Welcome to California Broker’s 2010 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. Read the responses and sell accordingly.

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 CareSM
• Aetna DMO(R) Access
• Aetna Dental Care RewardSM
• Aetna DentalFund(r) (our consumer-directed dental plan)
• Indemnity
• Vital Savings by Aetna(r), a dental discount program.

All of our dental plans may be offered on a voluntary basis.

Aflac: Voluntary Individual Table of Allowances plans.

Ameritas: 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.

Aflac: Voluntary Individual Table of Allowances 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 two lives, with multiple network and out-of-network options down to the employee level.

BEST Health Plans: We offer the Advantage DHMO plans in Calif and Texas. A prepaid dental plan is available in Fla. as well. Advantage Plus PPO/Indemnity dental plans are available as a dual-choice option, alongside an Advantage DHMO plan.

Blue Shield: Blue Shield provides a wide range of affordable and comprehensive dental PPO and HMO plans. 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 as riders to health plans or on a stand-alone basis. Individual and family dental PPO and HMO plans are available to our IFP medical members as riders to health plans or we offer stand-alone dental PPO plans. We also offer two 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 co-pays 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).
• 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: Nationally, Dearborn National offers a flexible portfolio of dental plan options, as well as custom options for larger groups. With the proprietary claims adjudication system, employers have flexibility in customizing their dental plan. Funding options include fully insured, self insured, and voluntary plans. Dental plans are offered for groups as small as two employees to national accounts exceeding 40,000 employees.

In addition, with our partnership with Calif. Dental Networks (CDN), we offer both PPO plans and DHMO plan options in the state of Calif.

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.

Golden West: Golden West Dental & Vision offers a comprehensive line-up of dental plans and products that include: PP0 (nationally), dual option, triple option, stand-alone and DHMO for individuals, small groups, and large groups. We offer voluntary dental plans for small and large 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’s flexibility allows us to customize plans based on the needs and price points of the employer group, whether small or large.

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.

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: MetLife offers dental PPO, dental PPO-co-pay, dental HMO, and Indemnity plans with flexible designs and funding arrangements available to accommodate employer plan requirements. MetLife offers 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 Calif., Fla. and Texas 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 Calif.

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 a DHMO mixed-model provider panel comprised of (a)contracted independent, general dentists and specialists, along with (b) Western Dental employee dentists and specialists, who work in the company’s owned Western Dental Centers. Western Dental currently operates over 220 general dentistry and orthodontic office throughout Calif., Ariz., and Nev.

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.

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 Health Plans: BEST Health Plans’ Advantage DHMO plans offer orthodontic benefits to groups with two or more enrolling. Prepaid S200 and S500 are available to groups with a minimum of 15 employees enrolled. Rates for Calif. and Texas DHMO plans vary by employer-contribution. Fla. prepaid Dental plans offer the same rates for employer-contributory and voluntary plans.

Blue Shield: Rates for our large group dental HMO and PPO plans are typically lower than our small group and IFP plans due to customization of offerings for groups with more than 300 employees. Rates may vary depending on the actual plan design. We offer one dental HMO and one dental PPO network regardless of participation in a group or individual/family plan. Group plans offered vary in deductibles and annual benefit maximums. Our individual, family, and medicare Supplement dental plans vary in waiting periods, deductibles, and annual benefit maximums. All comprehensive dental plans offered include generous benefits, competitive premiums, and our strong Calif. and national provider networks.

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-saving 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 co-pays, and other cost savings mechanisms. They go up to very rich, low-co-pay 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 dental plans nationally for groups as small as two employees to large-group plans. There is an extensive portfolio of standard plan design options for small groups. 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 comparable 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.

Golden West: Our small and large group products are specific to location, size, industry and contributions. While larger groups have more flexibility in customizing benefit options than do smaller groups, Golden West still focuses on plan flexibility for all size groups. This enables employers to custom design their products for their personal needs.

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 or Guardian medical products. Dental coverage is not available to individuals.

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 Calif., Fla., and Texas 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. There are also, however, a few benefit limitations on very small cases, which apply to groups under 10 lives.

Securian Dental: Small group rates are developed on a pooled basis. Large group rates are developed on a custom basis.

United Concordia Dental: The primary factors that affect our group rates are location, experience, and credibility. 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 with cost-effective, quality choices.

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: Evidence-Based Policies: We determine which services should be covered based on the following:
• 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 do not cover services that research shows as experimental, investigational or unproven. We do not cover ViziLite, VELscope, or brush biopsies. There is no evidence showing that using these services are an improvement over conventional oral cancer screening. The Journal of the American Dental Association (JADA) recently published results from a study that indicated that use of ViziLite or VELscope along with a conventional screening examination for lesions deemed clinically innocuous was not beneficial in identifying dysplasia or cancer.

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, and stand-alone hearing care benefits.

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 options for employers and employees than do 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.

Blue Shield: The new oral cancer screening coverage is not only a value-added benefit, but also comes at no out-of-pocket cost to the member. And the standalone IFP dental plans give brokers a much wider pool of potential prospects since these plans can be sold to those without Blue Shield medical coverage.

CIGNA: Our DHMO 07 Series features four cleanings per year, two at $0 co-pay and another two at a minimal co-pay, when recommended by the network dentist; expanded fluoride treatment options; and a robust variety of schedules and co-pay structures. The 07 Series is focused on affordability, preventive care, and wellness. Teeth whitening (take-home trays with bleaching gel) is also available on most of the 07 schedules. We’ve added free identity theft resolution services with this Series.
CIGNA added the D Series for clients that can’t afford to continue offering full service plans or those that thought they couldn’t afford dental coverage. It offers preventive and diagnostic coverage only. It provides preventive dental services and access to network discounts for services that aren’t covered under the plan.
CIGNA’s dental plans include several enhancements, such as coverage for oral cancer screening procedures including brush biopsy and VizilitePlus. We removed the age limit on sealants for DHMO plans. On most schedules, individuals don’t need a referral to a pediatric dentist for dependent children under seven. Individuals can also visit network orthodontists without a referral. Our WellnessPlus features reward individuals for getting preventive care by increasing their benefits in the following plan year. Dental customers also get discounts on xylitol products, health management programs, and other valuable health and wellness products and services.
The DPPO network now gives employers more choice. The CIGNA Dental Core Network is appropriate for employers looking for a strong balance between network access and discounts. The larger CIGNA Dental Radius Network offers the greatest nationwide access to dentists at all discount levels and is appropriate for employers where 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 when they exceed their annual maximum or other plan limitations, such as frequency, age or missing tooth. Employees get lower out-of-pocket expenses since most of our DPPO network dentists have agreed to offer enrollees their 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. The DNSP provides access to a supplemental network of dentists who provide out-of-network care at a discounted rate. This means additional claim savings for clients and lower out-of-pocket costs for customers when they use a participating DNSP dentist. 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).

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, Dearborn National also offers the largest PPO network of dental access points, with now over 150,000.

New DHMO products were created to cover additional cleanings (beyond the standard two times per year), alternative name brand crowns, and many other services typically used to up-sell patients.

Delta Dental: Most mid-large group plans can be customized within basic parameters. We incorporate changes in treatment standards and technology as they evolve. Delta Dental has added the following enhancements to our standard benefit package:
• Coverage allowed for one panoramic x-ray and one full mouth x-ray within the five-year frequency limitation for each of these procedures.
• Coverage for IV sedation to mirror general anesthesia for covered oral surgery
• Coverage allowed for IV sedation and general anesthesia for select endodontic and periodontal procedures.
Previous enhancements include the following:
• Coverage for dental implants, implant-supported prosthetics and other implant services.
• A benefit enhancement during pregnancy, which includes an additional oral evaluation and either one additional prophylaxis (D1110); up to four quadrants of periodontal scaling/root planing (D4341/D4342); or one additional periodontal maintenance procedure (D4910) (Written confirmation of the pregnancy must be provided by the enrollee or the dentist when the claim is submitted.)
• The option of waiving the annual maximum on diagnostic and preventive services (cost impact varies based on client’s existing plan design).

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.

Golden West: Most recently, we launched our High/Low PPO and Triple Option dental plans, which allow employees to choose their own level of coverage. In addition, our low cost DHMO plans offer cosmetic and elective procedures as an option in addition to our free vision and ortho benefits for all DHMO and PPO (CA) members.

Guardian: We can vary deductibles, annual, and lifetime maximums and service frequencies; include deferrals of services; move services or groups of service to different service categories; and offer many coverage options including implants and cosmetic services. We also offer MAC plans, incentive coinsurance, incentive maximum, preventive-only, and preventive-plus plans. Plans can be tailored exactly to meet almost any client’s requirements while providing the prompt case implementation and rapid claim processing that our systems have always ensured.

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 (under 500 employee) market – providing more choices to help them meet cost objectives without sacrificing quality.

Principal Financial Group: Our current plan offers significant flexibility 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.

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: A shared family maximum plan is being rolled out.

BEST Health Plans: We launched our DHMO/prepaid dental product lines in January. The California DHMO plans offer no office visit fees as well as posterior composites and oral cancer screenings at fixed co-payments. There is no charge for most diagnostic and preventive services. Enrolled members can access their information through a member portal to access our dentist locator, a treatment cost calculator, to verify eligibility, request ID cards, and review plan information. A dental education section helps our members stay informed on recommended dental health practices.

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.

Blue Shield: We recently reduced pricing on four of our small group dental plans. We rolled out our Suite Deal Dental package that increases the number of plans small group employers can offer from two to five.

