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Selling Point #4: Flexible Plan Designs

Dec 02, 2010

Why Delta Dental? Selling point #4: Flexible plan designs

This is the final article in our series highlighting selling points you can use when talking to clients about Delta Dental. You can find the previous articles in this series in the fall 2009, winter 2010 and spring 2010 issues of Insider Update.

Why choose Delta Dental? We know that plan designs can be a tough balancing act between the employer’s plan costs and the employee’s out-of-pocket expenses. That’s why Delta Dental offers flexibility for clients to create a plan design that works both for them and for their employees.

More opportunities for cost savings
Delta Dental coverage outpaces the competition with cost and quality protection for up to 90 percent of all claims processed.

While PPO network utilization is comparable among most national carriers, our “network within a network” combination of the Delta Dental PPOSM and Delta Dental Premier® networks gives enrollees access to more dentists and is unmatched by the competition. This feature provides a “safety net” by expanding the opportunity for savings for enrollees who visit non-PPO dentists.

Approximately 60 percent of employees who visit a dentist outside the PPO network will visit a dentist from our Delta Dental Premier network. And since our Premier network dentists accept reimbursement at their contracted amount, both the employer and the enrollee enjoy greater opportunities for claims savings.

Specialist reimbursement
Delta Dental recognizes the additional training that is required of specialists and considers this in their reimbursement. Periodontists, oral surgeons and endodontists receive higher fees for the procedures that are associated with their specialty. Our extensive experience has shown that providing reimbursement commensurate with specialty training offers greater access for patients who need care from a specialist.

Out-of-network reimbursement
Delta Dental has the capability and flexibility to pay out-of-network claims at various percentiles, differentials and fee tables.* Our standard reimbursement model pays non-Delta Dental dentists at a lower percentile to encourage network utilization by enrollees and as a cost-savings benefit to employers. The higher percentile paid to our network dentists rewards them for their participation and allows us to provide enrollees with greater network access.

While paying out-of-network claims at a relatively high percentile or low coinsurance level may be attractive to the employee, it results in higher claims costs (or premiums) for the employer, and we try to balance these needs. Delta Dental plans traditionally pay out-of-network benefits at the level that would satisfy 51 percent (a majority) of the dentists in the service area.

Self-funded plans
For self-funded plans, some national carriers impose arbitrary restrictions on group size such as enrollment of 500 or more enrollees. Delta Dental takes our commitment seriously to improve access to great dental health, and thus our products are available to businesses of all sizes.

Prepaid plan designs
Delta Dental offers a national prepaid DHMO-type plan called DeltaCare® USA everywhere that state regulations permit us to do so. In non-DHMO states, we offer a fixed copayment plan with freedom of choice for out-of-network services. This strategy allows us to meet client needs for an affordable plan design that offers both predictable costs and a comprehensive schedule of covered services.

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