The Cal Broker 2019 Dental Survey

It’s that time of year again! California’s top dental providers offer updated info on their plans, provider networks and more!

Compiled by Thora Madden

  1. What types of plans do you offer?

Beam: Beam offers a wide range of fully customizable PPO options from preventive plans to benefits rich Ultra plans. Each plan comes with access to our nationwide network of over 335,000+ access points and includes Beam Perks, our smart electric toothbrush, paste and floss, delivered to each member’s door every six months.

Blue Shield: Blue Shield provides a wide range of affordable and comprehensive dental products to meet our clients’ needs. Our Dental PPO and HMO plans offer members a wide variety of plan designs and networks that fit their budget.

  • For individuals/families, we offer a unique dental PPO plan that provides member copayments instead of the usual coinsurance percentages. Our dental HMO plan offers comprehensive benefits with pre-determined member copayments. Finally, our Duo plan offers members dental and vision coverage at a single price. Our plans can be sold with medical plans or on a standalone basis.
  • For senior members, we offer two comprehensive dental PPO plans for Medicare supplement plan members. There is also a dental plus vision plan package option for Medicare supplement plan members.
  • For groups, some of our dental PPO and HMO plans are available on a contributory or voluntary basis, most can be sold with or without Blue Shield medical plans and are UCR- or MAC-based.

Delta Dental: Delta Dental offers managed fee-for service, PPO and DHMO dental plans for individuals and groups of all sizes. Our group plans are available for both employer-paid and voluntary premium contributions, and with a choice of fully insured or ASO funding options for fee-for-service plans. We also offer ACA-compliant small group and individual DHMO and PPO plans, Medicare Advantage, Medicaid and provide coverage to additional groups and individuals through our partnerships with various health plans across the country.

Guardian: Guardian offers an array of plan types and options to meet the needs of employers/employees and individuals/families. Employer plans can be customized according to needs and price points. Dental PPO, Managed Dental Care (Prepaid/DHMO), Indemnity, Dual and Triple Choice, Monthly Switch (between a DHMO and PPO), and Administrative Services Only Plans can be offered as voluntary, contributory, or on an employer-sponsored basis. Individuals/Families can buy direct from  Additionally, Guardian offers family and individual plans through its subsidiaries Premier Access and Access Dental on the Covered California exchange.

Humana: In California, Humana offers dental PPO, prepaid/DHMO, Traditional Preferred (TRP), and Preventive Plus plans. These plans are available on a voluntary or employer-sponsored basis.

National General: We offer fixed indemnity dental plans. These plans provide a set cash reimbursement to the member for specific services rendered. An optional additional benefit is a dental/vision savings card to take those insurance dollars even further and get member pricing from retail to wholesale rates within the participating providers.

Premier Access:  Premier Access offers a wide selection of plans to meet the needs of employers and their employees.  Dental PPO, Dental HMO, and Indemnity plans are available on an employer-sponsored or voluntary basis.  Dual and triple choice, monthly switch (between a DPPO and a DHM), and Administrative Services Only plans are available as well.  We specialize in customized plans for groups of all sizes based on the needs and price points of the employers and employees.

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

Beam: We specialize in pricing for small to mid-size businesses and offer unique savings opportunities for all of our clients. Each one of our dental plans comes with Beam Perks (our smart electric toothbrush, paste and floss) included automatically. Members use our brush and app together, and then clients can save up to 15% at renewal—just for brushing their teeth.

Blue Shield: There are different underwriting considerations for each business segment.  Our ability to customize offerings for groups with more than 300 employees typically results in lower rates and more choices to meet the employer’s needs.

  • Group PPO plans come in a wide range of deductibles and annual benefit maximums.
  • Our individual, family and Medicare Supplement dental PPO plans may vary in waiting periods, deductibles, and annual benefit maximums based on the plan selection.
  • All dental plans include generous benefits, competitive premiums, and strong California and national provider networks that are available to all members; we don’t differentiate our provider network for small groups or individual or family markets.

