Our annual dental survey asks providers crucial questions about the plans they provide, helping agents make the educated decisions about what plans to provide for their clients.
1. What types of plans do you offer?
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.
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.
BEN-E-LECT: BEN-E-LECT offers fully insured PPO, EPO, pre-paid and self-insured dental plans for the group market. Employer-paid and voluntary plans with multiple network and out-of-network options down to the employee level are available to groups with as few as two lives.
BEST Life: In California, we offer employer-sponsored PPO, and indemnity dental plans to groups with two or more employees enrolling. Voluntary PPO/indemnity dental plans are available to groups with five or more employees enrolling. Custom dental plans can be offered for groups with 100 or more employees enrolling. We also offer group vision and term life coverage.
Cigna: We offer a full spectrum of dental solutions, including the Cigna Dental Care® (DHMO) plan, Cigna DPPO plan, Cigna Traditional indemnity plan, and Cigna Dental Shared Administration. We also offer additional product features that enhance our plans. Individual, small group and large group plans are available on a stand-alone basis. Cigna Dental Plans are also available alongside medical and/or vision plans.
In California, Cigna DHMO plans are insured by Cigna Dental Health of California, Inc. Cigna DPPO and Traditional indemnity plans are insured or administered by Cigna Health and Life Insurance Company, with DPPO network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. All dental insurance policies and dental benefit plans contain exclusions and limitations. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation.
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 43 state and federally administered exchanges. In 2016 we are covering nearly 300,000 lives in these exchanges as a stand-alone dental plan, and just over 500,000 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 & 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.
Guardian: Guardian offers an array of plan options to meet the needs of employers and their employees. Dental PPO, Prepaid/DHMO, and Indemnity plans are available on a voluntary or employer-sponsored basis. Dual and Triple Choice, Monthly Switch (between a DHMO and PPO), and Administrative Services Only plans are also available. Guardian specializes in customized plans based on the needs and price points of the employers and employees. We also offer dental plans for individuals/families, both on and off Covered California, the state’s insurance exchange. Consumers can purchase Guardian’s dental plans directly from www.mydental.guardianlife.com
Humana: In California, Humana offers PPO, prepaid/DHMO, traditional preferred, and preventive plus plans. These plans are available on a voluntary or employer-sponsored basis.
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.
2. How do plans you offer for the individual and/or small group compare in rates and benefits to the large-group plans?
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 customer needs. Non-group individual plan pricing is higher than group individual pricing due to the nature of the risk.
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.
BEN-E-LECT: The majority of BEN-E-LECT’s plans compete very well in the large group market. The benefit design and structure of these plans remain consistent across the small and large group markets.
BEST Life: Rates vary by plan design, group size and employer contribution. However, we offer a lot of plan design flexibility for groups with 10 or more enrolling. Waiting periods for major and ortho services are waived for groups with 10 or more employees enrolling. Some benefits are standard regardless of size. We offer a separate accident benefit on all of our dental plans which provides up to $1,000 for accidents to sound and natural teeth. There is no maximum on number of occurrences and the amount is not counted toward the calendar year maximum. A child vision benefit is also standard on plans with orthodontic coverage.
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 offers individual plans in the state of California, available stand-alone or as a buy-up option to our medical plan offering. The plans are DPPO and very similar to our group plans aimed at businesses trying to control costs while offering a large network. Larger groups generally want more robust and flexible plans, while smaller groups and individual plans include more standard offerings. We can custom-fit DPPO plans to offer a variety of cost-savings options for employers, such as missing tooth limitations, class shifting, and varying deductibles, coinsurance, waiting periods, and annual benefit maximums. Our DHMO plans start with basic coverage, specialty discount, split copays, and other cost savings mechanisms and go up to very rich, lower copay plans at the higher end of the cost spectrum, including plans with coverage for surgical implants and related procedures. Cigna can also deliver solutions for the smaller employer segment through the Cigna Voluntary limited benefit dental plan.
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.
Guardian: Guardian offers nearly the same plan options to small group employers as to large employers, plus an array of cost-reducing options. We also offer dental benefits through the California state exchange (through Premier Access) and through our direct-to-consumer website www.mydental.guardianlife.com.