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 (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. Beginning June 1, we added a third teeth cleaning per year covered at 100% when using a network provider for Dental PPO plans designed specifically for our Medicare supplement plan members.
In addition, all Blue Shield dental PPO plans now cover oral cancer screenings as a preventive and diagnostic benefit, covered at 100% for the member. Additionally, we’ve expanded our dental PPO network of providers from 77,000 to nearly 110,000 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. 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 enhancements 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’ve recently enhanced the Benefits Administrator Support Guide on our website. It features new content, including an administrative manual and our extensive dental health flyer library. As part of Delta Dental’s initiatives to reduce environmental impact, we provide many resources in the enhanced guide to help benefits administrators “go electronic” in their communications with employees.

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.

Golden West: Our DHMO network has increased to over 4,800 participating providers; our national PPO plan reaches over 79,000 participating providers. Our PPO plans offer industry discounts, which qualifies employers up to as much as 15% discount off PPO pricing. For DHMO plans, self-referrals have been routine for our plan participants. Our Individual SmileChoice plan includes cosmetic/elective benefits, vision and ortho coverage.

Guardian: Guardian Choice is a new plan design, which allows employee choice between a MAC or UCR PPO plan using one blended rate and the ability to switch at annual open enrollment. We have introduced new features that encourage preventive care, allowing members to get even more value from their annual maximums including Maximum Rollover, Maximum Rollover Lite, and Preventive Advantage. Other PPO plan design enhancements include benefits for up to four periodontal treatments per year (with the option to cover under preventive), oral cancer screenings, adult fluoride, cosmetic teeth whitening, and the ability for employers to offer their employees a triple-choice plan. Our new enhanced DHMO plans will waive office visit co-pays after three years and include orthodontia in progress benefit and coverage for services such as oral cancer screenings and adult fluoride. We also introduced the Direct Referral program that allows DHMO members to see any in-network specialist without pre-authorization, providing faster, easier access to important treatment.

Health Net Dental: All of our Classic Plus, Classic, Essential and Basic 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: MetLife is offering the following:
• MetLife Dental Health Manager — This proprietary dental disease management program provides educational content and personalized report cards that illustrate participants’ risk for oral disease and general dental health. It 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.
• Back to the BASICs plan — This dual-option plan focuses on the essential dental services aligned with research, treatment protocols, and market trends to maximize the value to employers and their employees. The base plan has low monthly premiums and provides coverage for services needed to maintain oral health, such as preventive exams, cleanings, X-rays, fluoride, sealants, fillings, and more. Employees can choose the enhanced plan for more comprehensive coverage including coverage for orthodontia services. The enhanced plan also provides lower out-of-pocket costs through lower deductibles and higher coinsurance reimbursement and annual maximums.
• MetLife International Dental Travel Assistance Program — With this new program, participants who travel internationally get around-the-clock access to multilingual coordinators who can connect them with dental providers in over 200 countries.
• Provider Discounted Membership in the Institute of Medical Emergency Preparedness (IMEP).
• Enhanced Oral Health Library — MetLife launched an enhanced web-based consumer education resource, the MetLife Oral Health Library at www.metlife.com/dental and clicking on “MetLife Oral Health Library.”
• Enhanced Full Service Dental for Retirees — Expected to be available Summer 2010, this product enhancement will provide a Trust option for our Full Service Dental for Retirees product. This turnkey product allows customers to enrich their retiree benefits programs with no benefit expense and minimal administration. The new Trust features means no contracts to sign for employers while providing voluntary dental options for their retirees.

Principal Financial Group: Our newest feature to our dental plans is the Preventive Passport option. 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 a college student, an unemployed individual, a young family,  a senior citizen, or anyone else that may need quality dental care at an affordable price.

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.

DMO – Members must seek care from a participating DMO provider unless a state allows a member to seek out of network care.

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. Members 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 Health Plans: Members on the Advantage DHMO/prepaid Dental plans must use a dentist in the network. If a member’s dentist is not part of the network, the member can nominate the dentist to join the Advantage network.

Blue Shield: 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: In the PPO dental plan, members can use an in-network or out-of-network dentist. However, they save more by going to 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 33,600 Delta Dental Premier dentists in Calif. 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 20,700 Delta Dental PPO dentists in Calif. 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.

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.

Golden West: Members who are covered under our True Advantage PPO and indemnity plans can get services from a non-panel provider. Their greatest discounts will be through our panel providers under our True Advantage PPO plan.

Guardian: Members who are 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: Our members can see any dentist (even if the dentist is not on the participation list) if they are enrolled in either our PPO or POS design. If a member is enrolled in our EPO design, 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 may be higher when visiting a non-participating dentist. 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 prevented 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 and the 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. Most Ameritas PPO providers offer a discount on non-covered procedures (if allowed by the state) and members are financially  responsible for those 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 Health Plans: No, network dentists are contracted not to balance bill our members.

Blue Shield: In-network providers cannot bill members for fees that exceed the negotiated rate. Out-of-network providers, however, may bill for charges that exceed the plan’s allowed amount.

CIGNA: In-network dentists are not allowed to balance bill for covered services. We can’t prevent non-network dentists from balance billing.

Dearborn National: If a member sees an in-network dentist, per our contract, dentists are not allowed to balance bill. However, if a member sees an out-of-network dentist, that provider could balance bill the member.

Delta Dental: Contracted dentists agree not to balance bill patients for services covered under the program for which he or she has contracted service fees. Delta Dental holds its Delta Dental PPO and Premier dentists to their contracted fees when providing services to eligible enrollees.
DHMO enrollees do not pay more than their set co-payment for benefits under the DeltaCare USA plan. Specialists are paid the difference for charges exceeding the enrollee’s co-payment for all preauthorized services. When an enrollee chooses a more costly procedure not covered under the plan, the enrollee is responsible for the difference in cost between the network dentist’s usual fees for the covered procedure and the optional treatment, plus applicable co-payment for the covered procedure.

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.

Golden West: Network dentists are contractually prevented from balance billing above the negotiated rate. Non-panel dentists can balance bill a PPO or indemnity member the difference of the billed fee and the average fee charged for that particular geographic area.

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. For some SafeGuard Dental HMO plans, there is a 25% fee reduction off of a participating dentist’s customary fee for non-listed procedures. (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. A dentist that is not a part of one of our networks 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.

Aflac: We do not have network requirements. If the dentist’s charge exceeds the benefit amount paid, the dentist may balance-bill the patient.

Ameritas: The explanation of benefits calculates the insured’s portion of the bill automatically 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 Health Plans: Network dentists are contracted to accept capitation and member co-payments as full payment. Members receive information on how their plan works at the time of enrollment. Our member portal also provides a treatment cost calculator, and helps members understand how they will be billed for treatment they receive. Member complaints are forwarded to our Provider Relations Department for review and resolution.

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

CIGNA: Balance 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 co-pays is between the patient and the dentist. We encourage dentists to collect co-pays 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 co-pay 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 (co-payment 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 co-payments 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 co-payments 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.

Golden West: Explanation-of-benefits statements are sent to members identifying the discounts taken and the member’s responsibility. The compliance department and dental consultant monitor utilization. Additionally, a proprietary claims system identifies over-utilization trends and patterns.

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 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 explanation-of-benefits is our first protection for the patient against over-billing. It clearly identifies the charges for services that the patient has a responsibility to pay. In addition, our customer service area 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 the 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 Web site (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 5/1/10

DMO – 48,270 dentist locations nationally and 7,328 in Calif.
PPO – 131,004 dentist locations nationally and 25,364 in Calif.

Aflac: We do not have network requirements. Policyholders may visit any provider they choose.

Ameritas/FDH Network: 37,022 Calif. provider access points,

(23,852 Ameritas; 13,170 FDH); 21,972 Calif. locations, (16,399 Ameritas; 5,573 FDH)

Anthem Blue Cross: As of 04/30/2010

California Dental Blue PPO locations:

Dental Blue 100 about 18,734

Dental Blue 200 about 20,466

Dental Blue 300 about 21,373

Prudent Buyer 18,915

DHMO locations: more than 5,000 in California

BEN-E-LECT: Our dental plans utilize the Smart Health (Interplan), First Health (CCN) and Western Dental networks, which contain thousands of offices statewide.

BEST Health Plans: In Calif., we contract with 7,828 providers.

Blue Shield: Members have network access to over 8,000 HMO and 20,000 PPO providers in Calif.,

and nearly 110,000 providers nationwide.

CIGNA: Nationally we have more than 47,000 DHMO contracted access points and more than 167,400 DPPO Radius Network contracted access points. In Calif. 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: Dearborn National has the largest PPO network of dental access points nationwide offering over 150,000 access points for our members to chose from.

Delta Dental: In Calif., Delta Dental Premier, 33,600, Delta Dental

PPO, 20,700, and DeltaCare USA (DHMO), 4,200. We also give our enrollees access to the national Delta Dental networks.

Dental Health Services: Our network of participating dentists consists of nearly 800 general practice offices with 2,698 participating dentists, and an additional 1,751 specialists. Our PPO network carries more than 16,000 dentists.

Golden West: Our National WellPoint PPO Network contracts with over 79,000 providers. Our DHMO network has over 14,700 statewide participating providers.

Guardian: There are over 131,500 PPO dentist-locations across the country and more than 22,000 in Calif. We are the largest PPO network in the state based on unique dentists. Guardian recently purchased the Preferred Dental Network in Nevada and is no longer leasing access to the Diversified network. For the DHMO, there are 10,730 locations across the country and 4,854 in Calif.

Health Net Dental: As of May 2010, our California PPO network includes 23,988 access points in 8,438 locations. Our California DHMO network includes 2,677 locations.