Delta Dental: We offer small businesses a wide range of dental benefits plans, many of which are often available only to larger groups. The majority of our small business plans are offered through a special program that evaluates risk on a pooled basis, helping to keep both rates and plan designs extremely competitive. Attractive features available through our small business plans include missing tooth coverage, composite (white) fillings on posterior teeth and coverage for all three phases of orthodontics for adults and children. While large groups often have the most flexibility in customizing plan options and obtaining rates that balance their experience and cost effectiveness, the range of benefits available through our Small Business Program make our plans particularly attractive to small group purchasers.

We have both DHMO and PPO off-exchange plans for individuals and families. Rates are especially affordable for plans that emphasize preventive care, and we offer more comprehensive plans that benefit major procedures as well. We also market plans designed to meet the needs of seniors, offering benefits most utilized by this particular population. The small business plans and individual plans that are available through the state and federal exchanges emphasize preventive care and coverage for the most commonly used services.

Guardian: Individuals and small group employers can choose from nearly similar plans as large groups with cost-reducing options. Individuals/families can buy direct from or on the exchange through Covered California.

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. Members who see dentists participating in our dental networks receive deep discounts.

Typically rates for large group clients are lower than small group, as the risk is spread out among a larger membership pool.

For individuals, Humana offers our Complete Dental plan, a comprehensive plan that offers broad preventive, basic, and major services coverage. This plan works well for those who may be recently retired or are moving off of a group dental plan. Complete Dental is a PPO plan, allowing members the flexibility to have coverage with in-network and out-of-network dentists.

National General: The rates for the dental indemnity product are comparable if not slightly lower than a traditional plan offered through a group chassis. The ‘cash dental’ plan- as ours is -also takes a less traditional approach but the net effect of the benefits tends to work out the same. Plans range in cost from $15.50 to $145.10 per month.

Premiere Access: Our standardized and customized plans for small group employers are the same as the ones we offer for large group employers.

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

Beam: Beam is using machine learning and AI to produce quotes and process claims which will lower costs of insurance for our partners uniquely.

Blue Shield: We are always looking to enhance our plans and provide valuable benefits to our members.

  • In 2020, for Large groups, we are introducing 14 new dental PPO plan to our portfolio which provide richer benefit options.
  • For Small groups, we are introducing 6 new dental PPO plans with richer benefits to our small group portfolio designed to fill in gaps in the benefit spectrum. We are also continuing to offer a 2- year rate guarantee.
  • For IFP, we are offering 2 new DPPO plans with a $2,000 annual maximum to our portfolio. One of these plans also offers ortho benefits up to a lifetime maximum of $1,500.
  • For Medicare Advantage we are expanding into full counties LA/OR/SB/RV.  Our optional dental DHMO plan rate decreased and our optional PPO dental rate increased
  • 10/01/19 MedSupp Optional PPO 1000 plan rate decreased and we changed the waiting period from 12 months to 6 months for major services.   For the MedSupp Specialty Duo we removed the 90 day waiting period for vision benefits.

In addition to new plan designs, all BSC plans include oral cancer screening coverage as a value-added benefit, which comes at no out-of-pocket cost to the member. We also offer enhanced dental services for pregnant women to all dental PPO plans. Pregnant women receive one additional routine adult prophylaxis, and/or one course (up to four quadrants) of periodontal scaling and root planing, and/or periodontal maintenance if warranted by a history of periodontal treatment. Treatment is payable at 100% of the allowable amount for in and out of network.

Delta Dental: Delta Dental continues to offer benefit procedures that we feel are trend setting. We have covered dental implants for many years and continually look for new technology and procedures to benefit our members. Recently, Delta Dental selected Amplifon Hearing Health Care and QualSight to offer commercial group enrollees access to preferred pricing on hearing aid and LASIK services.

Guardian: Guardian constantly develops innovative ideas in order to meet our customers’ needs. As the cost of college tuition continues to rise, Guardian helps our members and their families by offering the College Tuition Benefit®, a value-added benefit that helps them pay for college. Members enrolled in a Guardian plan, like dental, that includes the College Tuition Benefit® can earn 2,000 Tuition Reward® points annually, per product. Each tuition reward point equals $1 in tuition reduction; accumulated points can be used to pay up to one year’s tuition at one of more than 400 private colleges and universities across the nation. The benefit can be included with up to four lines of Guardian coverage with rewards increasing each year and with each line of coverage.