Humana: We offer flexible plan designs with a range of deductibles, co-payments, and out-of-pocket expense limits to meet the needs of small to large groups. We also offer large groups the additional flexibility to customize plan options. All our dental plans provide employees with incentives for preventive dental care, which promotes their overall health. Customers who see dentists participating in our dental PPO network receive deep discounts. Humana does not offer individual dental plans in California.
Principal Financial Group: The only significant rating difference between our small and large group rates pertains to experience rating which is used on groups with 200+ employees. The benefits offered are the same for small and large groups. We do not offer individual dental plans.
3. What have been the most recent changes in your plan(s)?
Ameritas: With Ameritas Rewards, employers can offer a dental plan and add benefits like vision, LASIK, orthodontia and hearing for more comprehensive coverage. By visiting the dentist and keeping paid benefits under a specified amount each year, employees can earn rewards to carry over to the following year. After the dental benefit maximum is used, rewards can be applied to dental. And specified portions of rewards can be applied to other types of coverage once their maximums are met.
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 and composite fillings on all teeth. 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. Changes for 2016 include 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). In terms of plan design, our Dental Prime and Dental Complete products now allow for preventive and diagnostic procedures to not reduce a members annual maximum, options for increased annual maximums up to $5,000, and a new feature called Carry-In which allows members to bring with them any annual-maximum ‘roll-over’ dollars from a prior carrier when their employer switches dental plans.
BEN-E-LECT: BEN-E-LECT has evaluated its Freedom PPO benefits portfolio and narrowed it down to four plans that have proven to be most beneficial to its members. By focusing on development of those four plans, BEN-E-LECT is now more able to create sustainable rates for its groups taking into account size and location. BEN-E-LECT has also eliminated the waiting period for groups and new hires on its employer-paid plans for added convenience. We have also added an EPO option to our portfolio which allows for even more cost savings and offers one of the strongest networks available.
BEST Life: We’ve increased broker service fees throughout California and have numerous promotions and incentives throughout the year, including a 2 year rate guarantee. Our plans are customizable to meet the needs of any group and we have some of the largest regional and national networks available. Our dental plans cover implants and also include a separate dental accident benefit that covers up to $1,000 for accidents to sound and natural teeth that is not counted toward the calendar year maximum.
Cigna: We developed the Cigna Dental Oral Health Integration Program® years ago to reinforce the importance of good oral health in relation to overall health. We continue to stress the importance of associations between oral health and certain medical conditions and enhance the program to reflect the latest medical and dental research. Currently the program includes the following list of clinical conditions: cardiovascular disease, cerebrovascular (stroke), maternity, diabetes, chronic kidney disease, head and neck cancer radiation, and organ transplants. The program also provides 100 percent reimbursement of copays and coinsurance on certain dental procedures associated with treating gum disease. We continue to enhance the customer experience with this program. Previously, customers submitted a reimbursement form each time an eligible service was performed. Now, customers can register once (for each eligible condition) and their coinsurance/copays for qualifying procedures will automatically be reimbursed within 2-3 weeks from when we receive the claim from their dentist (for DPPO plans, reimbursements apply to and are subject to the plan annual benefit maximum). We have also made several enhancements to our DPPO products to provide additional benefit flexibility including cost saving capabilities with our dental code classification process thru improved class shifting functionality.
Delta Dental: Delta Dental enrollees benefit from cost estimating tools now available to them:
• Fee Finder – With Delta Dental’s Fee Finder tool, PPO and Premier enrollees can access the average fees for 35 commonly used procedures by entering their ZIP codes and a procedure by either entering a procedure code or by selecting a procedure using a drop-down list. The Fee Finder tool provides the average submitted fee for all dentists in the specified ZIP code.
• Cost Estimator — Developed by the Delta Dental Plans Association (DDPA), Delta Dental offers a Cost Estimator feature available for our enrollees via the deltadental.com web portal and the Delta Dental Apple iOS and Android App. This tool uses a 3-digit ZIP code, NPF fee data, and the enrollee’s plan design to provide an estimated cost. The tool also allows the enrollee to select a specific provider to see actual dentist fees.
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.
Guardian: Guardian constantly develops new, innovative ideas in order to meet our customers’ needs by helping keep their teeth healthy and saving them money. Guardian recently introduced the College Tuition Benefit®, a value-added benefit that helps Guardian dental members pay for college. Employees covered by a Guardian dental plan that includes the College Tuition Benefit® earn Tuition Rewards® that can be used to pay up to one year’s tuition at one of over 340 private colleges and universities across the nation. Guardian is the only dental carrier to offer the College Tuition Benefit®. In addition, this year we are introducing enhanced PPO plan designs that offer employers and employees more flexibility and control over savings.
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.
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. In addition to our Maximum Accumulation feature which allows members to carry over a portion of their unused annual maximum for use in future years, we also have a Preventive Passport feature.
4. Can an insured use their own dentist even if they are not on your participation list?
Ameritas: Members can use any provider, but they may incur additional out-of-pocket expenses when visiting a provider not in the Ameritas network.
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.
BEN-E-LECT: Yes, BEN-E-LECT’s plans offer in and out-of-network coverage with multiple options for coverage and benefits. The members maintain complete control over the dentist they choose to utilize.
BEST Life: Yes, group and individual products allow members to visit any dentist of their choice and receive coverage for services.
Cigna: Insureds can use their own dentist in the DPPO and dental indemnity plans. However, in California there are no out-of-network benefits with DHMO (except for emergency coverage). 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. We are continuously expanding our network to meet the needs of our members, and current and potential clients.
Delta Dental: Delta Dental Premier enrollees can visit any licensed dentist for care, although there are advantages to visiting one of more than 56,000 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 45,000 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 5,900 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.
Guardian: Members covered under our PPO plans can visit any dentist; however, benefits may be paid at a lower coinsurance rate for non-participating dentists. DHMO members must choose a participating primary care dentist.
Humana: PPO members can visit the dentists of their choice. Out-of-pocket savings are greater when members visit participating network dentists. DHMO members must select a participating dentist.
Principal Financial Group: Yes, 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, network dentists must be seen for services in order to receive benefits under the plan.
5. How many provider locations do you have?
Ameritas: California only – Ameritas/FDH Network: 95,354 California provider access points, (67,384 Ameritas; 27,970 FDH); 20,777 California locations, (13,298 Ameritas; 7,479 FDH) Nationwide – total provider access points = 419,913.
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 18,953 unique dentists and nearly 50,450 access points in California alone — and more than 122,600 unique dentists and 332,600 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.
BEN-E-LECT: BEN-E-LECT’s dental plans utilize the First Dental Health, Dentemax, and Western Dental networks, which contain thousands of offices statewide.
BEST Life: We offer access to regional and national PPO networks — First Dental Health (FDH) and DenteMax. Our California network has over 68,672 access points and an additional 9,593 provider locations throughout the state. Our national network has over 285,000 provider locations, which offers our members network access when they are outside of California.
Cigna: As of May 2016, across all specialties, Cigna has over 140,930 unique DPPO network dentists nationally and over 21,484 in California. For DHMO, Cigna offers access to 22,655 network dentists across the country, with 6,715 DHMO network dentists in California.
Delta Dental: Our networks offer access to more than 56,000 dentist locations for Delta Dental Premier, more than 45,000 dentist locations for Delta Dental PPO and more than 5,900 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.
Guardian: There are over 325,282 PPO access points across the country and more than 43,704 in California. We are one of the largest PPO networks in the state based on dentists. The DentalGuard Alliance network tier, a smaller group of dentists offering greater discounts, has over 6,970 dentist access points in California. For the DHMO, there are 51,027 dentist access points across the country and 16,335 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. In addition, a supplemental listing of out-of-network dentists, Out-of-Network Plus, provides Guardian members greater selection in finding an affordable dentist.
Humana: Nationally, Humana has more than 275,000 provider locations. In California, we have approximately 34,000 provider locations.
Principal Financial Group: We have approximately 69,500 PPO provider locations and 25,900 EPO provider locations in the state of CA.
6. What percentage of your network is closed to new enrollment? How many offices does this represent?
Ameritas: PPO: California only – Only 419 Ameritas Offices and 37 FDH Offices are closed to new enrollment. This represents approximately 0.73%.
Nationwide – 5,380 offices are closed to new enrollment, which represents approximately 1.45%.
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.
BEST Life: All participating PPO dentists are accepting new patients.
Cigna: DHMO — We look at data on dentist capacity and current and projected Cigna Dental Care member loads. Network managers regularly monitor capacity and projected growth. They contact dentists as necessary to discuss capacity expansion through staff increases or office hour changes. If these actions are not feasible, we will consider adding more dental offices. Nationwide, as of May 2016, approximately 9 percent of the Cigna Dental Care network dental offices are closed or capped to new members. DPPO Network dentists do not cap or close their offices to new members, and DPPO members are not required to select a primary network dental office.