HumanaDental: Our dental PPO network is one of the largest in California, which encourages dentists to participate in our network, enabling us to negotiate attractive dental fee schedules. We have a PPO network with more than 27,000 dentist locations in California, and continue to grow daily. Almost 99% of the dentists who join our network stay in our network. Also, HumanaDental has a unique recruiting campaign targeting all dentists used by employees.

MetLife: As of May, our Dental PPO network includes over 135,000 participating dentist locations nationwide (12% growth from 2009), including over 22,800 in Calif. And, the Dental HMO network includes more than 13,000 participating dentist locations in Calif., Fla. and Texas (18% growth from 2009), including over 6,900 in Calif., over 4,000 in Fla. and over 2,100 in Texas.

Principal Financial Group: We have approximately 25,500 PPO provider locations and 14,000 EPO provider locations.

Securian Dental: 87,000 dentist access points.

United Concordia Dental: We have more than 69,000 dentists at nearly 112,000 practicing locations nationwide in our Advantage Plus PPO network. In Calif. alone, we have more than 13,100 dentists at over 29,600 total locations. Our DHMO network includes more than 2,600 primary dental offices and 1,500 specialists nationwide, with over 1,500 primary dental offices and 590 specialists in Calif.

Western Dental: Our provider network is unique among DMO carriers because it has over 220 Western Dental Centers (staff model) in addition to more than 1, 000 IPA offices with more than 2500 dentists.

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 Health Plans: Members may request another network provider on a monthly basis. Members can request a provider change online or by calling Member Services. Requests must be made by the 25th of the month to become effective on the 1st of the following month.

Blue Shield: Yes, DPPO members may change providers at any time without notice. DHMO members may change in-network dentists on a monthly basis; requests made by the 10th of the month become 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 www.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.

Golden West: DHMO members can change their providers once a month by calling our member services department and requesting the change. In addition, members are allowed up to three dental offices per family unit. For the PPO plan, members choose their dental office from a list of participating providers through our Website or their own (non-contract) provider.

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 on-line 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 on-line 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.

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

Aetna: Participating dental offices get a Dental Office Guide, which includes information on plan designs, policies, and procedures. We offer a Website for dentists, which includes real-time eligibility and benefits information, a 24/7 speech recognition system called “Aetna Voice Advantage,” and a dentist solutions team in our dental service centers. Unusual treatment patterns may be discovered during our review of utilization reports. This usually results in an office audit that includes a review of patient files and general office practices. The results are discussed with the dentist and recommendations are made for improvement.

Aflac: We have materials that may be provided to dentists with information on how to file claims and access online materials. A dedicated section on aflac.com provides dentists with claim forms and instructions as well as online access to verify policy benefit amounts. If the dentist has any additional questions, they may call our Customer Service Center.

Ameritas: Providers can access individual plan information using the toll-free voice response system, the fax-back system, or our online benefit Website. We hope this educates the provider and insured of covered benefits. If not, periodic surveys and automated utilization review mechanisms help provide a way to monitor issues about plan coverage misunderstandings.

BEN-E-LECT: The members are given material specific to the dentist to ensure benefits are understood. We also offer extended customer service hours with a department dedicated to assisting dentists with benefits information. We have regular outside auditors who review claims for this information in addition to scrub during time of payment.

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

CIGNA: A large staff of dental network managers, based in specific field locations and in operational offices, meets continuously with dental care professionals on our administrative and quality policies. Our network teams counsel any offices found not to be in compliance; remediation plans are put into place to ensure compliance.

DHMO — Each network dental office on the plan has received the CIGNA Dental Care Reference Guide and Patient Charge Schedules at a Glance as well as specialty referral guidelines. These comprehensive documents describe the policies and procedures to administer the plan and help members, the patient charges for each plan, and the benefits of participating in the CIGNA Dental Care network. Network Update is a bulletin we produce to communicate information about nationwide and state-specific policies, procedures, and regulations that affect dentists. This bulletin is mailed with monthly payment packages to all dental offices to which the information is applicable.

DEPO/DPPO — The CIGNA Dental Office Reference Guide and fee schedules are provided to each network dental office on the plan. These comprehensive documents describe the policies and procedures to administer the plan and help patients; the contracted fee schedule for the office; and the benefits of participating in the CIGNA Dental PPO network.

Dearborn National: Upon contracting with our network, providers will be informed of the established fee schedule that will be their basis of reimbursement. The fee schedule highlights reimbursement rates for specific benefits offered through our network.

Statistically based utilization review helps ensure that dental services are medically necessary, dentally appropriate, of acceptable quality and within the scope of a group contract. A dentist’s practice pattern is evaluated through post payment utilization of paid claims based on statistical analyses and comparisons to the dentist’s peer groups. Throughout the utilization review process, dental consultants are available to provide professional advice or answer questions requiring clinical knowledge. Our dental consultants are thoroughly trained on contractual plan provisions and in the review of claims for appropriateness of care.

Delta Dental: Detailed program information for all enrollees is available through a secure area of our Website and through a toll-free telephone number including maximums, deductible and benefit levels. Additionally, Delta Dental issues a bimonthly newsletter to network dental offices that covers Delta Dental policy, industry news, seminars, new Delta Dental clients, tips on submitting claims, and other useful information. Delta Dental publishes a quarterly dentist newsletter and holds seminars to keep dentists up to date. Regular enrollee surveys seek information on various quality issues, such as services rendered that are not covered by the program;

services delivered as claimed; office cleanliness and appearance; and customer service.

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

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

Guardian: Dentists can access plan benefits using our online Web tool, GuardianAnytime.com, or by phone. All PPO dentists get information about Guardian’s plans through local network recruiters as well as mailings of pertinent information. Our claim system tracks and monitors each dentist’s practice patterns for bundling, over-utilization, etc. We consult with dentists who are not meeting our expectations. If they are unable to do so, we may discontinue their network participation. We recommend that members get a voluntary pre-determination of benefits before proceeding with any treatment that will cost $300 or more, but we do not reduce or deny benefits if the member does not submit the treatment plan for pre-determination. The member will be advised if the treatment plan includes services that are not covered under his or her plan. All offices that join our DHMO network get an orientation that fully explains the plan. Additionally, our DHMO regional network managers visit the offices periodically to review the plan. Dental offices submit encounter data of services provided to DHMO members, which is reviewed quarterly by our Quality Assurance Committee.

Health Net Dental: We educate our providers about our administrative policies, including guidelines on appropriate care. Providers are encouraged to submit pre-treatment plans for review in order to learn what procedures would be covered under the member’s benefit plan and the level of reimbursement. In the process of reviewing pre-treatment estimates and in completed claims, we track and monitor each provider’s practice patterns. Providers with aberrant patterns get a focused review, including statistical analysis and record audits, which may result in appropriate corrective action plans. Our Professional Network Relations reps meet with providers to counsel them and to answer any questions about planning care for members. Our Internet portals provide real-time information to providers and members on their benefits.

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

Once selected to participate in MetLife’s Dental PPO network, dentist’s treatment patterns are monitored to help ensure maintenance of appropriate practice patterns — not plan design since they may not address the unique needs of individuals. If a dentist’s treatment patterns become unacceptable, the dentist is educated and monitored via MetLife claim review processes, and, if warranted, removed from the network.

If a participant has a complaint about charges for services (covered or not covered by a MetLife plan) our trained customer service representatives will review the issue with the participant and generate a response and follow-up investigation, if necessary.

For the Dental HMO, each dental office gets a facility reference guide with a section on the plans. A provider-relations representative conducts a thorough orientation with the dental office staff to help them fully understand the plans. Quality Management reviews member concerns and conducts regular chart audits. (Transactions are processed in real-time except when the systems are undergoing scheduled or unscheduled maintenance or interruption.)

Principal Financial Group: We provide online, telephone, and fax

service options for providers to verify benefits and eligibility. We encourage pre-determination to be performed for inlays, onlays, single crowns, prosthetics, periodontics, and oral surgery.

Securian Dental: Dentists can verify benefits by calling our toll-free customer service phone number or via our Website.

United Concordia Dental: Dental offices can confirm benefit coverage information on our Website via “My Patients’ Benefits,” through our telephone interactive voice response (IVR) system, or by speaking to a customer service representative. In some instances, we also inform dentists of important benefit changes through our quarterly newsletter, a stuffer included with dentist checks, and/or with an automated telephone call. Dentists can also reference benefit information on our Dentist Reference Guide, available on our Website. Professional relations representatives are available to provide assistance when necessary. We identify abnormal practice patterns through a comprehensive quality assurance process. United Concordia Dental reviews thousands of claims each year to ensure the acceptability of treatment and quality of services. Advisors and consultants also review dentists’ fees and practice patterns. Dentists who fall outside of the norm are targeted for education and additional monitoring.

Western Dental: Each provider is trained and given training materials to ensure that they are knowledgeable about Western Dental programs. Western Dental Services also monitors customer service inquiries and grievances in addition to reviewing utilization data supplied by each provider.

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

Aetna: In 2009, we experienced a turnover rate of 3% on the DMO and 2% in the PPO. We are not at liberty to provide specific dentist information, such as names and phone numbers.

Aflac: dental has no provider networks. Policyholders have the freedom to choose any dentist without restriction

Ameritas PPO: 947 provider access points were lost (Ameritas = 641, FDH = 306). Yes, we would provide names, if requested.

BEN-E-LECT: For all plans combined, the turnover is less than 2%.

Many offices have been terminated due to lack of meeting credentialing standards, retirement, or death of the provider. BEN-E-LECT does maintain the information for these offices. However it is not common practice to release the information.

Blue Shield: California DPPO: In 2009, there were 208 dentists who voluntarily terminated from our network. The voluntary turnover rate (excluding deaths, retirements and practice relocations) was less than 1%. California DHMO: In 2009, there were 101 dentists who voluntarily terminated from our network. The voluntary turnover rate (excluding deaths, retirements and practive relocations) was 1%.

