the option of an unlimited annual maximum for large group customers of the Anthem Dental Essential and Consumer Choice PPO plans. We also offer our Carry-Over benefit feature allowing qualified members to enhance their annual maximum each benefit year by carrying over an unused portion of the prior year’s annual maximum when certain qualifications are met. Additionally, we have the flexibility to vary the annual maximum for members who visit an Anthem Prime or Complete PPO provider versus a non-participating provider. Currently, lifetime limits are only imposed on child or child and adult orthodontia benefits. Lifetime maximums can range from $500 to as much as $3,000 or more dependent upon individual or group coverage and group size. There are no annual and/or lifetime limits on Dental Net HMO policies.
Beam: All plans have customizable maximums. Beam’s new Ultra plans can support annual maximums of $5000 and orthodontic maxes of $3000. One of our strategic advantages is flexibility; we can underwrite a wide variety of maximums based on the needs of the employer!
Blue Shield: Our annual maximums vary from as little as $500 to as much as $5,000 or more dependent upon individual or group coverage and group size. Employers have a choice in annual maximum with more flexibility for large group customers to customize their annual maximum to meet their needs.
- For large groups, we also offer our Rollover Rewards benefit feature allowing qualified members to boost their annual maximum. The annual account reward will vary depending on the annual claims threshold which is determined by the plan’s annual maximum chosen. The annual network reward for members who visit an in-network vs. a non-network dentist is $100.
- For 2019, we will be adding lifetime limits on child orthodontia benefits on some PPO plans. Lifetime maximums can range from $1000 to as much as $2,000 dependent upon plan chosen.
Delta: Virtually none of our DeltaCare USA (DHMO) plans impose annual or lifetime maximums on dental coverage. For most PPO and Premier plans, annual and lifetime maximums vary, and are determined by the group purchaser. Maximums typically range from $1,000 to $2,000.
Guardian: For PPO, the maximum refers to the total of benefit dollars actually paid for covered services incurred within the annual period, or the member’s lifetime in the case of orthodontia. Guardian has significant flexibility with maximums. Typically, Preventive, Basic and Major have a combined maximum. We offer both an annual single maximum option (range from $500 – $5,000) and an annual split maximum option (maximums differ for in-network and out-of-network services). With the Preventive Advantage option, only Basic and Major services count toward the annual maximum. Maximum Rollover allows a portion of unused annual maximums to carry over for future years. We also offer an option to cover cleaning after the maximum is reached and an unlimited maximum plan. For orthodontia, the lifetime maximum options range from $500-$2,500. Our DHMO plans do not include an annual maximum.
Humana: We offer flexible plan designs with a range of annual maximums to meet the needs of small to large groups. We do not have lifetime maximums. We are the only specialty carrier in the market to offer an Unlimited Annual Maximum.
National General: Yes. The Basic Plan has a $500 maximum calendar year benefit; Intermediate is $1,000; and the Plus plan is $1,500. However, preventive benefits do not take away from this annual benefit (adding $150-200/annually in benefit, depending on plan level). Members can use their savings card on covered and non-covered services at any and all times of the coverage being in force.
Premier Access: Premier Access offers plan design flexibility to allow brokers and employers to custom design their dental benefits, including annual or lifetime benefits. The most common annual benefit maximums are $1,000, $1,500, and $2,000. We do offer custom benefit plans above those amounts if the employer and broker desire that.
Question 10: Does your plan have a deductible. If so, what is it?
Anthem Blue Cross: The deductible for our plans can vary from no deductible to as much as $250. The Anthem Consumer Choice product is a high deductible, consumer driven dental plan with a minimum deductible of $100 per individual. We can also vary the deductible for members who visit an Anthem Prime or Complete PPO provider versus a non-participating provider. Large group customers also have lifetime deductible option as an alternative to annual deductibles. A lifetime deductible can be a good fit for a customer who maintains coverage with Anthem for multiple years. There is no annual and/or lifetime deductibles on Dental Net HMO policies.
Beam: Beam plans include a standard $50 deductible ($150 family) but is fully customizable. Our Ultra plans can go as low as a $0 deductible!
Blue Shield: Deductibles can vary from as little as $0 to as much as $300 or more dependent upon group size and individual or family coverage.
- Employers have a choice in deductible with more flexibility for large group customers to customize their annual deductible to meet their needs.
Delta: Virtually none of our DeltaCare USA (DHMO) plans require enrollees to satisfy a deductible. For most PPO and Premier plans, deductibles vary, and are determined by the group purchaser. Deductibles of $50 per individual / $150 per family are not uncommon.
