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Dental / Medical       Connection Dental / Medical       Connection

Dental / Medical Connection - PowerPoint Presentation

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Dental / Medical Connection - PPT Presentation

912522 Offered by Cigna Health and Life Insurance Company Connecticut General Life Insurance Company or their affiliates Importance of Dental Insurance for Employees and Employers Session objectives ID: 760680

dental cigna limited network cigna dental network limited solely 2017 unpublished duplicate property confidential personnel authorized distribute distribution oral

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Slide1

Dental / Medical Connection

912522 Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.

Importance of Dental Insurance for Employees and Employers

Slide2

Session objectives

2

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Understand

why dental insurance is important and cost effective

Recognize

factors to consider when quoting dental insurance

Review

common dental insurance concepts

Understand

the trends in dental insurance

Examine how dental coverage can promote overall health and productivity

Slide3

Importance of dental insurance

3

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide4

Importance of dental insurance

4

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Each year, Americans make about 500 million visits to the dentist, and an estimated $108 billion is spent on dental services for oral health problems – National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health, CDC – 2012Employed adults lose more than 164 million hours of work each year due to dental disease or dental visits ─ American Dental Association Website, Dentists: Doctors of Oral Health 2017

Slide5

Dental insurance is the third most popular benefit offered to employees behind health/medical insurance and retirement savings plans such as 401 (k)s. The NAPD study also found that 49% of employees ranked dental benefits as "essential.“1 Dental coverage helps to attract and retain employeesDental insurance is an economical way to enhance the value of benefits’ packagesDental care improvements can increase workplace productivityLess time lost due to dental problemsReduced complications for other chronic conditions (diabetes, heart disease, stroke, pre-term birth)

Importance of dental insurance as an employer benefit

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

CA Broker, a National Association of Dental Plans' Study (NADP) 2014

2

3

1

4

Slide6

Links between oral and overall health

6

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide7

Oral health linked to overall health

7

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Periodontal (gum) disease is a chronic bacterial infection that affects the gums and bones surrounding the teeth:

An estimated 50% of American adults have some form of periodontal (gum) disease which is 64.7 million adults 30 years and older – Centers for Disease Control 2014

The mouth can serve as an “early warning system” for other medical conditions

Slide8

Why it’s important

8

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Source: American Cancer Society. (n.d.). Oral cavity and oropharyngeal cancer.Retrieved from http://www.cancer.org/Cancer/OralCavityandOropharyngealCancer/DetailedGuide/oral-cavity-and-oropharyngeal-cancer-key-statistics

50%

7,000

35,000

25%

Late detection only about 50% survive more than 5 years.

Deaths

annually

Oral cancer cases diagnosed every year

Cases with

non-smokers without other risk factors

Slide9

Dental disease management and integration with medical

9

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed Feb. 3, 2015.National Diabetes Statistics Report, 2014 (released June 10, 2014) - See more at: http://www.diabetes.org/diabetes-basics/statistics/#sthash.aKanOGs7.dpuf

Studies have shown an improvement for those who have been treated for gum disease (reduction of premature births and controlling of blood sugar in diabetic patients)

Approximately 70 million Americans live with some form of cardiovascular disease, which is a leading cause of death for men and women of all racial and ethnic groups in the U.S. – almost 610,000 deaths each year–that’s

1 in every 4 deaths.

1

Diabetes facts – estimates say that 29.1 million have diabetes – and this includes approximately 8.1 million who are undiagnosed.

2

When diabetic patients’ periodontal infections were treated, they experienced improvement in their ability to manage blood sugar

Slide10

Working together

10

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

10

3.65%

LOWER MEDICAL COST

1

1. Preventive Dental Treatment Associated with Lower Medical Utilization and Costs,” national Cigna study presented at the International Association for Dental Research Meeting, 3/ 2015, Boston. Updated with additional 2015 data.2. Dental Outreach Program – Internal Cigna analysis of Dental BOB for the 12-month period through 3/2015, based on mail and telephone outreach to customers with chronic or high risk conditions who have not received dental care in seven or more months.     

EncouragePreventive care

ActivateTargeted communication

40%

VISIT A DENTIST2

Dental Outreach Program

Motivate

Enhanced benefits creates

incentive for high-risk

groups

.

DIABETES

29.9%

($1,687)

HEART

23.2%

($2,101)

STROKE34.7%($2,831)

Cigna Dental Oral Health Integration Program® average medical cost savings1

For better total health and savings

Slide11

Approximately 35,000 oral cancer cases diagnosed each year Sixth deadliest cancer, with over 7,000 deaths annuallyOral cancer is more likely to strike after age 40Tobacco use is a risk factorAlcohol use combined with smoking / tobacco greatly increases risk Over 25% of cases occur in non-smokers without other risk factors

Early detection of oral cancer

11

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Source: American Cancer Society. (n.d.). Oral cavity and oropharyngeal cancer. Retrieved from http://www.cancer.org/Cancer/OralCavityandOropharyngealCancer/DetailedGuide/oral-cavity-and-oropharyngeal-cancer-key-statistics

Improves outcomes and reduces healthcare costs

Late detection

of oral cancer results in 50% survival rate

Slide12

Early preventive visit has positive impact on

costs

12

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

$546

age four to five

$492

age three to four

$449

age two to three

$339

age one to two

$262

before

age one

Average dental-related costs per child

Age at first preventive visit

The age at the first preventive dental visit has a significant positive effect on dental-related expenditures, with the average costs being less for children who received earlier preventive care.