BEN-E-LECT: All of BEN-E-LECT’s dental PPO providers are accepting new patients. For the DHMO product, less than 3% of the offices are closed to new enrollment representing approximately 60 offices.
Delta Dental: 0%. 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; 3.64% DHMO dental facilities are closed to new enrollment.
Dental Health Services: Although roughly five percent of participating dentists have been lost over the past 12 months, our overall network size has increased by five 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.
Guardian: In California, only 0.03% of our PPO network and 3.2% of our DHMO network is closed to new patients.
Humana: Under Humana’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.
Principal Financial Group: Less than 5%.
7. What is the time frame for processing a referral in terms of member notification and payment to the specialist?
Ameritas: Since this is a self-referring process, this question is not applicable.
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.
BEST Life: No referrals are required. Members may self-refer to any specialist they choose.
BEN-E-LECT: A referral is not necessary. Members may call and schedule the appointment as desired.
DHMO–Network general dentists initiate patient referrals for endodontic, oral surgery, and periodontal treatment. Referrals are confirmed for 90 days from the approval date. Specialty referrals are not required for orthodontic treatment or pediatric care for children up to seven years old, as long as members visit network specialists. The network dentist may submit a request for preauthorization to Cigna for oral surgery, endodontic and periodontal services. Members are responsible for the applicable patient charges listed on the patient charge schedule (PCS) for covered procedures. After specialty treatment is finished, the member should return to the network general dentist for care.
If a network specialist is not available, the general dentist will refer the member to an out-of-network specialist, and the member will be responsible for charges listed on the PCS; however, Cigna Dental Care (DHMO) network general dentists render the range of services that are required for graduation from dental school, including diagnostic treatment, preventive treatment, operative dentistry, crown and bridge, partial and complete dentures, root canal therapy, minor oral surgery, preliminary periodontal therapy, and pediatric dentistry.
DPPO–There is no need for a referral by a primary care dentist to obtain services from a specialist with the Cigna DPPO plan. Members may choose to seek service from any in- or out-of-network specialist or general dentist in the U.S. Of course, network dentists have agreed to our reduced fee schedules, which helps lower our members’ out-of-pocket expenses.
Indemnity–Cigna Traditional indemnity members can seek care from any licensed dentist in the U.S.
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, preauthorizations for specialty care processed within 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.
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 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 2015, 98% of claims were processed within 14 calendar days.
Principal Financial Group: Not applicable to our plans.
8. How do you handle early termination of coverage when a member is still in the middle of orthodontic treatment?
Ameritas PPO: PPO provider discounts are determined using the treatment start date. Ameritas PPO providers are contractually obligated to honor those discounts for any ongoing covered treatment under their plan.
Anthem Blue Cross: Orthodontic payments will cease if coverage is not active at the time the payment is due.
BEST Life: Coverage terminates at the end of the month in which a member is no longer eligible.
BEN-E-LECT: Payment for benefits will cease at the end of the month for which the termination became effective.
Cigna: Coverage for orthodontic treatment which was started before disenrollment from the dental plan will be extended to for 60 days after disenrollment, unless it was due to nonpayment of premiums.
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.
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.
Humana: Humana will prorate to provide the appropriate amount given during the time the member was in the plan.
Principal Financial Group: On individual terminations, most of our plans allow for extended benefits that provide one month of additional coverage.
9. Does your plan have annual and lifetime maximums on dental coverage? If so, what are they?
Ameritas: Ameritas is known for plan flexibility and meeting employer needs rather than offering set plans to choose from. Annual maximums for dental procedures range from $400 to $3,000. Lifetime maximums for orthodontia range from $500 to $2,500. Ameritas will accommodate employer requests on plan maximums.
Anthem Blue Cross: 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 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.
BEN-E-LECT: Each of BEN-E-LECT’s PPO/EPO plans have an annual maximum; PPO/EPO $1,000 = $1,000 maximum; PPO/EPO $1,500 = $1,500 maximum; PPO/EPO $2,000 = $2,000 maximum; PPO/EPO $2,500 = $2,500 maximum. BEN-E-LECT’s Pre-Paid DHMO has no maximums.
BEST Life: We offer calendar year maximum options of $500; $1,000; $1,500; $2,000 and $2,500; depending on plan design for dental services. We offer $1,000 lifetime and $500 calendar year maximum for adult orthodontia benefit options. We offer $1,000 lifetime and $500 calendar year maximum or $1,500 lifetime and $750 calendar year maximum for child orthodontia benefit options.
Cigna: Cigna DHMO plans do not have any annual or lifetime maximums. Cigna DPPO plans have variable annual and lifetime maximums options. 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 maximums; lifetime maximum applies to orthodontia.
Dental Health Services: On Dental Health Services’ Prepaid (DHMO) plans there is no annual maximum. The company’s PPO/EPO plans feature annual maximums and lifetime orthodontic coverage.
Guardian: Annual and lifetime maximums vary by plan. Annual maximums can range from $500-$5,000 for all services combined or can exclude Preventive services. Lifetime
maximums on Orthodontia services can range from $500-$2,500. The Maximum Rollover benefit allows members to roll over funds for future use if the member visits the dentist each year and uses only a specified portion of the annual maximum benefit.
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.
10. Does your plan have a deductible. If so, what is it?
Ameritas: An Ameritas dental plan may or may not have a deductible. Plans are customized to meet employer and employee needs. Deductibles are typically waived on preventive procedures and vary based on procedure type. Ameritas offers calendar year or plan year, lifetime and per-visit deductibles, and also a family maximum deductible to cap the number of family members who must satisfy the deductible.
Anthem Blue Cross: Deductibles can vary from as little as $0 to as much as $300 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.
BEN-E-LECT: BEN-E-LECT’s plans have the following deductibles: PPO/EPO $1,000 = $0 Deductible; PPO/EPO $1,500 = $100 Deductible; PPO/EPO $2,000 = $100 Deductible; PPO/EPO $2,500 = $100 Deductible. Pre-Paid DHMO has no deductible.
BEST Life: We offer several calendar year deductible options: $0, $25, $50, $75 or $100. There is a 3 per family maximum on the calendar year deductible.
Cigna: Cigna DHMO plans do not have any deductibles. Cigna DPPO plans have variable deductible options.
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: Dental Health Services Prepaid (DHMO) plans have no deductibles. The company’s PPO/EPO plans have deductibles.
Guardian: Deductibles vary by plan and can range from $0-$300.
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.
Principal Financial Group: We have a wide range of deductibles available to fit the employer’s needs.
11. What percentage of preventive costs does your plan cover?
Ameritas: Ameritas plans typically cover preventive procedures at 80% or 100% to encourage members to maintain good dental health and avoid costly treatments in the future. Ameritas will also accommodate most other coinsurance requests.
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.
BEN-E-LECT: All of BEN-E-LECT’s PPO/EPO and Pre-Paid DHMO plans cover 100% preventative care.
BEST Life: Our plans pay 100% for in-network preventive services and Indemnity plans and 100% or 80% for out-of-network preventive services on our PPO plans, depending on the plan design.
Cigna: All Cigna DHMO and DPPO individual plans cover preventive care at either no additional cost or for a minimal cost. Cigna DPPO group plans have variable coinsurance options for Class I services, typically set by the employer. Cigna also offers group customers Cigna Dental Waiver Saver, where customers’ Class 1 (preventive) services can be waived for maximums and deductibles, providing an incentive for customers to seek preventive care.
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.
Guardian: Preventive services are typically covered at 100%, but this varies by plan and can
range from 0-100%.
Humana: Preventive care is always covered at 100 percent, unless a large group designs a custom plan. We encourage all employers to cover preventive care at 100 percent. We want to ensure there are no barriers to members receiving the necessary preventive care.
Principal Financial Group: We have a range of preventive care coinsurance options available to best fit the employer’s needs.
12. What percentage of root canal costs does your plan cover?
Ameritas: A root canal is generally covered as a Type 2 (Basic) procedure, but can be moved to Type 3 (Major) at the employer’s request. The plan benefit (percentage of the procedure that’s covered by Ameritas) varies based on procedure type. Ameritas sets the plan benefit for each procedure type based on employer request. But the most common plan benefits for Type 2 and Type 3 are 80% and 50% respectively. With an Ameritas incentive plan, a root canal covered under Type 2 could be covered at 100% during the employee’s third year on the plan.
Anthem Blue Cross: Root canals are most commonly covered at 50-60 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.