Guardian: Our PPO product offers many different deductible options ranging from $0-$300 and will vary by plan design with $50 historically being the most common. Deductibles are often waived for Preventive Services as Guardian’s plans are designed to encourage members to get preventive care, thereby avoiding the need for more extensive dental care in the future. All our DHMO plan designs offered in California have no deductibles.
Humana: We offer flexible plan designs with a range of deductibles to meet the needs of small to large groups. The deductible is always waived for preventive care. We want to ensure there are no barriers to members receiving the necessary preventive care.
National General: There are no deductibles.
Premier Access: Employers and brokers can custom design their dental benefits, including plans with no deductible. The most common designs requested are no deductible, $25, and $50.
Question 11: What percentage of preventive costs does your plan cover?
Anthem Blue Cross: When using an Anthem Blue Cross Dental Prime or Dental Complete PPO provider, preventive care is covered at 100 percent. Out-of-network coverage will vary based on plan selection, but is typically not less than 80 percent. Large group customers receive additional flexibility to customize the percent of costs covered. Most Dental Net HMO preventative care is covered with a $0 member office visit copay and $0 member service level copay.
Beam: Beam will cover preventive at 100% in all cases’ we strongly believe in preventive care’s role in the dental health equation for all members!
- Preventive care is standardly covered at 100% when using an in-network provider.
- Out-of-network coverage will vary based on plan selected but typically not less than 80 percent. Members may also be balanced billed for amounts exceeding the allowable payment to out- of- network providers based on their plan.
- For large groups, there is additional flexibility to customize the percentage of costs covered.
Delta: Delta Dental’s fee-for-service coinsurance percentages vary by plan. DHMO copays are set at a fixed schedule and vary by plan design.
Guardian: For PPO, we offer coinsurance percentages ranging from 0%-100% for preventive services. The preventive coinsurance percent for our most common PPO plan sold is 100%. Our DHMO plans offer a wide variety of covered services usually covered at 100%.
Humana: Preventive care is always covered at 100 percent, unless a large group designs a custom plan. We encourage all employers to cover preventive care at 100 percent. We want to ensure there are no barriers to members receiving the necessary preventive care.
National General: The member is reimbursed a select amount toward their preventive visit based on benefit level plan selected. For example, our ‘Plus’ plan offers $100 cash reimbursement toward preventive services.
Premier Access: Brokers and employers can customize this coverage from 0 percent to 100 percent; the most common is 100 percent coverage for preventive costs.
Question 12: What percentage of root canal costs does your plan cover?
Anthem Blue Cross: Anthem Blue Cross Dental Prime or Dental Complete PPO plans typically cover root canals at 50 or 80 percent. Out-of-network coverage will vary based on plan selected, but is typically covered at 50 or 80 percent. Large group customers receive additional flexibility to customize the percent of costs covered. Dental Net HMO members can expect a member service level copay between $30 and $225, dependent upon the type of root canal and plan chosen.
Beam: We will typically cover root canals at 50%, but it is customizable based on employer preference.
- For Large groups, root canals can be covered under Basic or Major services. Typically, Basic services are covered at 80% and Major Services are covered at 50%. Out-of-network coverage will vary based on plan selected but the most common percentage is 50 percent.
- For Individual/Family plans, root canals are typically covered under Major services at 50%
- For Small Group, root canals are typically covered under Basic services at 80%.
Delta: Delta Dental’s fee-for-service coinsurance percentages vary by plan. DHMO copays are set at a fixed schedule and vary by plan design.
Guardian: For PPO, we most often cover root canals as a basic service. We offer coinsurance percentages ranging from 0%-100% for basic services. The basic coinsurance percent for our most common PPO plan sold is 80%. Our DHMO plans cover many root canal procedures at various copayment levels based on plan type.
Humana: We offer flexible plan designs with a range of co-insurance percentages from 50 percent to 90 percent to meet the needs of small to large groups. A group can elect to have endodontic coverage in Basic or Major.
National General: According to our cost and transparency calendar, a molar root canal – for example – may cost $1,382. The plan cost is $707 with a network savings of $675 or a percentage savings of almost 50 percent.
Premier Access: Brokers and employers can customize this coverage from 0 percent to 100 percent; the most common designs cover 80 percent or 50 percent.
Question 14: What percentage of crown costs does your plan cover?
