1. What types of plans do you offer?
Anthem Blue Cross: Anthem Blue Cross, the trade name of Blue Cross of California, and Anthem Blue Cross Life and Health Insurance Company, independent licensees of the Blue Cross Association, offer a comprehensive line-up of dental plans and products that include: PPOs and DHMOs for individuals, small groups, large groups and national accounts. We offer voluntary dental plans for small, large, and national groups. For large customers there is added flexibility for custom fully-insured and/or administrative services only (ASO) plans.
Delta Dental: Managed fee-for-service, PPO, and DHMO group dental plans; individual DHMO dental plans and group HMO vision plans. We also offer ACA-compliant small group and individual dental benefits in 38 state and federally administered exchanges including the District of Columbia. In 2017, we are covering over 226,000 lives in these exchanges as a stand-alone dental plan, and just over 470,000 enrollees as the dental partner for about 15 health plans around the country. This required us to design pediatric and family dental plans based on different sets of rules for the federal and state exchanges, for stand-alone versus bundled scenarios, and for differing market conditions.
Dental Health Services: Dental Health Services offers high-quality, affordable prepaid (DHMO) dental benefit solutions for large and small employer groups and individuals. Other plans are also available, including PPO, EPO, indemnity (reimbursement) products for groups of all sizes, and ASO services for self-funded groups.
Humana: In California, PPO, prepaid/DHMO, traditional preferred, and preventive plus plans. These plans are available on a voluntary or employer-sponsored basis.
Liberty Dental: PPO, DHMO, Individual DHMO, Individual and SHOP DHMO Exchange plans
LifeMap: PPO and DHMO
National General Accident & Health: We offer fixed indemnity dental plans. These plans provide a set cash reimbursement to the member for specific services rendered. An optional additional benefit is a dental/vision savings card to take those insurance dollars even further and get member pricing from retail to wholesale rates within the participating providers.
Premier Access Insurance Company: Premier offers an array of plan options to meet the needs of employers and their employees. Dental PPO, prepaid/DHMO, and indemnity plans are available on a voluntary or employer-sponsored basis. Dual and triple choice, monthly switch (between a DHMO and PPO), and administrative services only plans are also available. We specialize in customized plans for all different-sized groups based on the needs and price points of the employers and employees.
United Concordia: United Concordia offers flexible fully insured preferred provider organizations (PPOs), EPO, POS and dental health maintenance organizations (DHMOs) plans. ASO funding arrangements are available based on client size. Most plans are offered on an employer-sponsored or voluntary basis.
Western Dental: Western Dental offers traditional DHMO plans that range from little to no copay plans to higher copay plans at a minimal monthly premium. We have a unique mixed-model provider panel comprised of (a) contracted independent, general dentist and specialists, along with (b) Western Dental employee dentist and specialists, who work in the company-owned Western Dental Centers. Western Dental currently operates general dentistry and orthodontic offices throughout CA, AZ, NV & TX.
2. How do plans you offer for the individual and/or small group compare in rates and benefits to the large-group plans?
Anthem Blue Cross: There are different underwriting considerations for each business segment depending on the product offered. With our Dental Prime and Dental Complete plans, both small and large groups can customize benefits to fit their employees’ needs. For individual plans, benefits are structured to meet individual oral health needs with affordability. Overall pricing is comparable between small group and individual policies with similar coverage.
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: Dental Health Services works with its group clients on customizing dental benefit solutions that meet their needs. All individual plans offer the same high-quality benefits and services at competitive rates.
Humana: We offer flexible plan designs with a range of deductibles, co-payments, and out-of-pocket expense limits to meet the needs of small to large groups. We also offer large groups the additional flexibility to customize plan options. All our dental plans provide employees with incentives for preventive dental care, which promotes their overall health. Customers who see dentists participating in our dental PPO network receive deep discounts. Humana does not offer individual dental plans in California.