CIGNA: CIGNA’s dental network turnover rates have been lower than published industry average data. Dentist and dental office information can be shared with clients and brokers if required.

Dearborn National: In 2009, there were a total of 1,325 providers terminated from our national dental PPO network – this equals less than 1% of the total current network.

Delta Dental: All of our networks increased in size in 2009: Delta Dental Premier, by 4.5%; Delta Dental PPO by 7.3%, and DeltaCare USA, our DHMO network, by more than 13.4%. Delta Dental does not release specific information on its contracted dentists. National turnover: Premier, 0.86%; PPO, 2.57%; and DeltaCare USA, 3.31%.

Dental Health Services: Although roughly 5% of participating dentists have been lost over the past 12 months, our overall network size has made up for this and has increased by 5% over the previous year through a focus on seeking out only the most qualified dentists while improving accessibility and availability. The names and phone numbers of all offices are available on request.

Golden West: The DHMO panel-retention rate average is 93%, including dental offices that have closed their practices. Golden West does not make it a practice to provide names and phone numbers of dental offices that have left the network.

Guardian: Over the past 12 months turnover in our DHMO and PPO nationwide networks has been approximately 6%. It includes dentists who voluntarily discontinue their participation (retirement, moving from area, closing the practice) and those whose participation is ended by Guardian. We can provide names and phone numbers of terminated offices, subject to permission from the offices.

Health Net Dental: In 2009, our DHMO turnover rate for voluntary terms was 3.1% and our PPO turnover rate was 1%. We do not release specific information on our contracted dentists.

HumanaDental: 87 California dentists were termed during the past

12 months, including seven that were termed by HumanaDental due to not meeting our credentialing standards. We will not identify terminated providers.

MetLife: For Dental PPO, our turnover rate was 1.4% for 2009. In California, the 2009 network turnover rate was 0.81%. For Dental HMO, 2.75% of contracted dentists in California left the network in 2009.

Principal Financial Group: For our PPO network, we’ve lost 4,000 provider locations. For our EPO network, we’ve lost 600 provider locations.

Securian Dental: Very few providers choose to leave the DenteMax network. Less than 3% of our network dentists discontinue participation with DenteMax every year. The majority of these terminations are due to a provider’s retirement or death or the moving or closing of a practice. We would be willing to provide names and phone numbers of terminated offices upon request.

United Concordia Dental: In California, we retained 98% of the dentists in our PPO network and more than 93% of the dentists in our DHMO network in the last 12 months. Yes, if requested, we can provide the names and phone numbers of dental offices that no longer participate in our network.

Western Dental: Turnover is about 3% for the past year. Yes, we will provide the names and phone numbers for 3 of these offices, if requested.

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

Aetna: For California, 96% of our DMO participating providers are open to new patients; 4% are closed. 100% of our participating PPO dentists are open to new patients.

Aflac: Aflac dental has no provider networks. Policyholders may visit any dentist they choose.

Ameritas PPO: Only 24 Ameritas Offices and 4 FDH Offices are closed to new enrollment. This represents approximately 0.1%.

BEN-E-LECT: All of our dental PPO providers are accepting new patients. For our DHMO product, less than 3% of the offices are closed to new enrollment representing approximately 60 offices.

Blue Shield: In 2009, 0.3% of our DPPO network providers maintained closed practices; 0.6% of our DHMO network providers maintained closed practices.

CIGNA: DPPO network offices don’t close to new enrollment. For DHMO in California, the total number of general dentist network locations is 1,475. Of those, 1,327 are open to new enrollment.

Dearborn National: All participating provider offices in our PPO network are open to new enrollment. Contractually, participating providers are required to maintain an open practice. For our DHMO network, less than 1% is closed to new members.

Delta Dental: Our fee-for-service dentist do not close to new enrollment; 6.7% DHMO dental facilities are closed to new enrollment.

Dental Health Services: About 8% of network general practice dentists are closed to new enrollment (63 offices). No specialty offices are closed to new members.

Golden West: All of our PPO providers are accepting new patients.

The DHMO providers, listed on our Website, indicate their availability for a selected plan. The system is updated on an ongoing basis to ensure accuracy.

Guardian: In California, only .02% of our PPO network and 2.6% of our DHMO network is closed to new patients.

Health Net Dental: As of May 2010, for DHMO, 1% (24 out of 2,677) of our offices are closed to new enrollment. For PPO, 0.13% (11 out of 8,438) of our dentists’ offices are closed to new enrollment.

HumanaDental: Under HumanaDental’s provider contract, 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.

MetLife: Nationally, less than 1% of our participating Dental PPO dentists have requested that their names be removed from our provider listing for purposes of not accepting new MetLife-eligible patients. For Dental HMO, 4.7% of general dentist offices are closed to new enrollment in California.

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

Securian Dental: All of our network dentists are open to new enrollment.

United Concordia Dental: In California, more than 99% of our PPO dentist network is open to new enrollment, as well as more than 98% of our DHMO dentist network.

Western Dental: Less than 3% of our network providers are closed to new enrollments – about 60 offices.

13. Do all of your contracted offices accept every benefit level sold by your company or do they have the option to pick and choose only the programs with co-payments they want to accept?

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

Aflac: Aflac dental has no provider networks.

Ameritas: All providers accept patients from all plans sold through Ameritas Group Dental.

BEN-E-LECT: This information is tracked closely with our Freedom Pre-Paid Dental Plans. The information is tracked via surveys and questionnaires for our PPO products.

CIGNA: All contracted DPPO offices accept all of the insured benefit DPPO plan designs that we offer. All contracted DHMO offices accept all of the DHMO plan designs that we offer. For our discount dental programs, not all DPPO contracted providers are required to participate. They may opt out of participation in these discount dental programs if they desire.

Dearborn National: The contracted offices of our PPO providers are required to accept the established fee schedules that include the benefit levels sold by Dearborn National. Providers are not allowed to pick and choose programs with co-payments they want to accept, but instead accept previously established fees. For our DHMO network, we do not require the dental office to accept all plan variations. Dentists are free to select only the plan products that work for them and their office.

Delta Dental: Delta Dental holds contracts with individual dentists for participation with each network (Premier, PPO and DeltaCare USA [DHMO]). Dentists can choose to participate only in those programs with co-payments they wish to accept.

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

Golden West: Golden West encourages all providers to accept all plans offered. The DHMO providers listed on our Website indicate the plan selected by each participating provider and is updated regularly.

Guardian: All contracted PPO and CA DHMO offices accept all of the plan designs that we offer.

Health Net Dental: All participating PPO dentists accept all of our plan designs. Contracted DHMO providers accept all Health Net Dental DHMO plans.

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

MetLife: For Dental PPO, all participating dentists accept all of our plan designs. They cannot pick and choose which MetLife plans to accept. For Dental HMO, when contracting with a dental-care provider, it is understood that the dentist will accept all Dental HMO plans. A few contracted dentists do not participate in some of the older custom DHMO plans.

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

Securian Dental: Yes, they accept every benefit level sold by our company.

United Concordia Dental: All contracted PPO dentists accept all United Concordia Dental PPO plans. All contracted DHMO dentists accept all United Concordia Dental DHMO plans.

Western Dental: The entire network accepts all of the new Series 7 plans.

14. Do you have a way to monitor the length of time patients have to wait in the doctor’s office?

Aetna: A semi-annual written survey is collected from all Calif. DMO general practitioners and specialists.

Aflac: Since policyholders can choose any dentist without restriction, we do not monitor wait times.

Ameritas: We monitor patient wait time through random customer and patient surveys. Providers are contacted, if necessary, to discuss specific feedback.

BEN-E-LECT: This information is tracked closely with our Freedom Pre-Paid Dental Plans. The information is tracked via surveys and questionnaires for our PPO products.

Blue Shield: Yes, we monitor and track wait times several ways. We document member complaints on this issue in our customer service workbench and track them electronically until they are resolved. We also conduct an annual member satisfaction survey, which contains specific questions about wait times with our network offices.

CIGNA: The dental network management team monitors wait times in our DHMO general dentist facilities via monthly telephone calls. Additionally, we are able to identify lengthy wait times through our patient satisfaction surveys.

Dearborn National: In-network dentists are expected to deliver care at the same professional standards as defined by the American Dental Association and found in their publication, “Principles of Ethics and Code of Professional Conduct.” Average waiting time for scheduling appointments is not tracked for our dental programs.

Delta Dental: Delta Dental conducts random enrollee surveys semi-annually for the fee-for-service enrollees and annually for DHMO enrollees. Surveys include questions about dentist access (for example, number of dentists from which to choose and appointment availability with their dentist) as well as other customer satisfaction issues. For the DHMO, the appointment availability is also monitored via regular office visits from a Delta Dental representative.

Dental Health Services: Yes, we monitor our members’ experiences through frequent member surveys, regular on-site dental office visits and quarterly access surveys.

Golden West: Golden West monitors this as a metric in our member satisfaction surveys. Our complaint/grievance tracking process reviews issues such as wait times, which are logged and monitored. We continue to monitor appointment wait times and emergency wait times through surveys conducted by our organization.

Guardian: We do not monitor appointment scheduling or wait times for the PPO plan, although every month we send member satisfaction surveys, which include questions concerning wait times, to randomly chosen PPO members who have been to a network dentist within the previous 90 days. The DHMO has established access standards and monitors this quarterly by mailing access monitoring forms, member satisfaction surveys, transfers, and grievance data. Telephone calls are utilized on an as-needed basis.

