Just as your early 12/1 renewals are winding down and you
can finally take that giant deep breath, relax and do some light reading on the
progress of Healthcare.Gov (I’m being facetious), out of nowhere comes a new test
for your experienced benefits mind—pediatric
dental in small group!
I’ve been out doing quite the road show lately regarding
this little wrinkle in the law and no doubt this thing came up on all of us out
of nowhere.
I trust by now all you have a working knowledge of the
situation but if you’re still at the 101 level, you can access a recent blog
post of mine that outlines it here.
If you’ve moved past the point of needing to understand it
to the point of trying to figure out a strategy, Benefit Profiles Inc has you
covered. In the articles below, we will
give you sound and outlined answers to this pediatric dental test starting with
a very BIG announcement!
Benefit Profiles Inc,
New GA for Delta Dental!
I
am pleased to announce BPI has entered into an agreement with Delta Dental to
distribute its products as a General Agent in Michigan. This is a great fit for many reasons:
- Benefit Profiles Inc’s pedigree and expertise in distributing small to medium sized group ancillary benefits, especially dental.
- Delta’s recent development of a small market strategy which includes very competitively rated certified EHB dental plans as well as the benchmark stand alone pediatric dental plan in Michigan.
Those of you who work with Delta in the small group know
that right now you can utilize a generic inbox to procure quotes and submit new
business. Now with BPI we can send you
small group quotes in a day utilizing an online quoting system. We can aid you in placing new business and in
ongoing service and none of our services will add cost in commissions nor your
groups in rates. Delta sees our
involvement as a win-win both in extra administration for them as well as the
ability to reach further into the agent community with our footprint.
The Solution for
Pediatric Dental
What further makes the addition of Delta so exciting to us
at BPI is, much like you, we need a stand- alone pediatric dental carrier. It’s become very apparent in the past few
weeks that there are three distinct scenarios for dental in the small group
following 1/1/14:
- Group has Blue Cross but no dental and needs to find a solution to comply--View our Solutions Chart!
- Group has PH but no dental and needs a solution--Solutions Chart
- Group has a fully-insured medical carrier and a stand-alone non-compliant dental carrier and would like to come into compliance with the EHB--Solutions Chart
Scenarios 1 and 2 are fairly simple with apparent
solutions. But Scenario 3 is causing
consternation for all of us involved in distributing small group dental simply
because most of the dental carriers are not certified EHB carriers for
1/1/2014. This includes Companion Life
and Kansas City Life!
So what are the solutions?
Scenarios 1 and
2—Blue Cross or Priority Health Groups with No Dental Currently
The easiest way to solve this issue is to add Blue or Delta
Pediatric Stand Alone dental to the plan.
This costs roughly $25-$33 a kid and it maxed at three kids so $25 to
$90 monthly tacked on to a double or family rate. Yeah, just like that. Fun huh?
Given we know the group has to purchase pediatric dental and
we know the stand alone options are expensive, BPI would like you to consider
finding solutions that might stretch those dollars. If we gulp down hard and accept the fact that
employees in small groups will have this new burden of cost, isn’t it our jobs
as agents to see where the best value lies for the money?
In this vein, we would urge you to look at Met or Delta’s
value plans. Met offers a great MAC
(Mandatory Allowable Cost—In Network Only Plan) option that can get family
rates below $90 monthly. The idea here
is if the cost is going to be $90 for three kids, why not find a plan that will
cover the parents at the same price? The
in-network only is a pain but Met’s network is bigger than Dentemax and
remember, these folks have no dental today.
Something is better than nothing!
Delta offers 50/50/50 or 80/50/40 plans that could get to
this price point as well.
Scenario 3—Blue Cross
or Priority Health Group with A Non-Compliant Stand Alone Dental Plan
This
is a stickier situation than the previous two scenarios: the group has already
established a dental plan like Companion Life who has not been certified to
sell an EHB plan in Michigan. What are the
options?
The
first way to handle this is to simply add a stand-alone pediatric option from
either Blues or Delta to satisfy the EHB requirement. This is expensive but many agents are doing
this just to ensure everyone is in compliance.
The question remains then, what to do with the Companion Life. The first thing you could do is to leave the
Companion in place. The kids would be
double-covered, Blues or Delta would be primary and Companion secondary. And the Companion would offer pediatric ortho
and some other benefits the pediatric option would not. The other option would be to carve the kids
right off the Companion plan and do an adult only plan. The final choice would be to do a ‘wrap’ option
with Companion whereby the adults are covered on a full dental plan but the
children under age 19 have certain benefits the pediatric only doesn’t cover
like orthodontia. Simple huh? This option is clunky but it does very much
satisfy the EHB requirement so some agents are strongly considering it for some
groups especially where the stand alone dental plan is voluntary already.
The
second way to handle this scenario is to simply replace the stand alone dental plan
with a certified EHB plan. In this
option BPI would send you only Met, MMA or Delta quotes and we could help you
understand the differences, pros and cons to moving to this type of plan.
Want to Talk Further?
Give me a call at 616.481.8675 or shoot me an email and we can cover all of this in person. I'm very proud of the solutions we have developed at BPI to help agents pass this test and I'm happy to drive to see you!
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