Liberty Dental: Individual products are limited to exchange and limited DHMO plans. All standard plans are available to both small or large groups markets. Pricing varies for large group which is experience rated versus small group rating done through a pool.
LifeMap: Benefit designs differ; we offer richer plans to larger groups than small group and individual.
Premier Access Insurance Company: We offer the same plan options to small group employers as to large employers.
National General Accident & Health: The rates for the dental indemnity product are comparable if not slightly lower than a traditional plan offered through a group chassis. The ‘cash dental’ plan- as ours is -also takes a less traditional approach but the net effect of the benefits tends to work out the same. Plans range in cost from $15.50 to $145.10 per month.
United Concordia: While larger clients have more flexibility in customizing benefit options than smaller clients, United Concordia offers an array of standard client products and options that provide small businesses with cost-effective, quality choices. To keep the small business client premiums comparable to those found in larger clients, slightly higher deductibles, lower coinsurance percentages and lower maximums are more commonplace within this market segment.
Western Dental: Our individual and small group rates are marginally higher for standard benefit plans. Customized benefits plans are available for large groups. However, our underwriting guidelines can be adjusted on a case by case basis to ensure that plans and rates are competitive.
3. What have been the most recent changes in your plan(s)?
Anthem Blue Cross: Our current suite of dental products include DentalNet DHMO and Dental Prime and Dental Complete products, which include modernized benefit designs, lower premiums, and a more robust dentist network locally and nationally. These plans include benefits, such as dental implants, annual maximum carryover, composite fillings on all teeth, annual maximums up to $5,000 and a carry-in feature for members who have a roll-over bank with another carrier and want to keep those funds when switching to Anthem. Plus, there are more options for out-of-network reimbursement, including the 90th percentile of FAIR Health. Voluntary plans are available with a minimum of five enrolled employees. We also offer an expanded network of participating providers in Mexico with more than 74 dental locations, with 62 general dentists and 22 dental specialists (endodontists, periodontists, oral surgeons, orthodontists and pedodontists).
For 2017, we continue to invest in our clinical integration story Anthem Whole Health Connection. Unique to the market, it works across all products, medical, dental, vision, life and disability offering an integrated, seamless solution to connected care. Pairing clinical programs and provider access to patient information, Anthem Whole Health Connection offers additional dental benefits based on chronic medical conditions automatically – no hassle. With our Time Well Spent program, and automated treatment reminders, our customers can be assured their members receive the most from their dental benefits.
Delta Dental: Delta Dental enrollees benefit from cost estimating tools now available to them:
• Delta Dental’s Cost Estimator tool has replaced our old Fee Finder tool. The goal of Cost Estimator is to provide more transparency about an enrollee’s out-of-pocket costs, and to encourage PPO network utilization by comparing costs for PPO and Premier providers.
• Cost Estimator (enterprise developed) – Delta Dental offers an advanced version of the cost estimator tool that:
• Provides personalized estimate (based on a 5-digit ZIP code) for an entire dental visit, not just a single procedure
• Calculates enrollee’s share based on current benefits (i.e., eligibility, deductibles, maximums), offering most accurate out-of-pocket cost estimate
• Is visit-based, not procedure-based; most common procedures grouped into typical visits; provides a link to the standard version, which lists more options
This feature is available to at no additional cost to all fully insured groups as well as self-funded clients who elect to go paperless. All other self-funded clients can receive this feature at an added cost.
Dental Health Services: Dental Health Services now offers dental implants as a covered benefit. Specialized crowns and upgrades are also now available. The company also covers all the most recent ADA Code changes to keep the plans current to offer extensive coverage on each of its plans.
Humana: Humana is the only dental PPO plan in the market to offer a plan with an unlimited annual maximum. For the first time, employers can provide a true dental insurance plan for their employees. Plans in our new generation of products are available as voluntary plans, and to groups with as few as two employees.
