October 30, 2008
Delta Dental has announced their California Small Group program changes going into effect January 2009. In comparison to year’s past, the changes being implemented are extensive but they are intended to deliver improved benefits to members while reducing their out of pocket costs.
Quoting is available at Beere & Purves for the Classic plans (5-49), Options plans (50-99) and DeltaCare USA plans (5-99). We are also available to assist you with any questions – 888.722.3373. Details within this announcement include:
INDUSTRY RATINGS (SIC CHANGES) |
In order to expand the list of industries that are eligible to enroll in Delta Dental plans, several previously ineligible industries have been added as Level 2 and Level 1. Industries previously listed as Level 2 have been moved to Level 1 in order to deliver more competitive rates. Some of the notables are provided below.
Level 2 to Level 1: (click here for a comprehensive list of changes)
- Computer Programming and Related Services (7371-7379);
- Engineering and Management Services (8711-8748);
- Construction Contractors (1500-1799)
Ineligible to Level 1: (click here for a comprehensive list of changes)
- Community Services Organization / Social Services (8300-8499)
- Government Funded Groups (8300-8499)
Please note that these changes will only apply to new groups. Existing groups are required to remain at their current rate level; exceptions will not be granted.
PPO Plans - Classic (5-49)
Group Size: The Classic portfolio will only be available to groups 5-49 to prevent confusion with the Options plans. They were previously available up to 99.
Plan Names: The PPO and Premier plans will experience a name change. See table below.
Current Plan Name |
New Plan Name |
PPO |
PPO A |
Premier 50 |
PPO B |
Premier 100 |
PPO C |
Benefit Changes (click here for benefits):
- PPO A (currently PPO): There will be no benefit changes; remains a fee schedule plan.
- PPO B (currently Premier 50):
- Addition of “PPO + Premier” feature (see below for details)
- In network benefits increase from 50/50/50 to 70/70/50 when accessing a PPO dentist
- Out of network benefits are still paid at 51st percentile when non-Delta dentists are accessed
- PPO C (currently Premier 100):
- Addition of “PPO + Premier” feature (see below for details)
- In network benefits increase from 100/80/50 to 100/80/60 when accessing a PPO dentist
- In network deductible is decreased from $50 to $25 when accessing a PPO dentist
- Out of network benefits are still paid at 51st percentile
- PPO + Premier Feature: The PPO + Premier feature included in the PPO B & PPO C (currently Premier 50 & 100 respectively) plans will encourage members to visit a PPO dentist and reduce their out of pocket costs due to lower PPO dentist fees. When visiting a Premier dentist (considered out of network) members will also benefit by not receiving a balance bill.
Please note that the conversion from the Premier to the PPO plan name, with the addition of the PPO + Premier feature will result in little or no change in premium for many groups (depending on geographic location). As a result, the enhancements mentioned above will take nothing away from the employer or the enrollee. Rather, they will provide enrollees access to greater savings if they visit a PPO dentist.
PPO Plans - Options (50-99)
Plan Removal: The Premier plan option is being removed from the Options portfolio. Groups currently enrolled in this plan will be migrated into the PPO 3 plan upon their renewal. The PPO 3 offers essentially the same plan design as the Premier plan.
Plan Names: The Premier plans will experience a name change. See table below.
Current Plan Name |
New Plan Name |
PPO 1 |
no change |
PPO 2 |
no change |
PPO 3 |
no change |
Premier |
PPO 3 |
Benefit Changes:
- PPO 1 & 2: There will be no benefit changes; remains a fee schedule plan.
- PPO 3:
- A new deductible option has been added: $0/$0 when visiting a PPO dentist
- Former Premier enrollees with $50/$150 plan deductible: when visiting a PPO dentist, the plan deductible will be decreased to $40/$120
- Former Premier enrollees with $25/$75 plan deductible: when visiting a PPO dentist, the plan deductible will be decreased to $0/$0
- PPO + Premier Feature: The PPO + Premier feature included in the PPO 1, 2 & 3 plans will encourage members to visit a PPO dentist and reduce their out of pocket costs due to lower PPO dentist fees. When visiting a Premier dentist (considered out of network) members will also benefit by not receiving a balance bill.
Please note that the conversion from the Premier to the PPO 3 will result in little or no change in premium for many groups (depending on geographic location). Again, this conversion will take nothing away from the employer or the enrollee. Rather, they will provide enrollees access to greater savings if they visit a PPO dentist.
DeltaCare Plans (5-99)
New Plan: The DeltaCare USA 15B will be added to the DeltaCare USA plan offerings to provide a lower-priced HMO-type plan option. Click here for the plan summary.