Health Net Dental: We monitor individual wait times in the dentist’s waiting room through our member satisfaction surveys and provider access surveys. Results of these surveys are a critical tool in assessing a member’s experience with network dentists and their specific offices. In addition, we get feedback on office wait times from members calling our toll-free Health Net Dental Member Services number.

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

MetLife: For the Dental PPO, we monitor patient impressions of wait time through monthly satisfaction surveys that specifically ask this question. For Dental HMO, SafeGuard (a MetLife company) monitors the length of time that patients wait in the reception area and the operatory through the quarterly accessibility survey and service visit reports by provider relations representatives. In addition, we track wait times through a monthly report and member satisfaction survey.

Principal Financial Group: We do not monitor this.

Securian Dental: We do not monitor this.

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

Western Dental: Western Dental monitors patient’s length of time by onsite reviews, surveys, and questionnaires. In addition, our staff model offices use the Quality Assurance Management System. The state-of-the-art, proprietary software tool tracks measurable items, such as wait times, which ensures that our members have timely access to quality dental care.

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

Aetna: Office hours are set by each individual dental office. We document dentists’ office hours as part of the credentialing process. We use the information to balance networks by contracting with dentists who offer weekend and evening hours.

Aflac: We do not have a network of providers. Policyholders may visit any dentist they choose, which includes those with extended hours.

Ameritas PPO: Yes, each office sets its own hours. Those hours are available to all our members on our online provider listings. Our goal is to balance care availability throughout the area to ensure needed care.

BEN-E-LECT: Yes, many of our offices offer extended evening and early morning hours in addition to weekend hours for ease of access.

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

CIGNA: DHMO — There are 2,804 network offices (24.8% percent of the total DHMO network) offering Saturday office hours, and 3,778 network offices (33.5% percent of the total DHMO network) with evening hours (6:00 p.m. or later).

DPPO — Since members are able to visit any licensed dentist for care, we do not measure evening or weekend hours for network dentists. Additionally, our dentist contracts require dentists to provide or arrange for emergency care 24 hours a day, 7 days a week and to provide emergency appointments within 24 hours.

Delta Dental: Our online dentist directory contains information on hours and access, including maps, directions, and languages spoken. In addition to posting hours and access, DHMO network dentists are required to provide 24-hour emergency service to enrollees seven days a week.

Dearborn National: Yes, there are in-network providers that schedule evening appointments and maintain business hours on Saturdays for the convenience of plan members appointments. Our Member Services Department can help members with details.

Guardian: Many PPO and DHMO provider locations have extended or weekend hours.

Health Net Dental: The office hours of each dentist location is listed in our online provider directory. This information is also available to all members through Health Net Dental Member Services. As part of our dentist agreement, all locations are required to have an emergency contact available for members whenever the dental office is closed.

HumanaDental: Members can see the provider of their choice and they are encouraged to contact their dentist for appointment availability. Based on today’s busy lifestyles, many providers are extending their hours to meet the needs of their patients.

MetLife: As part of MetLife’s credentialing criteria for the dental PPO, all participating dentists must provide acceptable hours of service and have established emergency care and/or off-hour protocols. For the Dental HMO, SafeGuard contracts with individual dental practitioners, many of whom have evening and Saturday hours.

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

Securian Dental: Yes.

United Concordia Dental: Yes.

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

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

Aetna: We establish varying compensation rates under each customer’s benefits plan for subscribers, spouses, and children. Monthly compensation rates are based on community averages and plan design. Actual capitation amounts are proprietary.

Aflac: We do not offer capitation plans.

Ameritas PPO and the FDH Networks: Neither of these networks is used for dental HMO purposes, so no capitation is paid.

BEN-E-LECT: This is not applicable for our PPO plans. All dentist capitation has been added to the dentist premium amounts collected for our DHMO products.

Blue Shield: This information is considered proprietary.

CIGNA: Dentist capitation amounts are considered proprietary information.

Dearborn National: We do not offer capitation to our PPO network providers. For our DHMO providers, this information is not public.

Delta Dental: Capitation rates are developed based on the plan design, annual utilization data, enrollee/dependent mix, and employer contribution. Compensation is designed to reimburse approximately 60% to 65% of usual fees.

Dental Health Services: Our compensation system involves many more components than capitation and is designed to keep the participating dentists whole while providing incentives for appropriate treatment and care.

Golden West: This is proprietary information.

Guardian: DHMO capitation amounts paid to the general dentist vary based on plan design, adult or child, and region.

Health Net Dental: Capitation information is proprietary.

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

MetLife: For Dental HMO, capitation is actuarially set by plan design and that information is proprietary. Capitation is augmented by supplemental payments for certain procedures. In addition, the plan pays fees for each member visit.

Securian Dental: We do not offer capitation plans. We offer PPO and Indemnity plans.

United Concordia Dental: Specific capitation amounts are considered proprietary information.

Western Dental: Series 7 plans reimburse providers with capitation and supplemental payments. Total compensation, as with fee for service designs, depends on how much treatment is provided.

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

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

Aflac: It is expected that the dentists selected by our policyholders treat their patients with the utmost respect and provide the highest standards of quality care without requiring incentives to do so. If our policyholders are unhappy with the service received, they may change dentists at any time.

Ameritas PPO: Provider thoroughness is an expectation; we do not offer an incentive for this. We do monitor patient care through quarterly utilization review. If standards are not met, the provider could be terminated from the network.

BEN-E-LECT: Yes, providers that exceed quality of services and accessibility standards may be offered a bonus.

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

CIGNA: Our Integrated Quality Management Program drives overall quality across our all of our dental networks. While we do not provide incentives, the expectation is that the dentists in our networks meet professionally recognized standards of care.

Dearborn National: There are no incentives to PPO providers to control costs or provide quality of care. As indicated in the provider agreement, along with our Quality Improvement Guidelines, network dentists are required to follow standards of care as defined by the American Dental Association. For DHMO providers, we subject them to quality assurance standards and routine audits; therefore this is nothing for them to gain by not being thorough.

Dental Health Services: Our supplemental payments and rigorous Quality Assurance Program are designed as incentives to provide appropriate and thorough care. Only caring, experienced, qualified doctors are accepted into our exclusive prepaid network. All of our dentists undergo a careful and highly selective screening process. To ensure ongoing quality, a panel of quality assurance professionals conducts regular monitoring, reviews, and audits while an extensive checklist helps to make sure that plan members get the best and safest care possible.

Golden West: Golden West does not provide monetary incentives to dentists. Our expectation is that the providers in our network meet professionally recognized standards of care while they are expected to perform in accordance with the high standards of competence, care, and concern for the welfare and needs of participants.

Guardian: Our PPO fee schedules and plan provisions are adequate to encourage proper care. We do not offer incentives. Guardian requires participating dentists to treat PPO members the same as any other patients and we investigate all quality of care complaints from members. Our DHMO reimbursement schedules, capitation payments, office visit fees, supplemental payments, and chair-hour guarantees are adequate to encourage appropriate care. Participating dentists treat DHMO members the same as any other patient and we have a grievance process in place to follow up on all quality of care complaints from members.

Health Net Dental: We do not offer financial incentives to our dentists. Our expectation is that our dentists perform in accordance with high professional standards without incentives. Our extensive credentialing process ensures that our contracting dentists are of the highest caliber.

HumanaDental: Fee-for-service reimbursement encourages thorough treatment. Member complaints are reviewed by our Quality Assurance Department and through our standard grievance process.

MetLife: Providers are expected to perform in accordance with high standards of competence, care, and concern for the welfare and needs of participants.

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

Securian Dental: All DenteMax dentists undergo a rigorous credentialing process to ensure the highest quality dentists are treating our members.

United Concordia Dental: Our expectation is that all services performed by participating dentists will meet the high standards of the dental industry. Participating DHMO primary dentists get supplemental reimbursement on the most highly utilized procedures in addition to monthly capitation and member co-payments, which encourages dentists to provide the services necessary to ensure the oral health of members. In addition, PPO participating dentists who consistently provide thorough service to members are given x-ray exempt status. This allows them to submit many claims without x-rays, saving them time and money.

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

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

Aflac: We do not require referrals.

Ameritas PPO and the FDH Networks: Yes, specialty coverage can be a part of any Ameritas plan designs. Our networks are comprised of a full-spectrum of specialists to cover the needs of our customers.

BEN-E-LECT: Specialist referrals are not necessary. Coverage is available for all types of specialty procedures including, but not limited to, endodontic, periodontic, cosmetic, orthodontics, oral surgery and pedodontics.

BEST Health Plans: Yes.

Blue Shield: For the DHMO member there is no coverage for prosthodontic specialists. DPPO members may self-refer to any specialist.

CIGNA: DHMO — Network general dentists initiate patient referrals for endodontic, oral surgery, and periodontal treatment. Referrals are valid for 90 days from the approval date. Specialty referrals are not required for orthodontic treatment, if covered on their plan design or for pediatric care for children up to age seven as long as individuals visit network specialists. The network specialist may submit a request for pre-authorization to CIGNA Dental for oral surgery and periodontal services. Individuals are responsible for the applicable patient charges listed on the Patient Charge Schedule for all covered procedures. After specialty treatment is complete, the individual should return to the network general dentist for care.

If it is determined that a network specialist is not available, the general dentist will refer the patient to a non-network specialist and the patient will only be responsible for charges listed on the Patient Charge Schedule.

Dearborn National: Yes, our DHMO program will provide coverage for all types of specialist referrals. Our PPO program does not require specialist referrals.

Delta Dental: Fee-for-service enrollees can self-refer; referral by the general dentist isn’t required. For DHMO enrollees, the primary care dentist is responsible for submitting the predetermination request and directing the enrollee to the appropriate specialist once authorization is received

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

Golden West: Yes, all our group plans include Periodontics, Endodontics, Oral Surgery, Pedodontics and Orthodontia specialists. Individual plans are offered discounts for specialty services.

Guardian: We provide coverage for all types of dental specialists.

Health Net Dental: Health Net Dental DHMO plans cover a wide range of specialty care, including endodontics, periodontics, oral surgery, pedodontics and orthodontics. If the procedure is covered under the plan, the member must first see a general dentist for a specialty care referral to a participating specialist. The member is responsible for paying the established co-payment for the covered procedure.

HumanaDental: Fee-for-service reimbursement encourages thorough treatment. Member complaints are reviewed by our Quality Assurance Department and through our standard grievance process.

MetLife: For Dental PPO, claims for services by licensed dental practitioners will be considered for reimbursement based on the participant’s plan design. For Dental HMO, the SafeGuard SGX series of Dental benefit plans have co-payments for endodontics, periodontics, oral surgery, pedodontics, and orthodontics services provided by a participating specialist.

Principal Financial Group: Generally yes

Securian Dental: Our plans do not require referrals. We provide coverage based on plan benefits.

United Concordia Dental: Our PPO plans do not require specialist referrals. Our DHMO plans require referrals for specialty coverage for endodontics, periodontics, pedodontics, oral surgery, and orthodontics. The services provided by specialists that are considered for benefit reimbursement are limited to the specifics of the dental contract for each covered member.

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

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

Aetna: For DMO plans, general practitioners can refer to a participating specialist directly based on published guidelines. DMO members have direct access to participating orthodontists and do not need a specialty referral. Indemnity and PPO plans have direct access for specialty services.

Aflac: We do not require referrals.

BEN-E-LECT: Referral is not necessary for any of our plans. The member may select a specialist and schedule an appointment upon making a phone call or personal visit.

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

CIGNA: DPPO plans don’t require referrals and general dentists aren’t required to act as gatekeepers. For DHMO plans, general dentists act as coordinators for all specialty services except pediatrics up to age seven (on most plans) and orthodontic network dentists. Referrals are not needed for orthodontia or for children under age seven to visit a network pediatric dentist. General dentists refer individuals to network specialists as deemed necessary. CIGNA works directly with the specialists for preauthorization and direct payment when appropriate.

Dearborn National: For our DHMO program, general dentists can refer members to an in-network dentist by calling our customer service or the member can call our customer service department directly for a list of specialists in the network.

Delta Dental: Fee-for-service enrollees can self-refer; referral by the general dentist isn’t required. For DHMO enrollees, the primary care dentist is responsible for submitting the predetermination request and directing the enrollee to the appropriate specialist once authorization is received.

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

Golden West: Using our direct referral process, the participating general dentist can refer a patient to a specialist without prior authorization. For PPO plans, member would self refer.

Guardian: For the DHMO plan, any complex treatment requiring the skills of a dental specialist may be referred to a participating specialist dentist. Our DHMO plans offer direct referral in which the member may be referred directly by their primary care dentist to a participating specialist without pre-authorization.
Health Net Dental: For DHMO plans that require pre-authorization, the contracting primary care dentist completes a specialty referral form and submits to Health Net Dental. Approvals are returned to the primary care dentist, member and specialist. Upon receiving the approval, the member contacts the specialty office to schedule an appointment for completion of treatment. Our PPO dental plans allow self-referrals to participating or non-participating specialists as needed.

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

MetLife: Our Dental PPO product does not require referrals for specialist care. For Dental HMO, the SafeGuard SGX series of dental benefit plans give participating general dentists the flexibility to refer members to participating specialists without prior approval from SafeGuard — except for orthodontic and pedodontic specialty services in Calif. where the member’s selected general dentists will contact SafeGuard for pre-approval.

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

Securian Dental: No referral is required.

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

Western Dental: Once the general dentist determines that the necessary procedure is out of his or her scope of practice, the office will submit a written referral request to our plan. Western Dental’s dental director then determines whether the referral is medically necessary and whether the procedure is covered under the benefit plan.

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

Aetna: Yes

Aflac: For benefits to be payable, the specialist must be licensed by his or her state to perform the required treatment.

BEN-E-LECT: Yes, all of our specialists are board certified as a requirement.

BEST Life: All of our specialists are certified and must meet a rigorous credentialing process to be included in our network. Before a specialist can join our network, we require a license to practice, DEA/CDS certificates, education/training including board certification, work history, malpractice insurance, malpractice claims history, hospital privileges, sanctions against their license, Medicare/Medicaid sanctions, and perform ongoing monitoring of sanctions or regulatory actions. All providers must go through the credentialing process every three years.

CIGNA: Yes, all network dentists contracted to provide specialty care have completed post-graduate dental specialty programs in their fields. CIGNA’s dental networks include specialists in periodontics, orthodontics, endodontics, pediatric dentistry and oral surgery. It is important to note that, in dentistry, board certification is not the norm. As a result, we do not require this item for credentialing. We accept dentists who are recognized specialists, including those who are board certified or board eligible.

Dearborn National: All specialists in our network must be board eligible to be accepted into our network. However, specialists are not required to be board certified.

Delta Dental: Delta Dental requires board certification where it is required by state law. Under the fee-for-service plans, Delta Dental credentials all of its participating specialists in the same manner, whether they are board eligible or board-certified. Under the DHMO plans, Delta Dental requires all DeltaCare USA network specialists to be board qualified.

Dental Health Services: The majority of our dental specialists are board certified.

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

Guardian: Many of our PPO specialists are board certified or eligible and all of the DHMO specialists are board eligible.

Health Net Dental: Yes.

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

MetLife: In order to participate with the dental PPO or HMO, speciaists must submit and keep current any certifications and/or other factors necessary to maintain their specialty.

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

Securian Dental: 100% of the specialists in our network are board certified or board eligible.

United Concordia Dental: Yes, as part of our credentialing process, we verify each dentist’s education, license and certifications.

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

21. How do you fund your specialty care?

Aetna: Specialty services are paid on a fee–for-service basis.

Aflac: Aflac dental is a simple plan that pays a set amount per procedure based on a table of allowances. Additionally, policyholders have the freedom to choose their own provider without pre-certification.

BEST Life: Specialty care is built into the premium. Specialty care received by a network provider is reimbursed at a discounted fixed fee schedule. Specialty care received by a non-network provider is reimbursed on what is usual and customary for that area, procedure and specialty.

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

Delta Dental: Specialty care is built into the premium. Under the fee-for-service plans, specialists are reimbursed by a combination of maximum plan allowances by procedure (contracted fees between Delta Dental and dentists) and coinsurance paid by the covered enrollee. Under the DHMO plan, network specialists are reimbursed on a per claim basis according to contracted fee schedule and co-payment paid by the enrollee.

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

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

Guardian: Our PPO specialists are paid on a fee-for-service basis.
For our DHMO plans, specialty care is funded through a portion of premium.

Health Net Dental: For both our DHMO and DPPO plans, we under-write and rate dental plans based on an assumed specialty care claims liability and build an allowance into our dental premiums.

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

MetLife: For Dental HMO, specialists are reimbursed based on a predetermined fixed fee schedule. The SafeGuard SGX series of dental plans have co-payments for specialty services — listed on the Schedule of Benefits for the plan. These plans also provide a 25% fee reduction off the participating dentist’s usual and customary fee for non-listed services, unless specifically excluded from coverage.

Principal Financial Group: Through normal plan provisions.

Securian Dental: Network dentists (general and specialty dentists) are reimbursed on the basis of a discounted fixed fee schedule. Network dentists agree to accept the fee schedule amount as full consideration, less applicable deductibles, coinsurance and amounts exceeding the benefit maximums and will not balance bill the member.

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

22. 
Does the member have to be referred by the primary dentist to the orthodontist or can he or she self-refer?

Aetna: Member can self-refer.

Aflac: We do not require referrals. Our policyholders may self-refer.

BEN-E-LECT: Member may self-refer to any orthodontist they prefer.
In network versus out of network and plan selection will determine coverage provided.

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

CIGNA: None of our plans require a referral for orthodontic care.

Dearborn National: Our DPPO program does not require members to select a primary dentist or an orthodontist. The member has the freedom to choose which network provider they want to frequent and may switch their provider at any time. This includes member visits to orthodontists. Our DHMO program does require a referral, but it is an automatic approval and the process allows us to provide a better oversight of our orthodontists.

Delta Dental: Under the fee-for-service plans, enrollees can self refer. For DHMO plans, the assigned network dentist submits a referral request for orthodontic treatment to Delta Dental. The network dentist is notified upon approval and is responsible for advising the DeltaCare USA enrollee who then contacts the assigned network orthodontist for an appointment.

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

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

Guardian: PPO members can self-refer to all types of specialty care, including orthodontia. General dentists in our DHMO network will refer the member to a Participating Orthodontist. The referral does not require plan authorization.

Health Net Dental: Our DPPO product does not require referrals for specialty or orthodontic care, so participants may self-refer. For DHMO, there are three types of specialty referral processes based on the member’s schedule of benefits. For plans that require pre-authorization, a specialty referral form must be submitted by the primary care dentist. For plans that have direct referral, the primary care dentist may directly refer the member to a participating orthodontist by visiting our website or by contacting our customer service. For plans that allow self-referral, the member may go directly to a contracted specialist by visiting our website or by contacting our customer service.

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

MetLife: Our dental PPO product does not require referrals for specialty or orthodontic care, so participants can self-refer. For the dental HMO in Calif., orthodontic specialty services require pre-approval. The member’s general dentist will contact SafeGuard for pre-approval, and once approved will contact the member with the name of a participating orthodontist.

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

Securian Dental: The member can self-refer.