All our plans offer an extended maximum benefit where members receive 30 percent coinsurance on services rendered after they reach their annual maximum (implants and orthodontia excluded). It’s important to note that because benefits never reach a maximum, network providers must continue to honor the network discounts, which are among the deepest in the market. This results in members paying as little as 30 percent of retail, depending upon the area of the state where they reside.
In addition, we offer open enrollment assistance, orthodontia benefits, and no waiting periods for major services for voluntary groups with 10 or more enrolled. Additional deductible choices, implant coverage, and acrylic filling coverage are also offered. Due to the connection between oral health and overall health, we have added – at no additional cost – oral cancer screenings to all of our products, excluding DHMO/prepaid plans, as well as four periodontal cleanings per year in addition to the two regular cleanings.
Liberty Dental: Liberty has updated all plans to be CDT 2017 compliant
LifeMap: Additional flexibility
National General Accident & Health: Based on valued feedback, we have provided an option to add on a $3 Network Savings Card at point of sale. This enhancement creates the ability for a member to maximize savings by using a PPO dentist, in addition, includes access to vision benefits.
Premier Access Insurance Company: We’ve introduced enhanced PPO plan designs that offer brokers and employers more flexibility and control over the plan design and opportunities for savings using our unique tiered network combined with our tiered benefit design. Members also have the option to enroll in a monthly election plan allowing them to switch between DHMO and PPO.
United Concordia: In 2016 we moved space maintainers from Class II to Class I due to industry trends. We also refiled our implant rider to include repair codes and cone beams going forward. Additionally, in 2016 we launched both our Concordia EPO and Triple Access POS products in California.
Western Dental: Our Series 7 plans increases the number of covered procedures to include the availability of cosmetic alternatives and more orthodontic options for children and adults. Our dental benefit designs are an effective way to reduce the rapidly increasing cost of dental benefits while improving access to quality of care. Our approach to dental benefit design delivers affordable dental plans that can meet your client needs and their budget. Additional significant benefits and advantages selecting Western Dental Office are:
• Flexibility in allowing members to visit any Western Dental Center without the worry of being appointed to a provider
• Electronic Health Records (EHR)
• Digital Intra-Oral Cameras
• Self Service Kiosk
• Centralized Electronic Appointment System
• 3M Digital CAD CAM machines for advanced digital impressions
• iPads for customer surveys following a customer visit
4. Can an insured use their own dentist even if they are not on your participation list?
Anthem Blue Cross: Yes, they can with all of our PPO plans. Members who choose a provider within the Dental Prime or Dental Complete network get the most savings on their dental costs. However, members can choose a non-Dental Prime or Complete dentist, but their out-of-pocket costs may be higher. The DentalNet DHMO plans are in-network only (excluding emergency care).
Delta Dental: Delta Dental Premier enrollees can visit any licensed dentist for care, although there are advantages to visiting one of more than 50,000 dentist locations for Delta Dental Premier dentists in California. Enrollees can go to any dentist, but they are only guaranteed to get in-network benefits and avoid balance billing when visiting a Delta Dental dentist. Delta Dental PPO enrollees also have freedom of choice, but can benefit from the protections associated with selecting one of more than 41,000 dentist locations for Delta Dental PPO dentists in California. PPO enrollees have access to Delta Dental PPO and Premier dentist networks with different levels of savings. DHMO enrollees must use a participating general dentist or approved specialist, except for emergency care. There are more than 6,000 dentist facilities for DeltaCare USA in California.
Dental Health Services: Members of the Dental Health Services’ prepaid (DHMO) and EPO plans choose their dentist from the company’s exclusive Quality Assured network. Participating dentists on all prepaid (DHMO) plan networks are subjected to credentialing, background checks and a 107-point quality checklist. They are also regularly monitored by the company’s Professional Services staff, and plan benefits are only available at these Quality Assured dentists. The company’s PPO and reimbursement plans allow members to receive treatment from any dentist.
Humana: PPO members can visit the dentists of their choice. Out-of-pocket savings are greater when members visit participating network dentists. DHMO members must select a participating dentist.
Liberty Dental: Dependent on the type of plan, such as a PPO, a member may seek services by a non-participating dentist but may also incur additional costs. For all DHMO plans, there is no coverage for out-of-network services, with the exception of limited dental emergency services. However, Liberty is always open to member nominations and is constantly developing and growing our network.
National General Accident & Health: Yes. Since this is a fixed indemnity dental plan, there are no networks. However, to maximize savings during a wait period, a member might consider using an in-network provider if they selected our Network Savings Card. This provides an average savings of 43 percent on dental care — on top of the cash benefits from our plan.
Premier Access Insurance Company: Members covered under our PPO plans can visit any dentist; however, benefits may be paid at a lower coinsurance rate for non-participating dentists. DHMO members must choose a participating primary care dentist.
United Concordia: In most cases, yes. If a member has one of our PPO products, they may utilize any licensed provider. If a member is utilizing our Concordia EPO or DHMO products, they would not receive benefits for seeking treatment from an out of network provider.
Western Dental: Through the DHMO plans, the member must use a dentist who participates in our network in order to have coverage. A member can nominate a dental office by contacting our Provider Relations Department at 1-800-511-8111.
5. How many provider locations do you have?
Anthem Blue Cross: We’ve had a lot of growth in our dental networks the last couple of years. Dental Complete members have access to more than 18,000 unique dentists and nearly 47,000 access points in California alone — and nearly 125,000 unique dentists at nearly 372,000 access points nationwide. We have doubled the size of our network nationwide since 2011. Through the efforts of a Dental Intermediary, we have added approximately 70 dental locations in Mexico along the CA border that our members can access as in-network for regular dental services. Our Dental Net DHMO network includes nearly 17,000 provider locations in California to choose from. Additionally, all Anthem dental members have access to our international emergency dentist network, with 24/7 assistance with locating an English-speaking provider for dental emergencies in approximately 100 countries worldwide. Services received through this program do not count toward the member’s annual maximum if their plan has one.
Delta Dental: Our networks offer access to more than 50,000 dentist locations for Delta Dental Premier, more than 41,000 dentist locations for Delta Dental PPO and more than 6,000 dentist facilities for DeltaCare USA in California.
Dental Health Services: Dental Health Services’ exclusive quality assured dental network consists of 950 general practice offices with 4,500 participating dentists and an additional 2,000 specialists.
Humana: Nationally, Humana has more than 290,000 dental PPO provider locations. In California, we have approximately 30,000 dental PPO provider locations and more than 18,000 DHMO provider locations.
Liberty Dental: DHMO Select (Office Assignment required)– 1,497; DHMO Choice ( No assignment required, members must seek care at a DHMO Choice contracted provider office) – 2,003; PPO Nationwide
LifeMap: The best way we can answer is to give unique provider count: 13,000
National General Accident & Health: We are a hybrid of sorts due to the platform of fixed indemnity and optional access to our Careington Maximum Care Dental Network — a national network of more than 200,000 dental practices.
Premier Access Insurance Company: Our PPO networks offer access to more than 56,000 dentist locations nationwide, with more than 12,000 in California. Our DHMO network in California has more than 3,300 dentist locations including specialists.
United Concordia: To support our diverse product portfolio consisting of fee-for-service, DHMOs and PPOs, we maintain some of the largest dentist networks in the nation. Our largest network provides access to 98,523 dentists at more than 343,842 access points. In California alone, we have 15,135 providers at 44,233 access points. Our DHMO network includes more than 2,396 primary dental offices and almost 1,667 specialists nationwide, with over 1,566 primary dental offices and 825 specialists in California. (All data is as of 12/31/16. Pulled from the Network Summation reports on the Reporting SharePoint site. Utilized the Advantage Plus 2.0, Concordia Plus PDO and Concordia Plus Specialist reports.)