PPO Plans - Classic (5-49) & Options (50-99)
Regional Rating:
Delta Dental is expanding their statewide rates from two to four rating regions; allowing them to deliver rates that are more competitive and more accurately aligned with the cost of dental treatments.
Delta Dental PPO Regions (driven by employer zip code, not by county):
Region 1 |
Region 2 |
Region 3 |
Region 4 |
| Los Angeles |
Alameda |
Central Valley zips starting with:
932, 933, 935-938, 952, 953, & 956-958 |
All Other Areas |
| Orange |
Contra Costa |
| San Diego |
Marin |
| San Bernardino |
Santa Clara |
| Riverside |
San Francisco |
| Ventura |
San Mateo |
Rate Increases (approximate by region):
- Southern California (Region 1) = 2%
- Northern California (Region 2) = 6.63%
- Central Valley (Region 3) = 4.6%
- All Other Areas (Region 4) = 4.6%
- Classic Rate Comparison - Click here to view a 2008 vs 2009 tiered rate comparison, by region, for Level 1 and Level 2 plans.
- Options Rate Comparison - Click here to view a 2008 vs 2009 tiered rate comparison, by region, for Level 1 and Level 2 plans.
Please note that these rate increases apply only to the Classic (5-49) and Options (50-99) PPO plans. The Premier plans for both portfolios will likely experience a reduction (or no increase in premium) due to the conversion of the Premier Plans to PPO plans with a “PPO + Premier” feature (details provided in the Portfolio Updates section).
DeltaCare Plans - (5-99)
Regional Rating:
DeltaCare plans will no longer be available for new business in Region 5. There will not be a forced migration for groups currently enrolled in a DeltaCare plan in that Region. [Delta Dental announced 11/5/08 that Region 5 will continue to offer DeltaCare plans]
Counties comprising DeltaCare Region 5: Butte, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Mono, San Benito, Santa Cruz, Shasta, Siskiyou, Sutter, Tehama, Trinity and Yuba.
Rate Increases:
The approximate increase to all DeltaCare plans is 2.6%.
DIAGNOSTIC & PREVENTATIVE MAXIMUM WAIVER OPTION |
Available to both the Classic (5-49) and Options (50-99) portfolios, the Diagnostic & Preventive (D&P) Maximum Waiver option is being made available to encourage enrollees to seek diagnostic and preventive care in order to prevent serious dental problems in the future. Since the addition of this waiver option will keep the cost of diagnostic and preventive procedures from counting toward the enrollees’ annual maximum, the full maximum amount will remain available to enrollees for other procedures.
Groups choosing to add the D&P Maximum Waiver option will impact their rates by the following:
- 2% for plans with $2,000 calendar year maximum
- 6% for plans with $1,500 calendar year maximum
- 8% for plans with $1,000 calendar year maximum
Delta Dental is introducing four new, and clarifying three existing underwriting rules which apply to the Classic PPO, Options PPO and DeltaCare USA plans.
New Underwriting Rules:
- Out-of-state enrollees: The maximum percentage allowed for out-of-state enrollees in Alaska, Hawaii, New York, Washington and the District of Columbia will increase from 10% to 50% for PPO plans.
- Dual choice: DeltaCare USA groups may only be offered as a Dual Choice alongside Delta Dental PPO plans.
- Transferring between existing Delta Dental pools: Transfers from an existing Delta Dental pool to the California Small Group program will not be permitted.
- Retiree coverage: Coverage is only available to retirees if all of the rules below apply.
- If there is no break in coverage;
- If the employer contribution is identical for both active employees and retirees;
- If coverage is available to all retirees
Clarified Underwriting Rules:
- Deductible rollover credit: Deductible credit will be removed effective January 1, 2009.
- Management carve-out: The following conditions must apply in order for a management carve-out to be accepted:
- Available only to groups that offer Dental Dental PPO ( with or without the PPO + Premier feature) to their management employees
- Non-management employees must be offered a DeltaCare USA plan
- Management carve-outs will be classified as Level 2
- Eligible employees: Confirmed by the employer as full-time, permanent employees will qualify to receive benefits after completing any eligibility waiting period required by the employer.
Due to Delta Dental’s January 2009 changes, existing groups will be assigned new group numbers. As a result, members will receive new ID cards and Explanation of Coverage (EOC) booklets. The employer number will not change.
Please contact Beere & Purves if you have any questions on the changes Delta Dental is making or if you need assistance with your 2009 Delta Dental quotes.
Sincerely,
Beere & Purves
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