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!