BEN-E-LECT: All of BEN-E-LECT’s PPO/EPO plans cover root canals at 50%, Pre-Paid DHMO is covered by a co-pay.
BEST Life: Our plans offer the option to cover endodontics with periodontics in either basic or major services.
If endodontics are covered as a basic service:
• Indemnity High: 90%
• Indemnity Mid: 80%
• Indemnity Value: 50%
• PPO High: 90% in-network / 80% out-of-network
• PPO Mid: 80% in-network / 50-80% out-of-network, depending on plan design.
• PPO Value: 50% in-network / 20% out-of-network. If endodontics are covered as a major service.
• Indemnity High: 60%
• Indemnity Mid: 50% or not covered, depending on plan design.
• Indemnity Value: not covered
• PPO High: 60% in-network / 50% out-of-network
• PPO Mid: 50% in-network / 50% out-of-network or not covered, depending on plan design.
• PPO Value: not covered.
Cigna: For Cigna DHMO plans this varies by the plan type selected. Cigna DPPO plans have variable coinsurance options for endodontic services.
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.
Guardian: Preventive services are typically covered at 100%, but this varies by plan and can range from 0-100%.
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.
Principal Financial Group: We have a range of coinsurance options for root canals available to best fit the employer’s needs.
13. What percentage of crown costs does your plan cover?
Ameritas: Ameritas plans usually cover a crown as a Type 3 (Major) procedure. The plan benefit for Type 3 procedures varies from 40% to 60%, or employer request.
Anthem Blue Cross: Fillings, both amalgam (silver) and composite (tooth-colored) are most commonly covered at 80 percent when using a Dental Prime or Dental Complete provider. Out-of-network coverage will vary based on plan selected but most commonly coverage at 60-90 percent with additional flexibility for large group customers to customize the percent of costs covered.
BEN-E-LECT: BEN-E-LECT provides benefit plans including dentist’s costs for all PPO/EPO and DHMO plans, as well as copay amounts, if necessary. More information regarding plan details is provided on our website at -www.benelect.com/dental
BEST Life: Crowns are covered as a major service:
Indemnity High: 60%
Indemnity Mid: 50% or not covered, depending on plan design.
Cigna: For Cigna DHMO plans this varies by the plan type selected. Cigna DPPO plans have variable coinsurance options for prosthodontic services.
Indemnity Value: not covered
PPO High: 60% in-network / 50% out-of-network
PPO Mid: 50% in-network / 50% out-of-network or not covered, depending on plan design.
PPO Value: not 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 crowns.
Guardian: This varies by plan and can range from 0-100%.
Humana: We offer flexible plan designs with a range of co-insurance percentages to meet the needs of small to large groups. Fillings are typically covered as part of Basic services.
Principal Financial Group: We have a range of coinsurance options for crowns available to best fit the employer’s needs.
14. Do you provide dentist cost and quality transparency tools?
Ameritas: Ameritas provides an online dental cost estimator tool members can use to access cost estimates for out-of-network dentists by area. Ameritas also provides an online directory of network dentists along with contracted dentist fees by area. All network dentists must complete a strict credentialing process and office evaluation to be included in the network directory. Members can contact Ameritas Customer Connections for assistance Monday-Thursday, 7:00 a.m. to midnight CST and 7:00 a.m. to 6:30 p.m. CST on Friday.
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.
BEST Life: We offer predetermination to members that provide them with an estimate of how their benefits will be processed.
Cigna: Cigna makes selecting a dentist and budgeting for dental expenses easier. Most DPPO customers have access to personalized out-of-pocket cost estimates by service and by dental office as well as detailed profiles about each dentist, often including photos and videos. The tools are available on myCigna.com, Cigna’s personalized customer website, and the myCigna mobile app.
Delta Dental: Yes. A variety of tools are available to Delta Dental enrollees. On our website at deltadentalins.com, we offer a fee finder tool, which shows enrollees the average submitted fees of Delta Dental contracted dentists, and, for specific clients, we have a cost estimator tool that can estimate 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.
Guardian: Guardian’s web site, Guardian Anytime (www.guardiananytime.com), includes a dental cost estimator tool for greater cost transparency. The tools allows members to
better plan for care and see the cost difference between in- and out-of-network care.
Humana: At this time, Humana’s website does not provide cost information for our dental products.
Principal Financial Group: We provide an online resource that members can use to access a variety of oral health information including a procedure cost estimator. H