In addition, Guardian’s Administrative Services Only (ASO) option offers the same product features, network and claims processing as fully-insured. For those hesitant to move to ASO, we offer an innovative Level-Funded option that offers fixed monthly costs starting with a 105% aggregate stop loss and if claims are lower than expected, Guardian returns the entire surplus to the employer.

Humana: Recently we enhanced and expanded the coverage of our dental PPO and TRP plans to encourage members to get the care they need whenever they need it. These updates included:

  • Enhanced Preventive Care: Our new benefits include a wider array of preventive benefits covered at 100 percent, including additional periodontal cleanings, space maintainers for children, and oral cancer screenings for members 40 years of age and older.
  • Extended Annual Maximum: Members who reach their annual maximum no longer need to put off the care they need. As a standard benefit in all of our dental PPO and TRP plans, Humana offers an innovative plan design that provides a 30 percent coinsurance paid by Humana for preventive, basic, and/or major services after members meet their annual maximum.
  • Optional Unlimited Annual Maximum: Members can now receive care whenever they need it without the worry of reaching their annual maximum. With our Unlimited Annual Maximum, offered as an optional rider for an additional cost, the member’s coverage continues throughout the plan year, regardless of the total accumulated amounts paid. It takes into consideration only deductibles, coinsurance amounts, and standard limitations and exclusions.
  • Implants: While implants themselves can become a covered benefit through Humana’s dental PPO and TRP plans with an optional rider, now all implant-supported prosthodontics—such as crowns and dentures—are covered whether the group selects the implant rider or not.

National General: Our Dental plans can now easily be offered to groups through List Bill – no contribution or participation requirements.

Premiere Access: Our enhanced PPO plan designs offer brokers and employers more flexibility and control over their plan design and provide opportunities for savings using our unique tiered network combined with our tiered benefit design.  Members also have the option to enroll in a monthly election plan that allows them to switch between the DPPO and the DHMO.  Additionally, we have expanded our Premier Choice Network throughout the state giving more access to quality dentists at an increased discount.

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

Beam: Beam plan comes with great out-of-network coverage. Our plans come standard with 90th percentile UCR and is customizable based on the out-of-network coverage needs of an employer.

Blue Shield: Yes, both dental PPO plan members can choose to go to any dentist, although their benefits will be covered at a higher percentage when choosing a network dentist, with less out-of-pocket expense.

Delta Dental: Yes. Members can receive care from a non-contacted dentist. Delta Dental offers our members the choice of two provider networks, PPO and Premier. Member dentists in each network are contracted to fee allowances that are well below retail charges and cannot balance-bill the member above the contracted fee. They are also subject to quality assurance and utilization management provisions. Enrollees of these two plans can utilize any licensed dentist anywhere and are not subject to service area restrictions.

DeltaCare® USA (DHMO) enrollees must visit their selected general dentist or approved specialist to receive benefits, with the exception of emergency out-of-area care.

Guardian: Members covered under our PPO plans can visit any dentist; however, benefits may be paid at a lower coinsurance rate for non-participating dentists. Managed Dental Care/DHMO members must choose a participating primary care dentist.

Humana: Yes, dental PPO, TRP, and Preventive Plus members can visit the dentist of their choice; however, out-of-pocket savings are greater when members visit participating network dentists. DHMO members must select a participating dentist.

National General: Yes. Since this is a fixed indemnity dental plan, there are no networks. However, to maximize savings during a wait period, a member might consider using an in-network provider if they selected our Network Savings Card.  This provides an average savings of 43 percent on dental care — on top of the cash benefits from our plan.

Premier Access:  Members covered under our PPO plans can visit any dentist they choose; however, benefits may be paid at a lower co-insurance rate for non-participating dentists.  DHMO members must choose and use a participating primary care dentist.