Western Dental: We have over 4000 provider access points across the state of CA alone. This being a combination of both IPA and Western Dental locations.
6. What percentage of your network is closed to new enrollment? How many offices does this represent?
Anthem Blue Cross: Our Dental Prime and Dental Complete network model is open-access, and we do not contractually require providers to report on new-patient status. We have not heard reports of any members having issues with finding a participating dentist that is open to new patients.
Delta Dental: 0 percent. Under the PPO/Premier plans, enrollees are free to see any licensed dentist. Contracted dentists can close their practices to new patients but cannot close their practice exclusively to new Delta Dental patients; 2.96 percent of DHMO dental facilities are closed to new enrollment.
Dental Health Services: Although roughly 5 percent of participating dentists have been lost over the past 12 months, our overall network size has increased by 5 percent over the previous year. By focusing on seeking out only the most qualified dentists, the company improves accessibility and availability for members. The names and phone numbers of all offices are available upon request.
Humana: Under Humana’s dental 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. Approximately 97 percent of practices are open to new patients.
Liberty Dental: DHMO 4.74 percent for a total of 71 offices.
National General Accident & Health: None – the core plan is ‘go anywhere’. If the dental/vision savings card is selected, those providers are all available to new participants.
Premier Access Insurance Company: Less than 5 percent of the DHMO network is closed to new patients; this figure represents 159 general dentist locations.
United Concordia: Less than 1 percent, or 2,355 offices of our largest wholly owned network is closed to new enrollment. (Data pulled from the Table 898, Monthly Full Files as of 12/31/16.)
Western Dental: Turnover is about 3 percent for the past year. Yes, we will provide the names and phone numbers for 3 of these offices, if requested.
7. What is the time frame for processing a referral in terms of member notification and payment to the specialist?
Anthem Blue Cross: For PPO line of products, we do not require a referral for any dental members to see a dental specialist. Dental specialists submit dental claims directly to the plan and are paid in the same manner
as general dentists. More than 98 percent are processed in 14 days.
Delta Dental: For PPO and Premier patients, specialty care referrals are not required, and payments to specialists are processed the same as for general dentists. For DHMO enrollees, our standard turnaround time for processing specialty care preauthorization requests is five business days.
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 three weeks.
Humana: Humana’s dental 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 2016, 98.3 percent of clean claims were processed within 10 business days (14 calendar days).
Liberty Dental: Plans requiring specialty referral are typically processed within 14 calendar days of receipt, unless it is flagged as urgent. Payment to the specialist is processed the same as general dentist payment, typically within 30 days of receipt of the claim.
LifeMap: No referrals needed.
National General Accident & Health: This kind of transaction would be handled in the member services area in the same manner as regular treatment. So, as long as the services are deemed necessary and covered, benefits would be available as per the contract.
Premier Access Insurance Company: 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.
United Concordia: 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 are usually finalized within 14 to 30 calendar days of receipt of the paper claim. Claims filed electronically may be finalized in a shorter time frame compared to paper claims. Please also submit the referring provider information with the electronic claim. Payment for both paper claims and electronic claims is made during the weekly check writer cycle which occurs on Thursdays.
Western Dental: Dental Offices have the capabilities of emailing and emergency referrals which is handled within 24-hours. The standard turnaround time for non-emergency referral is three business days or less. Specialists can expect payment in 10 business days for clean claims.
8. How do you handle early termination of coverage when a member is still in the middle of orthodontic treatment?
Anthem Blue Cross: Orthodontic payments will cease if coverage is not
active at the time the payment is due.
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: [answer not provided.]
Humana: Humana will prorate to provide the appropriate amount given during the time the member was in the plan.
LifeMap: Coverage ends.
Liberty Dental: Payment for orthodontic treatment is pro-rated and paid on a monthly basis, should a member lose his/her coverage in the middle of treatment, future payments would cease and the member or the new carrier would be responsible for the remaining months of treatment.
