Dental Coverage in Today\'s Market

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Dental Coverage in Today’s Market

Superior Dental Care | CE Course


L E A D I N G T H E W A Y I N D E N T A L B E N E F I T S

Agenda

• Evolution of Dental Plans• Types of Dental Plans• Dominant Plan Designs• List of Covered Services • Dental Trends• Accepted Practice• Dental Utilization & Statistics• The Importance of Dental Coverage• Selling Considerations• Questions

Stats throughout this presentation were collected from:

• The Milliman 2010 Mid-Market Survey

• The NADP (National Association of Dental Plans)

• Mercer National Survey of Employer-Sponsored Health Plans, 2010


The Evolution ofDental Plans

• Indemnity Plans• Dental Health Maintenance Organization Plans

(DHMO)• Dental Preferred Provider Organization / Dental Point-

Of-Service Plans (DPPO/DPOS)• Individual Practice Association Plans (IPA, now

licensed under HIC’s)

Plan Types


Funding Options:• Fully Funded• Self Funded

Types of Plans:• Indemnity Plans

– Do not use a network– Designed around several categories of procedures with pre-determined percentages of coverage

• DHMO – Dental Health Maintenance Organization– In network only benefits– Typically ‘scheduled’ plans with set co-pays for services

• DPPO – Dental Preferred Provider Organization– Passive – same benefit percentage for in and out of network benefits. Balance billing may happen out of network.– Incentivized – different percentage out of network and balance billing drives network use and cost control

• DPOS – Dental Point of Service Plan– Benefits are based on a network or non-network provider

• Dental Discount Plans– Discounts off of retail charges offered through the network

• Direct Reimbursement Plans


Plan Type Prevalence

• Indemnity – 10%• DHMO – 13% • DPPO – 72%

• DPOS – 2%• Fee Schedule – 3%• Direct Reimbursement – less than 1%

Dominant Plan Designs


Preventive100% = 98%90% < 2%

Basic80% = 58%50% = 41%85% < 1%

Major

50% = 92%

30% < 5%

60% < 1%

Ortho

50% = 17%

60% < 1%

Dominant Plan Designs


Annual Maximums Deductibles$500 = 2% No Deductible = 71%$750 = 19% $50/$150 = 25%$1,000 = 84% $50/$100 = 3%$1,500 = 4%$2,000 < 1%$2,500 < 1%

List of Covered Services


LOCS – List of Covered Services or SPD – Detailed list ofhow services are covered and under which category

• Preventive• Basic• Major• Orthodontia• Frequency

Comparing list to list – service to serviceCarriers move services to win contracts Rates are impacted by how and where services are covered

Dental Trends


Dental claims on the rise• Advances in technology

– Equipment manufacturers driving treatment– Heroic dentistry – how much is one tooth worth?

• Dental “Care” vs Dental “Marketing”– Spa dentistry – added services being offered – is this dental care?– Cosmetic vs dental health

• Greater participation in dental coverage– Treatment plans are becoming benefit driven– Just because there is a code – should it be covered?

Dental Trends


Provider awareness • Those with dental coverage are:

– 52% more likely to have a root canal

– 32% more likely to have a crown

– 18% more likely to have a cavity filled

– 30% less likely to have had an extraction

Accepted Practice


• Accepted treatment protocol and dental coverage

• Organized dentistry – ADA role in industryand how it’s changed

• Role of dental coverage

• Dental industry vs insurance carriers

• Care vs benefits

Accepted Practice


• Cleanings – how many are needed• Fluoride – how often and to what age• X-rays – how often • Fillings – the controversy continues

– Composite – Amalgam

• Inlays – how they differ from fillings

Accepted Practice


• Periodontal services and cleanings – when are ‘extra’ cleanings needed

• Sealants – who really needs these and how should they be covered

Accepted Practice


• Implants – understanding the impact of this growing trend

Dental Utilization


• Record high utilization experienced• Competition drives plan designs not dental necessity• Increased coverage leads to increased utilization

which leads to increased costs• Danger of out-pricing coverage for the majority of

users for the sake of the few high-users• Economic pressures on members and dentists

Dental Utilization


• Typical PPO - 50-75% out of network claims (Local carrier trends at 3% of claims are from out of network provider)

• Less than 5% of employees reach annual maximum of $1,000

• Claim Volume Break Out:– Preventive – 76%– Basic – 19%– Major – 5%– Orthodontics – less than 3% use their

available benefit

Dental Statistics


Of those who go to dentists…• 30% of insured visit their dentist• 58% are women and 42% are men• 59.2% had income of $60K+• 61% are married, 22% single, 17% divorced/widowed/

separated• Region: Northwest 21%, Midwest 24%,

West 22%, South 33%

The Importance of Dental Coverage| The Employee


• Makes dental care more affordable • Early detection for many

medical conditions• Prevents absenteeism • Increases job satisfaction• Helps create overall

health and wellness

The Importance of Dental Coverage| The Employer

• Enhances benefit package• Attracts and retains qualified staff• Reduces absenteeism• Increases employee morale• Enhances overall health and wellness of staff• Helps create overall health and wellness


The Importance of Dental Coverage| The Consultant / Agent


• Secure your position in the market• Provide expertise to your clients • Protect your business • Provide full spectrum value to your clients• Helps create overall health and wellness

Selling Considerations


• Get creative!• Look at details of plan• Design plan around actual needs of clients and their

employees• Help afford quality dental care!


Questionsand

Thank You!

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Dental Coverage in Today\'s Market