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

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

23. 
What is the time frame for processing a referral in terms of member notification and payment to the specialist?

Aetna: DMO general practioners usually provide a member with an
immediate referral. Specialty payments are made on receipt and adjudication of the claim.

Aflac: Aflac dental doesn’t require referrals because policyholders
have the freedom to choose their own dentist without restriction.

BEN-E-LECT: Referral is not necessary with our plans. Members may call and schedule the appointment as desired.

BEST Life: No referrals are required on our dental PPO/Indemnity
plans. Members may self-refer to any specialist they choose.

CIGNA: For the DHMO, typical turnaround time for specialty referrals
is five days for pre-authorization and five days for payments.

Dearborn National: For our PPO program, referrals are not required. For our DHMO program, referrals are approved in no more than five working days. Claims are paid within 15 days of receipt. The time for treatment is at the discretion of the patient and provider.

Delta Dental: For fee-for-service patients, specialty care referrals are not required and payments to specialists are processed the same as for general dentists. In 2009, the average time for processing predeterminations was eight days. For DHMO enrollees, specialists were paid for preauthorized specialty care within an average of six business days of claim submission.

Dental Health Services: Emergency referrals are processed immediately. In a non-emergency situation, referrals are processed within one to two weeks. Claims are paid within two to three weeks.

Golden West: The general dentist provides a real-time referral to the specialist. Plan approval is not required.

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.

Health Net Dental: The average turnaround time in processing a non-emergency referral is 48 hours and then seven to 10 business days for the EOB to be received by the member. Once the claim is submitted by the specialist, our average turnaround time in processing is 10 business days of receipt and then seven to 10 business days for specialists to receive payment in the mail. If claim was sent electronically, it will be sooner.

HumanaDental: Most HumanaDental 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 2008, 85% of claims and 97.4% referrals were processed within 14 calendar days.

MetLife: For Dental HMO, standard referrals are processed in an
average of five business days for member notification and 14 business days for payment to the provider.

Securian Dental: No referral is required.

United Concordia Dental: All referrals are immediately effective. The member is instructed to provide the referral to the specialist at the time of service and the specialist files the referral with the claim. All claims, including specialist claims, mailed to United Concordia Dental are usually processed within 14 days. Claims filed electronically through Speed eClaim are processed for payment immediately unless a review of an x-ray or other documentation is required.

Western Dental: Emergency referrals are handled within 24-hours.
The turnaround for non-emergency referrals is three business days. Specialists can expect payment in 10 business days for clean claims.

24. 
If you limit services with an annual or lifetime maximum, what does the maximum dollar amount allowed refer to?

Aetna: The total amount Aetna will pay for covered benefits.

Aflac: The annual maximum refers to the maximum amount of benefits that may be received within a policy year per covered person. Annual maximums do not apply to wellness and X-ray benefits.

BEN-E-LECT: The maximum dollar and lifetime maximum refers to all
services and procedures unless specified otherwise by benefit.

BEST Life: Lifetime maximum applies to orthodontia benefits. BEST
Life offers multiple choices of calendar year maximums for preventive, basic and major procedures.

CIGNA: For the DHMO: There is no annual or lifetime maximum. For
the DPPO/DEPO/Dental indemnity: The maximum dollar amount refers to the maximum amount payable by CIGNA for covered services rendered.

Dearborn National: As a general rule, lifetime maximums usually only apply to orthodontic services. For our PPO program, annual maximums are applied each year, which includes every service outside of orthodontia. For our DHMO program, annual limits apply only to treatment by a dental specialist.

Delta Dental: Under the fee-for-service plans, the maximum dollar amount refers to the maximum dollar amount paid by the plan. Our DHMO plans do not have annual or lifetime maximums.

Dental Health Services: The majority of our prepaid plan offerings have no annual dollar maximums, although this option is available by client request. PPO plan annual maximums range from $500 to $2,000.

Golden West: The maximum dollar amount is the total amount paid by the plan.

Guardian: 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. With Preventive Advantage, only basic and major services count toward the annual maximum. We also offer an option to cover cleaning after the maximum is reached.

Health Net Dental: The maximum dollar amount is the total amount the plan will pay for covered benefits.

Humana Dental: Annual maximum refers to the maximum amount
paid annually for services, excluding orthodontia. Orthodontic treatment has a lifetime maximum.

MetLife: For the dental PPO, maximums affect only the total annual
reimbursement amount available under a plan to an individual or family. It does not limit access to our negotiated fees for services after the maximum is exceeded.* For the Dental HMO, there are no calendar or lifetime maximums.

Principal Financial Group: The maximum dollar amount refers to benefits paid.

Securian Dental: The annual and lifetime maximum refer to the
maximum dollar amounts we will pay for covered services in a calendar year (annual maximum) or over the coverage lifetime (lifetime maximum). Our plans generally include an annual maximum for non-orthodontic covered services and a separate lifetime maximum for orthodontia.

United Concordia Dental: DHMO plans do not have annual or lifetime maximums. PPO plan annual and lifetime maximums vary by benefit plan and refer to the total amount paid in benefits byUnited Concordia Dental annually or over the member’s lifetime.

Western Dental: The Series 7 DMO plans do not have an annual or
lifetime maximum.

25. 
How and when do you provide eligibility information to your dental offices? How can you ensure that your offices will provide services to a member if they are not on the eligibility listing and it is after regular plan hours?

Aetna: Eligibility is available to our providers 24/7 by calling our automated telephone inquiry system or by accessing the online eligibility roster. DMO providers receive eligibility rosters the first week of each month.

Aflac: Providers may verify eligibility online or by calling our Customer Service Center. We do not require pre-qualification for treatment.

BEN-E-LECT: Our Interactive Voice Response (IVR) system will provide eligibility 24/7. Our pre-paid product will provide services upon collecting information from the member. This information will be transferred to our system electronically.

Best Life: Providers can use BEST Life’s fax back eligibility system to determine if a member is eligible, outside of normal business hours. Offices routinely check eligibility prior to appointments and have a process in place for dealing with emergency situations.

CIGNA: Dentists can view eligibility information in real time by visiting our secure website for health care professionals (24/7). In addition, we send eligibility information to our DHMO general dentists on a monthly basis. The general dentist can also call the plan for automated verification for an individual who is assigned to a particular office but is not on the eligibility list. This automated system will fax the dentist a written confirmation of eligibility. There is no eligibility listing given to DPPO dentists as people can seek treatment from any DPPO network dentist at any time. If a DPPO dentist wants to verify an individual’s participation in the plan, they can check the secure website or call our toll-free number.

Dearborn National: For our PPO program, providers can use our 24 hour, seven day a week IVR phone response system or call Customer Service during regular business hours. For our DHMO program, providers can access member eligibility online at anytime.

Delta Dental: Dental offices can verify eligibility by contacting Delta Dental via our website, calling our automated information line or speaking with a customer services representative. Under the fee-for-service plans, a patient who is not shown as eligible may be asked to pay the bill up front. The dental office would be responsible for refunding the patient their overpayment after receiving Delta Dental payment. Under the DHMO plans, in addition to verifying eligibility as listed above, network dentists also receive eligibility lists at the beginning of each month. If an enrollee is not contained in Delta Dental’s eligibility database and claims to be eligible for benefits, Delta Dental contacts the client or the client’s benefit administrator to verify eligibility. If the eligibility verification is for an enrollee who has urgent or emergency needs, our customer service representatives will extend an urgent care authorization.

Dental Health Services: Participating dental offices get eligibility rosters twice a month. If immediate eligibility is needed at any time, the dental office can call our 24-hour automated eligibility verification system or check eligibility online through our website.

Golden West: Eligibility is provided on the first week of the month to
the DHMO providers. Eligibility lists are available in electronic format if the dental office selects this method of notification. A customer service representative can also phone, email or fax in member eligibility. The plan maintains a 24/7 emergency phone number for after-hour emergencies.

Guardian: We do not provide eligibility lists for the PPO plan. Dentists can use our online self-service website, GuardianAnytime.com or call our toll-free line and receive a faxed verification of benefits from 3:00 a.m. to 8:00 p.m., Monday through Friday and from 3:00 a.m. to 1:00 p.m. on Saturday, Pacific Time. Eligibility rosters for the DHMO plan are provided to the offices twice a month, at the first of the month and the 10th of the month. Dental offices may also call our Member Services Department from 8:00 am to 5:00 pm Monday through Friday.

Health Net Dental: Our DHMO dentists receive a monthly updated eligibility list that includes member name, member status (active, dropped, suspended or transferred), member ID number, dependent names and eligibility status, fee schedule code, group number and capitation amount, if applicable.  DPPO dentists do not receive an eligibility roster since members are not required to select a primary care general dentist. Members would simply choose any network dentist (or non-participating dentist, if they desire) and schedule an appointment.  DPPO and DHMO dentists can verify eligibility information via our interactive voice response system and Website, which are both accessible 24-hours a day, seven days a week. Because the IVR and Web site are available 24/7 eligibility can be verified anytime of the day regardless of whether the need occurs during business hours.

HumanaDental: Participating offices are encouraged to check eligibility before providing treatment. They can verify members and benefits by calling our toll-free customer service line or through our automated information line to get 24 hour-a-day, seven-day-a week eligibility verification.

MetLife: For Dental PPO and Dental HMO, MetLife has developed a multi-channel technology platform for customer service inquiries including Web, fax, or phone. Through dedicated, real-time* channels, dentists have access to the same plan information provided to employees at the time of service. Dental offices do have access to dedicated online and automated phone system benefit information services to verify eligibility and plan details at any time. Additionally, Dental HMO, eligibility data is forwarded once a month to each participating dentist.
* Transactions are processed in “real-time” except when the systems are undergoing scheduled or unscheduled maintenance or interruption.