National General Accident & Health: Not applicable to our coverage, as our plan does not provide such benefits.
Premier Access Insurance Company: If a member is undergoing orthodontic treatment and his or her Premier 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.
United Concordia: 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 a continuation fee which allows our members to continue their orthodontic care with the treating orthodontic office. The continuation fee is based on the completed months of treatment.
9. Does your plan have annual and lifetime maximums on dental coverage? If so, what are they?
Anthem Blue Cross: Our annual maximums vary from as little as $500 to as much as $5,000 dependent upon individual or group coverage and group size. Employers have a choice in annual maximum with more flexibility for large group customers to customize their annual maximum to meet their needs. For groups, we also offer our Carry-Over benefit feature allowing qualified members to boost their annual maximum by $250 each year up to an additional $1,000. We can also vary the annual maximum for members who visit a Dental Prime or Dental Complete dentists vs. a non-network dentist. Currently, lifetime limits are only imposed on child or child and adult orthodontia benefits. Lifetime maximums can range from $500 to as much as $3,000 or more dependent upon individual or group coverage and group size.
Delta Dental: Annual maximums for our Premier and PPO plans vary and, for group plans, are determined by the group purchaser; lifetime maximums apply only to certain procedures such as orthodontia (if covered by the plan). Under our DeltaCare USA DHMO, there are no annual plan maximums; lifetime maximum applies to orthodontia.
Dental Health Services: On prepaid (DHMO) plans there is no annual maximum. The company’s PPO/EPO plans feature annual maximums and lifetime orthodontic coverage.
Humana: We offer flexible plan designs with a range of annual maximums to meet the needs of small to large groups. We do not have lifetime maximums. We are the only dental plan in the market to offer an unlimited annual maximum.
Liberty Dental: PPO plans do include annual maximums that can vary by plan, lifetime maximums apply to orthodontic services. We do not impose any lifetime or annual maximums on our DHMO or individual plans.
LifeMap: Only annual. The maximum amount varies.
National General Accident & Health: Yes. The Basic Plan has a $500 maximum calendar year benefit; Intermediate is $1,000; and the Plus plan is $1,500. However, preventive benefits do not take away from this annual benefit (adding $150-200/annually in benefit, depending on plan level). Members can use their savings card on covered and non-covered services at any and all times of the coverage being in force.
Premier Access Insurance Company: Premier offers plan design flexibility allowing brokers and employers to custom design their dental benefits including unlimited annual or lifetime benefits. The most common annual benefit maximums are $1,000, $1,500, and $2,000.
United Concordia: All United Concordia PPO/EPO/POS Plans contain an annual max; several standard options exist for groups to select from: $500, $750, $1,000, $1,250, $1,500, $1,750, $2,000, $2,500, and $5,000. Orthodontic services are excluded from the annual maximum, but have a separate lifetime maximum. The standard amounts are: $1,000, $1,250, $1,500, and $2,000. Please note, fully credible, experience rated business does have the option of selecting non-standard amounts. DHMO plans do not contain an annual maximum standardly.
Western Dental: There are no lifetime or annual maximums on the DHMO plans. Members have a listed copayment based on the services received.
10. Does your plan have a deductible. If so, what is it?
Anthem Blue Cross: Deductibles can vary from as little as $0 to as much as $100 or more dependent upon individual or family coverage. Employers have a choice in deductible with more flexibility for large group customers to customize their annual maximum to meet their needs. We also offer large group customers a lifetime deductible option as an alternative to annual deductibles. A lifetime deductible can be a good fit for a customer who maintains coverage with Anthem for multiple years.
Delta Dental: Deductibles for our Premier and PPO plans vary and, for group plans, are determined by the group purchaser. Deductibles do not apply under our DeltaCare USA DHMO plans.
Dental Health Services: Prepaid (DHMO) plans have no deductibles. The company’s PPO/EPO plans have deductibles.