Anthem Blue Cross: Anthem Blue Cross Dental Prime or Dental Complete PPO plans typically cover crowns at 50 or 80 percent. Out-of-network coverage will vary based on plan selected, but is typically covered at 50 percent. Large group customers receive additional flexibility to customize the percent of costs covered. Dental Net HMO members can expect a member service level copay between $25 and $240 dependent upon the type of crown and plan chosen.
Beam: We will typically cover root canals at 50%, but it is customizable based on employer preference.
Blue Shield: Typically, for all lines of business, crowns are considered Major services and are covered at 50%.
Delta: Delta Dental’s fee-for-service coinsurance percentages vary by plan. DHMO copays are set at a fixed schedule and vary by plan design.
Guardian: For PPO, we most often cover crowns as a major service. We offer coinsurance percentages ranging from 0%-100% for major services. The major coinsurance percent for our most common PPO plan sold is 50%. Our DHMO plans offer a wide variety of different crown option procedures covered at various copayment levels based on plan type.
Humana: We offer flexible plan designs with a range of co-insurance percentages to meet the needs of small to large groups. Crowns are typically covered as part of Major services and the coinsurance ranges from 50 percent to 60 percent.
National General: The cash benefit for a Crown ranges from $45 to $450. However, if the Careington Network is used – for example – the cost for a Crown (porcelain fused to noble metal) may cost $1,424. The plan cost is $726 with a network savings of $698 or a percentage savings of almost 50 percent.
Premier Access: Brokers and employers can customize this coverage from 0 percent to 100 percent; the most common design covers 50 percent.
Question 15: Do you provide dentist cost and quality transparency tools?
Anthem Blue Cross: Yes, all Anthem Dental Essential and Consumer Choice PPO consumers have access to free online tools via the member services portal. These tools include Dental Health Assessment, which helps consumers better understand their oral health by answering questions about their mouth, teeth, and overall health to produce an individualized report they can share with their dentist for follow-up care. To help plan for needed care, Anthem also offers an additional online tool called a Dental Cost Estimator allowing members to search for common procedures including exams, cleanings, x-rays, fillings or root canals and get an estimated cost within seconds.
Beam: Our Lighthouse portal is for brokers and administrators and offers the ability to quickly and effectively edit account and member level details, manage everything from enrollments to COBRA, and gain unique insights into how a group is performing against plan, especially as it relates to their Beam Brush data and renewal rates.
Blue Shield: Yes. Once registered on our website, members may review their claims information and locate providers. They also have access to treatment cost information through the Treatment Cost Calculator. The Treatment Cost Calculator allows members to search for common procedures including exams, cleanings, x-rays, fillings or root canals. This tool is quick and easy to use with members being able to get an estimated cost for procedures quickly.
Delta: Yes. Enrollees can use our Cost Estimator to determine costs for procedures based on dentist participation and location. Additionally, our Find a Dentist tool provides links to Yelp reviews as well as other helpful information including languages spoken, wheelchair accessibility and public transit access.
Guardian: We have a Dental Cost Estimator tool that provides an estimated range of allowable charges (fee schedule amounts) for the selected procedure codes in a selected region and provider contracted tier. Note that this is not the actual Guardian fee schedule amount for a provider nor the expected paid amount for a particular Guardian plan design. At this time, we do not offer provider quality ratings.
Humana: Humana’s website does not currently provide cost information for our dental products.
National General: Yes. If a member decides to use our Careington Network for specific services, they can go to: http://www.careington.com/ngahdsavings/. These resources provide a simplified way to determine costs of treatment.
Premier Access: We are currently developing cost and quality tools for the website, which we believe we help consumers make better informed decisions. We also offer pre-determination of benefits to members who request them through our phone-based customer service representatives.
Question 16: Who can readers contact for more information?
You can email Beam at email@example.com for more information, and one of our Broker Success Managers will be in touch with you right away!
Brokers who currently work with Blue Shield of CA contact their BSC representative.
For those who do not have a direct contact, they can locate more information by logging onto our website at our Broker Connection. The link is listed below.
Readers can navigate to https://www.deltadentalins.com/about/contact/ to find the number specific to their location and area of interest.
The Guardian Life Insurance Company of America
Rick Porterfield, Regional Director
San Francisco, Sacramento & North, including Oregon/Washington, Hawaii and Alaska
415.490.4433 office email: Richard_Porterfield@glic.com
Joe Stefano, Regional Director
SoCal Metro, San Diego, Las Vegas, & Central California Markets
949.885.1720 office,email: Joe_Stefano@glic.com
Sales Executive: Robert Semrow – firstname.lastname@example.org
(888) 326-3210 email: email@example.com