  1. How many provider locations do you have?

Beam: +335,000 nationwide

Blue Shield: Members have network access to over 21,415 dental HMO and 47,563 dental PPO providers in California, and more than 406,169 providers nationwide. These are two of the largest statewide provider networks in the industry.

Delta Dental: Delta Dental PPO offers more than 47,000 participating provider locations in California and nearly 320,000 locations nationally. Premier dentists offer more than 55,900 locations in California and nearly 392,000 locations nationally. Currently there are more than 6,600 participating DeltaCare USA facilities in California to choose from.

Guardian: There are over 435,000 PPO access points across the country and more than 54,568 in California (Source: Netminder). We are one of the largest PPO networks in the state based on dentists. The DentalGuard Alliance network tier, a smaller group of dentists offering greater discounts, has 6,523 dentist access points in California. For the DHMO, there are 15,886 general dentists and specialist access points in California. Guardian’s PPO network also includes dental offices in Mexico. International Assist, a value-added service available, provides dental members with access to dental care if needed while traveling outside of the U.S.

Humana: Nationally, Humana has more than 94,000 dental PPO providers with over 14,000 dental PPO providers the State of California. For DHMO, Humana has more than 63,000 DHMO provider locations in specific markets. In California, we have over than 5,600 DHMO provider locations.

National General:  We are a hybrid of sorts due to the platform of fixed indemnity and optional access to our Careington Maximum Care Dental Network — a national network of more than 200,000 dental practices.

Premier Access:  Our Dental PPO networks offer access to more than 56,000 dentist locations nationwide, with more than 12,000 in California.  Our DHMO network in California has more than 3,300 dentist dental locations, including specialists.

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

Beam: N/A

Blue Shield: In 2018, approximately 7% of dental HMO plan network providers maintained closed practices; this represents approximately 148 offices out of 2,154 unique locations.

Delta Dental: All of Delta Dental PPO and Delta Dental Premier offices are open to new enrollment. Our fee-for-service providers may close their practice, but while in operation they must accept patients without discrimination, regardless of age, gender, ethnicity or being new to the practice.

Guardian: In California, only 0.03% of our PPO network and 2.73% of our DHMO network are closed to new patients.

Humana: Less than 1 percent of Humana’s dental PPO providers are closed to new patients. Under Humana’s dental provider contracts, participating dentists must schedule and treat members without discrimination, including benefit or payer differentials. Approximately 2 percent of practices are closed to new patients in the Liberty DHMO plans.

National General: None – the core plan is ‘go anywhere’. If the dental/vision savings card is selected, those providers are all available to new participants.

Premier Access: Less than 5percent of the DHMO network is closed to new patients; this figure represents about 159 general dentist locations.

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

Beam: N/A

Blue Shield: For PPO members, Specialist referrals are not required, and payments to specialists are processed the same as for general dentists. For DHMO members, pre-authorizations for Specialists are normally processed within 5 business days.

Delta Dental: For PPO and Premier, referrals and preauthorization are not required; payments to specialists are processed by the same guidelines as general dentists. Our standard turnaround for processing DeltaCare USA specialty care referrals is five days.

Guardian: Referrals are not required under our PPO plans. For our DHMO plans, payment to the specialist is within 30 days of receipt of the claim.

Humana: Humana’s dental plans, including DHMO plans, do not require a referral from a general dentist to a specialist. In 2018, 96.6% of clean claims from all dentists, including specialists were processed within 14 calendar days.

National General: This kind of transaction would be handled in the member services area in the same manner as regular treatment. So, as long as the services are deemed necessary and covered, benefits would be available as per the contract.

Premier Access: Referrals are not required under our DPPO plans.  For our DHMO plans, payment to the specialists is within 30 days of receipt of the claim.

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

Beam: Beam will pick up orthodontic treatments in the middle of their period for new members. For an early termination, Beam will cease making payments on that coverage when it terminates.

Blue Shield: Orthodontic coverage/payments end at cancellation of coverage.

Delta Dental: Delta Dental’s obligation to cover orthodontic treatment ceases after the date the enrollee loses eligibility or terminates coverage.

Guardian: When an orthodontic appliance is inserted prior to the PPO member’s effective date, we will cover a portion of treatment. Based on the original treatment plan, we determine the portion of charges incurred by the member prior to being covered by our plan and deduct them from the total charges. Our payment is based on the remaining charges. We limit what we consider of the proposed treatment plan to the shorter of the proposed length of treatment, or two years from the date the orthodontic treatment started. Also, we enforce the plan’s orthodontic benefit maximum by reducing the total benefit that Guardian would pay by the amount paid by the prior carrier, if applicable.

If a member is undergoing orthodontic treatment and his or her Guardian coverage terminates, we pro-rate the benefit to cover only the period during which coverage was in force. We do not extend benefits.

Our DHMO agreement provides for the Contracted Orthodontist to complete treatment at the contracted patient charge on a number of our plans. As an additional contract rider, we can allow for supplemental transfer coverage for Orthodontia under our DHMO.

Humana: For orthodontic claims, Humana pays benefits monthly through the month that the member is termed. Orthodontia is prorated over the time of treatment, depending on how long the member is in treatment.

National General: Not applicable to our coverage, as our plan does not provide such benefits.

Premier Access: If a member is undergoing orthodontic treatment and their Premier Access coverage terminates, we will pro-rate the benefit to cover only the time period during which coverage was in force.  We do not extend the benefits beyond the policy termination.  Our DHMO agreement provides for the contracted orthodontist to complete treatment at the contracted patient charge on a number of our plans.

  1. Does your plan have annual and lifetime maximums on dental coverage?

If so, what are they?

Beam: All plans have customizable maximums. Beam’s new Ultra plans can support annual maximums of $5,000 and orthodontic maxes of $3,000. One of our strategic advantages is flexibility; we can underwrite a wide variety of maximums based on the needs of the employer!

Blue Shield: Our annual maximums vary from as little as $500 to as much as $5,000 or more dependent upon individual or group coverage and group size.  Employers have a choice in annual maximum with more flexibility for large group customers to customize their annual maximum to meet their needs.

For large groups, we also offer our Rollover Rewards benefit feature allowing qualified members to boost their annual maximum.  The annual account reward will vary depending on the annual claims threshold which is determined by the plan’s annual maximum chosen.  The annual network reward for members who visit an in-network vs. a non-network dentist is $100.

Delta Dental: Virtually none of our DeltaCare USA (DHMO) plans impose annual or lifetime maximums on dental coverage. For most PPO and Premier plans, annual and lifetime maximums vary, and are determined by the group purchaser. Maximums typically range from $1,000 to $2,000.

Guardian: For PPO, the maximum refers to the total of benefit dollars actually paid for covered services incurred within the annual period, or the member’s lifetime in the case of orthodontia.  Guardian has flexibility with maximums. Typically, Preventive, Basic and Major have a combined maximum. We offer both an annual single maximum option (range from $500 – $5,000) and an annual split maximum option (maximums differ for in-network and out-of-network services). With the Preventive Advantage option, only Basic and Major services count toward the annual maximum. Maximum Rollover allows a portion of unused annual maximums to carry over for future years. We also offer an option to cover cleaning after the maximum is reached. For orthodontia, the lifetime maximum options range from $500-$2,500. Our DHMO plans do not include an annual maximum.

Humana: We offer flexible plan designs with a range of annual maximums to meet the needs of small to large groups. We do not have lifetime maximums. We are the only specialty carrier in the market to offer an Unlimited Annual Maximum.

National General: Yes. The Basic Plan has a $500 maximum calendar year benefit; Intermediate is $1,000; and the Plus plan is $1,500. However, preventive benefits do not take away from this annual benefit (adding $150-200/annually in benefit, depending on plan level). Members can use their savings card on covered and non-covered services at any and all times of the coverage being in force.

Premier Access: Premier Access offers plan design flexibility to allow brokers and employers to custom design their dental benefits, including annual or lifetime benefits.  The most common annual benefit maximums are $1,000, $1,500, and $2,000.  We do offer custom benefit plans above those amounts if the employer and broker desire that.

  1. Does your plan have a deductible. If so, what is it?

Beam: Beam plans include a standard $50 deductible ($150 family) but is fully customizable. Our Ultra plans can go as low as a $0 deductible!

Blue Shield: Deductibles can vary from as little as $0 to as much as $300 or more dependent upon group size and individual or family coverage. Employers have a choice in deductible with more flexibility for large group customers to customize their annual deductible to meet their needs.

Delta Dental: Virtually none of our DeltaCare USA (DHMO) plans require enrollees to satisfy a deductible. For most PPO and Premier plans, deductibles vary, and are determined by the group purchaser. Deductibles of $50 per individual / $150 per family are not uncommon.

Guardian: Our PPO product offers many different deductible options ranging from $0-$300 and will vary by plan design with $50 historically being the most common. Deductibles are often waived for Preventive Services as Guardian’s plans are designed to encourage members to get preventive care, thereby avoiding the need for more extensive dental care in the future. All our DHMO plan designs offered in California have no deductibles.

Humana: We offer flexible plan designs with a range of deductibles to meet the needs of small to large groups. The deductible is always waived for preventive care. We want to ensure there are no barriers to members receiving the necessary preventive care.

National General: There are no deductibles.

Premiere Access: Employers and brokers can custom design their dental benefits, including plans with no deductible, the most common designs requested are no deductible, $25, and $50.

  1. What percentage of preventive costs does your plan cover?

Beam: Beam will cover preventive at 100% in all cases’ we strongly believe in preventive care’s role in the dental health equation for all members!

Blue Shield: Preventive care is standardly covered at 100% when using an in-network provider. Out-of-network coverage will vary based on plan selected but typically not less than 80 percent. Members may also be balanced billed for amounts exceeding the allowable payment to out- of- network providers based on their plan. For large groups, there is additional flexibility to customize the percentage of costs covered.

Delta Dental: Delta Dental’s fee-for-service coinsurance percentages vary by plan. The majority of fee for service plan designs benefit preventive and diagnostic procedures at 100%. DHMO copays are set at a fixed schedule and vary by plan design.

Guardian: For PPO, we offer coinsurance percentages ranging from 0%-100% for preventive services. The preventive coinsurance percent for our most common PPO plan sold is 100%. Our DHMO plans offer a wide variety of covered services usually covered at 100%.

Humana: Preventive care is always covered at 100% in network, unless a large group designs a custom plan. We encourage all employers to cover preventive care at 100%. We want to ensure there are no barriers to members receiving the necessary preventive care.

National General: The member is reimbursed a select amount toward their preventive visit based on benefit level plan selected. For example, our ‘Plus’ plan offers $100 cash reimbursement toward preventive services.

Premier Access: Brokers and employers can customize this coverage from 0 percent to 100 percent; the most common is 100% coverage for preventive costs.

  1. What percentage of root canal costs does your plan cover?

Beam: We will typically cover root canals at 50%, but it is customizable based on employer preference.

Blue Shield: For Large groups, root canals can be covered under Basic or Major services.  Typically, Basic services are covered at 80% and Major Services are covered at 50%.  Out-of-network coverage will vary based on plan selected but the most common percentage is 50 percent. For Individual/Family plans, root canals are typically covered under Major services at 50%. For Small Group, root canals are typically covered under Basic services at 80%.

Delta Dental: Delta Dental’s fee-for-service coinsurance percentages vary by plan. As a dental carrier, we can administer any coinsurance level that the employer or broker requests. DHMO copays are set at a fixed schedule and vary by plan design.

Guardian: For PPO, we most often cover root canals as a basic service. We offer coinsurance percentages ranging from 0%-100% for basic services. The basic coinsurance percent for our most common PPO plan sold is 80%. Our DHMO plans cover many root canal procedures at various copayment levels based on plan type.

Humana: We offer flexible plan designs with a range of co-insurance percentages from 50 percent to 100 percent to meet the needs of small to large groups. A group can elect to have endodontic coverage in basic or major.

National General: According to our cost and transparency calendar, a molar root canal – for example – may cost $1,382. The plan cost is $707 with a network savings of $675 or a percentage savings of almost 50%.

Premier Access:  Brokers and employers can customize this coverage from 0 percent to 100%; the most common designs cover 80% or 50%.

  1. What percentage of crown costs does your plan cover?

 Beam: We will typically cover crowns at 50%, but it is customizable based on employer preference.

Blue Shield: Typically, for all lines of business, crowns are considered Major services and are covered at 50%.

Delta Dental: Delta Dental’s fee-for-service coinsurance percentages vary by plan. As a dental carrier, we can administer any coinsurance level that the employer or broker requests. DHMO copays are set at a fixed schedule and vary by plan design.

Guardian: For PPO, we most often cover crowns as a major service. We offer coinsurance percentages ranging from 0%-100% for major services. The major coinsurance percent for our most common PPO plan sold is 50%. Our DHMO plans offer a wide variety of different crown option procedures covered at various copayment levels based on plan type.

Humana: We offer flexible plan designs with a range of co-insurance percentages to meet the needs of small to large groups. Crowns are typically covered as part of major services and the coinsurance ranges from 50% to 60%.

National General: The cash benefit for a Crown ranges from $45 to $450. However, if the Careington Network is used – for example – the cost for a Crown (porcelain fused to noble metal) may cost $1,424. The plan cost is $726 with a network savings of $698 or a percentage savings of almost 50%.

Premier Access: Brokers and employers can customize this coverage from 0 percent to 100%; the most common design covers it at 50%.

  1. Do you provide dentist cost and quality transparency tools?

Beam: Our Lighthouse portal is for brokers and administrators and offers the ability to quickly and effectively edit account and member level details, manage everything from enrollments to COBRA, and gain unique insights into how a group is performing against plan, especially as it relates to their Beam Brush data and renewal rates.

Blue Shield: Yes. Once registered on our website, members may review their claims information and locate providers.  They also have access to treatment cost information through the Treatment Cost Calculator. The Treatment Cost Calculator allows members to search for common procedures including exams, cleanings, x-rays, fillings or root canals.  This tool is quick and easy to use with members being able to get an estimated cost for procedures quickly.

Delta Dental: Yes. Enrollees can use our Cost Estimator to determine costs for procedures based on dentist participation and location. Additionally, our Find a Dentist tool provides links to Yelp reviews as well as other helpful information including languages spoken, wheelchair accessibility and public transit access.

Guardian: We have a Dental Cost Estimator tool that provides an estimated range of allowable charges (fee schedule amounts) for the selected procedure codes in a selected region and provider contracted tier. Note that this is not the actual Guardian fee schedule amount for a provider nor the expected paid amount for a particular Guardian plan design. At this time, we do not offer provider quality ratings.

Humana: Humana’s website does not currently provide cost information for our dental products.

National General: Yes. If a member decides to use our Careington Network for specific services, they can go to: These resources provide a simplified way to determine costs of treatment.

Premier Access: We are developing cost and quality tools for the website, which we believe we help consumers make better informed decisions.  We also offer pre-determination of benefits to members who request them through our phone-based customer service representatives.

  1. Who can readers contact for more information?

Beam: You can email Beam at for more information, and one of our Business Development Representatives will be in touch pronto!

Blue Shield of California: Brokers who currently work with Blue Shield of CA contact their BSC representative.

For those who do not have a direct contact, they can locate more information by logging onto our website at our Broker Connection.  The link is listed below.

Delta Dental: Readers can visit to find the information specific to their location and area of interest.

Guardian: For more information, your readers can contact Guardian through our website.

The Guardian Life Insurance Company of America®

Humana: Brian Sullivan, California Vice President

Northern California Office: 1320 Willow Pass Road, 6th Floor, Concord, California 94520

Southern California Office: 555 Marin Street, Suite 140, Thousand Oaks, California 91360

Telephone: 818-673-7202



National General: Kellie Bernell, Regional Sales Director

(805) 341-7843 / email:

Company Site:

Premier Access:

Phone: 888-326-3210

Sales Executive: Robert Semrow –