Slide13

Most dental disease is preventable, and dental benefit plans are structured to encourage patients to get regular, routine careDental caries (cavities) are largely preventable; they remain the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years – Center for Disease Controls (CDC), Hygiene Related Diseases 2016Approximately 80 percent of all cavities occur in just 25 percent of kids, and tooth decay is the major cause of tooth loss in children – American Academy of Pediatric Dentistry 2013 Preventive care often catches minor problems before they become major and expensive to treatRegular, routine care can also help to diagnose the onset of serious disease and potentially avoid complications for other diseases

The importance of preventive care

13

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide14

Dental Tips - impact on Oral Health

14

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide15

15

Healthy Diet, Healthy Mouth, Healthy You!

Slide16

16

Alcohol and your Oral

H

ealth

Slide17

17

Avoid Stress and the impact on Oral Health

Slide18

Get Healthy your smile will thank you

18

Slide19

Tobacco and your oral health

19

Slide20

Knowledge check

20

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

True or False?

Good early oral preventive care positively impacts employers and employees by reducing their costs and time away from work.

Slide21

Products and Features

21

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide22

Common types of dental products

22

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Preferred Provider Organizations (DPPOs)

Dental Health Maintenance Organizations (DHMOs)Indemnity Plans (Fee for Service)Referral (Discount Card) Programs – not insuranceMonthly Switch Feature

Innovation

Maximum Member Choice

Maximum Member Savings

DHMO

Monthly Switch Feature

DPPO

Indemnity

Discount Card Program

Flexibility

Slide23

Dental preferred provider organization

23

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

The Dental Exclusive Provider Organization (DEPO) product offers the flexibility of a broad network access with in-network only benefits by utilizing the DPPO network

Members enrolled in a DPPO or DEPO plan may obtain discounts on non-covered services and covered services where permitted by law

Members

can visit in-network or out-of network providers

In-network dentists may not balance bill whereas out-of-network dentists may balance bill membersOn certain plan designs roll over features may be available whereby members may qualify for increase in benefits (dollar maximums or co-insurance levels)

Flexible plan designs to fit cost needs.Most freedom of choice for customer.

Dental Preferred Provider Organization

DPPO

Driving in-network utilization

Slide24

Cigna DENTAL CARE®

24

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Members select a network general dentist upon enrollment – referrals may be required for specialty care

Plans generally cover general and specialty care procedures based on a Patient Charge Schedule amount – members pay pre-set fees unless alternate benefit provisions are applied; some plans cover specialty care at a discount

Select quality,

cost-efficient dentists to help save more.

Orthodontic

coverage for children and adults3Surgical implant coverage available3No annual maximumsNo deductibleAthletic mouth guards and teeth whitening4 coveredLower premiums and lower out-of-pocket costs5Product may not be appropriate for all geographical areas

The term DHMO (“Dental HMO”) is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna DHMO is not available in the following states: AK, HI, ME, MT, NH, NM, ND, PR, RI, SD, VI, VT, WV, and WY. 2. Cigna book of business analytics as of 1/1/2015. 3. In most states, individuals must receive non-emergency services through their network general dentist for coverage to apply. Prior authorization may be required for certain specialty care treatments. Only those procedures that are medically necessary and listed on the plan’s Patient Charge Schedule (PCS) are covered. Services related to the surgical placement of a dental implant are limited to one per year with replacement of a surgical implant frequency limitation of one every 10 years. The frequency limitations of certain other covered services are set forth in the PCS. The following are excluded from coverage unless otherwise listed on the PCS or required by law: (a) Experimental and cosmetic dentistry; (b) Treatments or surgery if associated with a poor or hopeless diagnosis; (c) Recementation of crowns, inlays and onlays, post and cores, and veneers within 180 days of initial placement; (d) Crowns, bridges and implant supported prosthesis used solely for splinting; and (e) Work already in progress for crowns, bridges, dentures, root canal treatment, or implant supported prosthesis. A complete list of your plan’s terms, including exclusions and limitations, is set forth in the applicable plan documents. 4. Athletic Guards and Take Home Whitening Trays covered on the 09 PCS Series only. Refer to your plan materials to see if your plan includes orthodontic coverage. The following orthodontic services are generally not covered: orthodontic treatment already in progress; incremental costs associated with optional/elective materials; orthodontic surgery appliances to guide minor tooth movement or correct harmful habits; and any services which are not typically included in orthodontic treatment. Coverage for treatment by a pediatric dentist ends on your child's 7th birthday. Effective on your child's 7th birthday, dental services generally must be obtained from a network general dentist. 5. 2014 Cigna Dental book of business, clients who offer both DHMO and DPPO have on average 40% lower DHMO premiums than their DPPO premiums. 6. Projected 2018 Year End access points. 95,200 DHMO access points as of 10/11/16).