Humana: We offer flexible plan designs with a range of deductibles to meet the needs of small to large groups. The deductible is always waived for preventive care. We want to ensure there are no barriers to members receiving the necessary preventive care.
Liberty Dental: PPO plans may include a deductible per individual with a maximum of three per family on a calendar or plan year. DHMO and individual plan offerings do not impose any deductibles.
LifeMap: Yes, varies by plan. Ranging from $0 to $50 is standard.
National General Accident & Health: There are no deductibles.
Premier Access Insurance Company: Brokers and employers can custom design their dental benefits including plans with no deductible; the most common are $25 and $50.
United Concordia: The majority of our PPO/EPO/POS products do contain a deductible standardly, however $0 is a standard option. Additional standard options include (individual/family): $25/$75, $50/$150, $75/$225, and $100/$300. Please note, DHMO products do not have a deductible.
Western Dental: As a DHMO, Western Dental does not have deductibles.
11. What percentage of preventive care costs does your plan cover?
Anthem Blue Cross: Preventive care is standardly covered at 100% when using a Dental Prime or Dental Complete provider. Out-of-network coverage will vary based on plan selected but typically not less than 80 percent with additional flexibility for large group customers to customize the percent of costs covered.
Delta Dental: Percentages vary according to the plan.
Dental Health Services: Dental Health Services values preventive services. Most of the company’s plans feature no cost for preventive services.
Humana: Preventive care is always covered at 100 percent, unless a large group designs a custom plan. We encourage all employers to cover preventive to ensure there are no barriers to members receiving the necessary preventive care.
Liberty Dental: Preventive is covered at 100 percent for most plans, however plans may vary.
LifeMap: We offer several plan designs, but usually cover preventive at 100 percent.
National General Accident & Health: The member is reimbursed a select amount toward their preventive visit based on benefit level plan selected. For example, our ‘Plus’ plan offers $100 cash reimbursement toward preventive services.
Premier Access Insurance Company: Brokers and employers can set this coverage from 0 percent to 100 percent; the most common is 100 percent.
United Concordia: The vast majority of all UCD products cover preventive services at 100 percent. The exception to this would be a couple of products created to hit a low cost price point.
Western Dental Plan designs provide 100 percent on preventative care.
12. What percentage of root canal costs does your plan cover?
Anthem Blue Cross: Root canals are most commonly covered at 50-80 percent when using a Dental Prime or Dental Complete provider. Out-of-network coverage will vary based on plan selected but the most common percentage is 50 percent with additional flexibility for large group customers to customize the percent of costs covered.
Delta Dental: Percentages vary according to the plan.
Dental Health Services: Dental Health Services offers many variations to plan designs and varies the cost sharing for members on procedures. The company offers plans with very low cost sharing on root canals.
Humana: We offer flexible plan designs with a range of co-insurance percentages to meet the needs of small to large groups. A group can elect to have endodontic coverage in basic or major.
Liberty Dental: We have a wide array of plan designs and member cost sharing can vary to allow employers to select an option that fits best with their needs and capacity. Our DHMO and individual plans include set member copayments ranging from a $0 copayment to a $530 copayment depending on the type of root canal and difficulty level (i.e. specialty required). For PPO plans root canal, therapy is typically considered a type 2 (basic) procedure but can also be considered a Type 3 (major) service. Basic services on our PPO plans are most commonly covered at 80 percent and major services are typically covered at 50 percent.
LifeMap: We offer several plan designs, we usually cover root canals at 80 percent.
National General Accident & Health: According to our cost and transparency calendar, a molar root canal – for example – may cost $1,382. The plan cost is $707 with a network savings of $675 or a percentage savings of almost 50 percent.
Premier Access Insurance Company: Brokers and employers can set this coverage from 0 percent to 100 percent. The most common is either 50 percent or 80 percent.
United Concordia: Standardly this is covered between 50-80 percent, depending on the plan design.
Western Dental Plans provide coverage for root canal procedures as a listed benefit copayment. These copayments depend on the benefit plan design.