Securian Dental: Dental offices can use a toll-free number to call customer service to verify eligibility and benefits. Dental offices can also access www.securiandental.com to verify eligibility.

United Concordia: Dentists can access member eligibility and benefit information online, or toll-free using United Concordia Dental’s IVR system. DHMO providers also receive printed eligibility rosters once per month.

Western Dental: Western Dental provides eligibility listings to our Staff Model Offices electronically and printed eligibility listings to our IPA Providers. This information is updated on the 1st and 15th of each month. For members who are not on the eligibility listing, we offer guaranteed capitation to our network of providers.

26. 
How do you handle early termination of coverage when a member is still in the middle of orthodontic treatment?

Aetna: Quarterly claim payments cease upon the member termination.

Aflac: Benefits will cease upon termination of coverage.

BEN-E-LECT: Payment for benefits will cease at the end of the month for which the termination became effective.

BEST Life: Coverage terminates at the end of the month in which a member is no longer eligible.

CIGNA: Individuals whose plans are ending are covered for services through the end of the month of their termination.

Dearborn National: An eligible expense is incurred when an episode of treatment is initiated prior to the termination of the plan. Covered services would be consistent with the benefit plan and could include such services as root canals, crowns and dentures. The amount of benefit for these services mentioned would be covered if the member leaves the plan. Actual coverage would be consistent with the benefit percentages and allowable charges that were in effect prior to termination. Orthodontia treatment in progress is handled differently, as the case is completed according to the number of months of treatment remaining.

Delta Dental: Delta Dental’s obligation to pay toward orthodontic treatment terminates following the date the enrollee loses eligibility or upon termination of the client’s contract.

Dental Health Services: If a member’s coverage is terminated in the middle of orthodontic treatment, we encourage the member to participate in a COBRA individual plan that will allow the member to retain orthodontic benefits. If the member chooses not to maintain their coverage, the dental office can prorate any additional treatment fees. The member would then only be responsible for the prorated amount of the full treatment cost.

Golden West: Coverage terminates at the end of the month in which a member is no longer eligible unless the member chooses to continue or maintain 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 time 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 if the member chooses to continue or maintain coverage.

Health Net Dental: Upon termination of coverage, we will pay for orthodontic cases in progress on a prorated basis up to the last effective date of coverage. Benefits are no longer payable after the member terminates and are the responsibility of the member and/or the new dental carrier.

HumanaDental: HumanaDental will prorate to provide the appropriate amount given during the time the member was in the plan.

MetLife: Benefit consideration for orthodontic treatment will cease
within the month that coverage terminates unless the participant obtains continuation of coverage, in which case benefits would continue as long as coverage remains in effect.

Principal Financial Group: On individual terminations, some of our plans allow for extended benefits that provide one month of additional coverage.

Securian Dental: Benefits are paid based on the services received while the member was covered by Securian Dental.

United Concordia Dental: The extension of orthodontic coverage for DHMO and PPO plans is 60 days if payments are being made monthly. However, if payments are being made on a quarterly basis, coverage will be extended to the end of the quarter in progress or 60 days, whichever is later.

Western Dental: Western Dental has designed a termination clause to protect the member. The member does not incur any additional fees for the early termination of a provider.

27. 
How do you handle the additional cost of OSHA required infection control in your participating offices?

Aetna: We consider these costs to be part of doing business.

Aflac: Since Aflac dental doesn’t have network requirements; policy holders can choose any dentist without restriction. It is the responsibility of the each individual dentist to meet OSHA requirements.

CIGNA: Typically, dentists include these costs into their overhead and we do not allow dentists to charge for this separately. For our DHMO plans, we pay an encounter fee to the dentist to help offset their added cost for OSHA-required infection control.

Dearborn National: Network providers are responsible for the additional costs of OSHA required infection control, with no cost being passed on to our members.

Delta Dental: The cost is included in regular dental office overhead. Network dentists are not contractually allowed to charge Delta Dental or its enrollees a sterilization/infection control fee.

Dental Health Services: The combination of member co-payments, supplemental co-payments, and capitation is designed to help cover costs associated with operating a dental office including necessary additional costs such as OSHA required infection control measures.

Golden West: OSHA costs are the responsibility of the provider.

Guardian: Most dentists have incorporated the cost of OSHA requirements into the fees for services and do not charge separately. If it is the office policy to charge separately for OSHA, we do not restrict or limit the fee as long as all patients, not just the PPO patients, are charged. Since there is no CDT/ADA code for OSHA, Guardian plans do not cover such charges. Also, we do not allow participating DHMO dental offices to charge additional fees for this.

Health Net Dental: OSHA-required infection control procedures are not eligible for payment. It is industry standard to implement OSHA compliant infection control standards for all equipment, facilities and staff without a standalone fee and/or reimbursement. For those dentists who do charge a separate fee, payment is the responsibility of the patient, although a Maximum Allowable Charge (MAC) is established.

HumanaDental: Most offices have incorporated the cost of OSHA required infection control in their overall service charges. These costs would be reflected in the data used to compile fee schedules. It’s not usually a separate billable expense.

MetLife: Most dentists include these charges as part of their general overhead expenses, which, in turn, are part of the fees submitted to MetLife and SafeGuard. MetLife and SafeGuard use these fees as the basis for reasonable and customary data and/or for determining Dental PPO or dental HMO provider fee schedules, as appropriate.

Securian Dental: The dentist must be in compliance with OSHA required standards including:
1. 
Meeting OSHA guidelines for hazardous material disposal including sharps.
2. 
Meeting all state and local requirements for safety and health. The participating office would absorb any costs associated with fulfilling this requirement.
United Concordia Dental: Participating dental offices include steril-
ization costs in their service fees. In turn, United Concordia uses
these fees to determine our maximum allowable charge (MAC) and fee schedules. Through a partnership with an outside vendor, we offer participating dental offices access to discounted sterilization monitoring services.
Western Dental: Western Dental handles
the additional cost of infec-
tion control in its rates and does not charge a co-payment.

28. Do you provide utilization data to your clients and brokers?

Aetna: Yes.

Aflac: Since our products are individually issued, this is not applicable.

BEN-E-LECT: Yes, all data is provided at plan renewal and may be provided throughout the year by request.

CIGNA: Yes, we can report group utilization data to our clients on an annual basis at no charge. For more frequent reporting, additional charges may apply.

Dearborn National: On large self-funded groups, utilization reports can be generated, pending what is requested and HIPAA compliance rules. For DHMO, claims experience and utilization information is not always reported back to Dearborn National, since a claims submission is not required for the providers monthly capitation payment.

Delta Dental: Delta Dental provides standard utilization reports to clients and brokers on an annual basis upon request.

Dental Health Services: We provide a wide range of utilization reporting, including treatment access, specialty claims activity, and member service call activity on client or broker request.

Golden West: Yes, utilization data is available to groups and brokers upon request.

Guardian: Our standard reports are available monthly, quarterly or annually, and include the following detail: (1) dental plan summary, (2) monthly claims review, (3) cost management, (4) top 25 CDT codes by paid amount, (5) top 25 CDT codes by frequency, (6) benefits category claims comparison, (7) network overview, (8) out-of-network submitted charge comparison, and (9) claims by membership type.

Health Net Dental: Yes, we will provide utilization data upon request for large groups.

HumanaDental: Yes, on request and within the boundaries permitted by HIPAA.

MetLife: Brokers are provided utilization data, if requested, as part of a proposal situation. Clients have online access to their utilization data or can be provided upon request. (Additional note: International dental Travel Assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife, and the services they provide are separate and apart from the benefits provided by MetLife. Referrals are not available in all areas.)

Principal Financial Group: Yes, based upon the request of the client and/or broker.

Securian Dental: Yes, we can provide this information to individually rated employer groups upon request.

United Concordia Dental: Yes, appropriate
utilization reporting is available to clients and brokers.
Western Dental: Yes, utilization data can be
provided on request to clients and brokers for large accounts.

29. 
Please provide contact infor-mation for your company:

Aflac: Visit aflacforbrokers.com,
call 888-861-0251 or
send an e-mail to
brokerrelations@aflac.com to
learn more about Aflac.

BEST Life: 800-210-BEST
fax 949.553.0883
www.besthealthplans.com;
info@bestlife.com

Dental Health Services:
3833 Atlantic Avenue
Long Beach, CA 90807
888.459.3314
www.dentalhealthservices.com\

Guardian Life Insurance Company:
Joe Stefano, director, All of Southern/
Central California & Phoenix
jstefano@glic.com,
800-662-6464,
direct line: 949-885-1720,
fax 949-453-9919
Arthur Stern, regional manager,                Los Angeles District Office
astern@glic.com,
800-225-3399,
direct line 310-765-2201,
fax 310-312-3371
Gregg Holdgrafer, regional manager,
San Diego District Office
gholdgra@glic.com, 800-769-6759,
direct line 619-881-3502, fax 619-296-3912
James Hill, regional manager, San Francisco District Office
jhill@glic.com, 800-832-9555, direct line 415-490-4413, fax 415.788.4412
Chris Anderson, regional manager, Sacramento District Office
canderso@glic.com

MetLife: David Heil
regional director, Northern California
1333 North California Blvd, Suite 170
Walnut Creek, CA 94596
925-658-1102
dheil@metlife.com
Jason Ackermann
Regional Director, Southern California
1 Park Plaza, Suite 1100
Irvine, CA 92614
949-471-2312
jackermann@metlife.com
The Principal Financial Group: Theresa McConeghey
dental product director
mcconeghey.theresa@principal.com
711 High Street
Des Moines, IA 50392
www.principal.com