Tuesday, July 1, 2014

Planning Your Fall--Plans to Manage Your Small Groups

It certainly has been a ride with the pediatric dental benefit in Michigan this year and this fall looks to be the pinnacle of the activity.  I'll begin my conversation with the Blues and possible plans to manage pediatric dental in these groups.  The HMO's and self funded groups offer quite a bit more flexibility and the Blue groups tend to take up most of our conversations as we consult with our agencies here at BPI.  

As it stands right now, Met, the MMA and Delta all remain pediatric dental certified for 2014 and 2015 so any groups you have with them currently will be completely fine and you can feel comfortable signing the Blues' attestation form this Fall.   

Companion Life and Kansas City Life have not gotten the official word but both feel confident they will be certified and ready to go 1/1/2015 with compliant plans.  But that will only be January 1, 2015.  Groups that renew this fall will still pose a problem, even if for a few months.  

The simplest solution will be to move those groups to an ACA compliant dental plan.  But what if your group is satisfied with their current carrier or many of the employees have met a lifetime deductible?  We have seen this time and time again this year already.  

In some of those cases, the group actually added the pediatric portion to the Blues and continued the dental with Companion or KCL.  Sometimes they removed the children from the dental plan in effect making the Companion or KCL plan an 'adult only' plan. This did offer a suitable solution but it still does leave some holes in coverage, orthodontia being the biggest.  

Companion Life has filed a 'Pediatric Wrap' option to add to this adult only plan that will allow you to leave the children on the plan but it will cover only items like orthodontia and other items excluded by the pediatric oral plans.  The rest of the dental plan will be covered by the Blues.  We don't have exact pricing and details on this but we'll shoot it out as soon as we have it.  

When it comes to Priority, the other HMO's in the State and the self funded solutions for small group, there really remains different options.  If a group 'grandmothers' or stays put with a pre-ACA plan, they don't have to worry about pediatric dental and they can continue with whatever plan they'd prefer.  If a group moves to a self funded arrangement, they don't have to worry about the 10 essential health benefits and they can avoid the pediatric dental.  If a group moves to an ACA compliant plan in an HMO, they'll have to go through the same steps as above.  

Make no mistake though, pediatric dental has caused more consternation than it was meant to in the State of Michigan.  We'll be constantly communicating this Fall with the goal to give you solutions to make it as easy as possible.  

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