Group Dental

Oral health is often considered the runner up behind medical benefits since proper hygiene can help prevent medical complications.

Group dental policies provide employees immediate access to benefits since most exclude waiting periods for services if there are a minimum of 10+ employees.  If there are waiting periods for certain services, they may be waived with proof of prior coverage.

All preventive services such as oral exams, x-rays, and bi-annual cleanings are covered at 100%.  Pediatric dental is embedded in all medical policies, meaning minimum essential care is available to children age 18 and under within their medical policy.

Dental policies are defined by their annual maximum, copays, network, MAC vs. UCR coverage, age limits,  and additional riders such as orthodontic coverage.

  • Annual Maximum: This is the dollar amount that you are entitled to receive as a benefit in any calendar year. The benefit resets every January, and it would also reset should a group switch carrier’s mid-year.
  • Copays: This is the dollar amount associated with your dentist visit, and will vary between in-network and out-of-network.
  • Network: Each carrier is contracted with x number of dentists. If your dentist is contracted with the carrier, they have agreed to a predetermined cost structure and would be considered in-network.  If your dentist is not contracted with the carrier, your serves will be deemed out-of-network and will end up costing you more.
  • MAC – Maximum Allowable Charge. When visiting an out-of-network dentist, each service has a predetermined cost associated to it, you would be liable for anything above said cost.
  • UCR – Usual, Customary, and Reasonable. This coverage structure is accompanied by a percentage, typically ranging from 80-95% which means the allowable benefit is accepted by X% of dentists in your location.  It is still possible to find a dentist that charges more than what is UCR in your area, for which you will be liable for the difference.
  • Age Limits – This is typically associated with Orthodontic coverage. Some plans may only cover children up to the age of 19, whereas others may cover up to the age of 26.

While the information above covers most dental definitions in a nutshell, we look forward to simplifying the purchasing and claims process even further when the time comes.

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CalChoice Health Savings Account (HSA) Options – Q4 2016

As the majority of group renewals are fast approaching, I wanted to outline the different HSA options available to CaliforniaChoice clients.  For the fourth quarter of 2016, there are twelve different HSA eligible medical policies from five different carriers. (Listed Below – Please note that not all plans are available in all 19 regions) Note that there are not any PPO HSA options available to CaliforniaChoice clients at the moment.  You may assume that Anthem’s EPO policy would be a close fit, but beware the limited network without any out-of-network coverage, aside from emergencies.   While the private exchange offers employees the flexibility to choose various plans without the need for employers to meet specific participation requirements, the only way to offer a PPO HSA currently is outside of CaliforniaChoice.  For employers that wish to concurrently offer a PPO alongside Kaiser, you must have a minimum of 5 non-Kaiser employees that wish to enroll, which make up at least 25% of eligible enrollees. While the state’s public exchange, Covered CA, has setup a mirrored network of health plans that offer the same participation flexibility as CaliforniaChoice, they are only offering six HMO HSA policies from three carriers: Kaiser, Sharp, and Western Health. As premiums continue to increase, and plans become more limited and standardized, small group shoppers are losing their flexibility within private exchanges.  We can only hope that the insurance carriers and partners will loosen the reins in 2017. Deductible – A specified amount of money that you must pay before an insurance company will contribute towards a claim. Out of Pocket Max – The most you will have to...