13. What percentage of crown costs does your plan cover?
Anthem Blue Cross: Crowns are most commonly covered at 50-80 percent when using a Dental Prime or Dental Complete provider. Out-of-network coverage will vary based on plan selected but most commonly covered at 50 percent with additional flexibility for large group customers to customize the percent of costs covered.
Delta Dental: Percentages vary according to the plan.
Dental Health Services: We offer many variations to plan designs, which vary the cost sharing for members on procedures. The company offers plans with very low cost sharing on crowns.
Humana: We offer flexible plan designs with a range of co-insurance percentages to meet the needs of small to large groups. Crowns are typically covered as part of major services.
Liberty Dental: We have a wide array of plan designs and member cost sharing can vary to allow employers to select an option that fits best with their needs and capacity. Our DHMO and individual plans include set member copayments ranging from a $0 copayment to a $530 copayment depending on the crown and elective upgrades. For PPO plans root canal therapy is typically considered a type 2 (basic) procedure, but can also be considered a Type 3 (major) service. Basic services on our PPO plans are most commonly covered at 80 percent and major services are typically covered at 50 percent.
LifeMap: We offer several plan designs, we usually cover crowns at 50 percent.
National General Accident & Health: The cash benefit for a crown ranges from $45 to $450. However, if the Careington Network is used – for example – the cost for a Crown (porcelain fused to noble metal) may cost $1,424. The plan cost is $726 with a network savings of $698 or a percentage savings of almost 50 percent.
Premier Access Insurance Company: Brokers and Employers can set this coverage from 0 percent to 100 percent. The most common is 50 percent.
United Concordia: Most frequently covered at 50 percent; but several products cover crowns at both higher and lower amounts.
Western Dental Plans provide coverage for crown as a listed benefit copayment. These copayment depend on the benefit plan design.
14. Do you provide dentist cost and quality transparency tools?
Anthem Blue Cross: Yes. Anthem Blue Cross offers all members Dental Prime and Dental Complete customers a Dental Health Assessment allowing them to answer questions about their mouth, teeth, and overall health and produces an individualized report they can share with their dentist for follow-up care. To help plan for needed care, Anthem Blue Cross also offers a Dental Cost Estimator allowing members to search for common procedures including exams, cleanings, x-rays, fillings or root canals and get an estimated cost within seconds. These tools are quick, easy, and convenient to use.
Delta Dental: Yes. A variety of tools are available to Delta Dental enrollees. On our website at deltadentalins.com, registered enrollees can access behind login our cost estimator tool, which estimates an enrollee’s approximate fee based on their eligibility, benefits, dentist and location information. At deltadental.com or via an app for Android and iOs, enrollees can access a cost estimator tool, which shows estimated costs as well as actual fees charged by a specific dentist(s).
Dental Health Services: Dental Health Services Prepaid (DHMO) plans offer a flat member copayment for all procedures. Regardless of what a dentist may charge in their practice, plan members only pay the set dollar amount listed in their schedule of covered benefits.
Humana: At this time, Humana’s website does not provide cost information for our dental products.
Liberty Dental: Liberty does not provide dentist cost and quality transparency tools at this time.
National General Accident & Health: Yes. If a member decides to use our Careington Network for specific services, they can go to: http://www.careington.com/ngahdsavings/. These resources provide a simplified way to determine costs of treatment.
Premier Access Insurance Company: Cost and quality tools for the website are in development. We do offer predetermination of benefits to members who request them through our phone-based customer service representatives.
United Concordia: Yes, we offer schedules of benefits (copay schedules), certificates of coverage and online tools for both members and dentists – My Dental Benefits for members and My Patients’ Benefits for dental offices. We also provide dental offices with a Dental Reference Guide and quarterly provide a newsletter, which are both available on our website.
Western Dental Plan uses Fair Health a national independent, nonprofit corporation to assist with transparency and cost. H