Dental

Health Maintenance Organization1

DHMO

Slide25

Dental preferred provider organization

25

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Retirees

Part-time

Seasonal

Uninsured

Takes advantage of pricing from discounted network dentist

No reimbursement from an insurance policyNot insurance – just access to discounted servicesAvailable as individual and group products

Takes advantage of network pricing, but provides no dental benefit.

Discount Card Programs

Slide26

Dental preferred provider organization

26

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Socialized rates

Slightly lowers DPPO rate

Significantly increases DHMO rate

Good way to introduce DHMO to a cautious client

Not a product, but a feature

Employer purchases/offers both plans; switch feature can be addedAllows the customer to switch monthly between the two plans through the year without penaltyCost effective and low noise method to offer greater flexibility and choice to employees

Allows customers to switch between DPPO plan and DHMO Plan

Monthly Switch Feature

Slide27

Networks and transparency

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

27

Slide28

What is a network?

28

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

The

“network” is an arrangement between a carrier or an administrator and the dental provider to reduce their fees for their common customersThe dental provider cannot balance bill the client for covered servicesThe dental provider can bill the client full value of non covered services (cosmetic, whitening, implants if not covered, etc.)Contracted dentists file claims on patient behalfBoth the customer and the client benefit from reduced costs

Carriers (carry the risk) or administrators and TPA’s use a network (do not carry risk)

Slide29

The importance of discounts

29

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Discounts from providers are important because they:Provide savings beyond the cost for network accessMaintain competitive pricing for the marketplaceReduce out-of-pocket cost on coinsurance and copays for customers

Factors to consider in evaluating network size:Balance of discount with accessAnalyze existing in-network vs. out-of-network utilizationReview highly utilized proceduresEvaluate highly utilized providers

And how network access affects them

Discounts

Network

access

Slide30

$

Effective discount

*

21%

Average network

60% utilization

Provider discount

35% savings

Effective discount*25.6%

Larger network can outweigh lesser discounts

$

Robust Network

75.6%

utilization

33.9%

savings

Broad network access and discounts save money

30

Provider discount

Evaluating network reach and discounts

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide31

Disruption

31

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

 Cigna DPPO network resultsAll MatchesSubmitted InfoTotal DPPOMatched Info% Matched# of Provider Access Points2,8351,92168%In Network Claim Total Charge$2,893,343$2,859,51499%In Network Claim Allowed Amount$1,850,816$1,823,52599%In Network Claim Paid Amount$1,337,111$1,315,38898%In Network Claim Count$7,359$7,22198%Out Network Claim Total Charge$8,375,929$3,759,70345%Out Network Claim Allowed Amount$6,931,248$3,078,12944%Out Network Claim Paid Amount$5,100,803$2,303,84845%Out Network Claim Count$24,357$10,54343%Claim Total Charge$11,269,272$6,619,21659%Claim Allowed Amount$8,782,064$4,901,65456%Claim Paid Amount$6,437,914$3,619,23656%Claim Count31,71617,76456%

Comparing match criteria – Cigna DPPO

Slide32

A Look at Trends in Dental

32

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Slide33

Trends in dental products and benefits

33

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Oral Health Integration

Increased movement toward enhanced benefits

Increased outreach / awareness

Increased analytics

Carriers covering new conditions

Cost Containment

Lean plan designs Package high / low plans Retiree offering Voluntary

ConsumerismGrowth of incentive plansUse of lean PPO plansConsumer decision support tools / increased cost transparencyFocus on wellnessIncreased consumer choice with exchange offerings

Leverage Networks

Tiering

Client specific network

Increased growth of Dental Service Organizations

More doctors of dental surgery accepting managed care plans

Slide34

Product innovation and trends

34

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

Benefit designs have not

changed dramatically:Deductibles still average $50 Annual maximums continue to range from $1,000 to $2,000Growing exploration of evidence-based dental concepts – linkages between general health and oral health translated into coverage

Do they exist?

Slide35

Product innovation

and

trends

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna

% of

members who reach $1500 CY

max

- with Ortho

% of members who reach $1500 CY max - without Ortho

% of members who reach $1000 CY max - with Ortho

% of members who reach $1000 CY max - without Ortho

Slide36

Membership enrollment by product type

36

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

The trend toward DPPO products is continuing among commercial products with 78% of all commercial productsDPPO is showing growth in market share at the expense of DHMO & Indemnity plansDHMO remains popular in states with large metropolitan populations with 79% of all DHMO in just ten states

Membership

Source: NADP/DDPA Joint Dental Benefits Report: Enrollment September 2013

Enrollment Trend by Product

Slide37

SESSION RECAP & Q&A

37

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna

Understand

why dental insurance is important and cost effective

Recognize

factors to consider when quoting dental insurance

Review

common dental insurance concepts

Understand

the trends in dental insurance

Examine how dental coverage can promote overall health and productivity

Slide38

Thank you

38

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna