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
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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
Slide2Session 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Confidential, unpublished property of Cigna.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
Slide3Importance of dental insurance
3
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna
Slide4Importance 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Confidential, unpublished property of Cigna.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
Slide5Dental 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Confidential, unpublished property of Cigna.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
Slide6Links 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
Slide7Oral 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
Slide8Why 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
Slide9Dental 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
Slide10Working 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
Slide11Approximately 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
Slide12Early 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.
Slide13Most 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
Slide14Dental 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
Slide1515
Healthy Diet, Healthy Mouth, Healthy You!
Slide1616
Alcohol and your Oral
H
ealth
Slide1717
Avoid Stress and the impact on Oral Health
Slide18Get Healthy your smile will thank you
18
Slide19Tobacco and your oral health
19
Slide20Knowledge 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.
Slide21Products and Features
21
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna
Slide22Common 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
Slide23Dental 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
Slide24Cigna 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
Slide25Dental 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
Slide26Dental 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
Slide27Networks and transparency
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2017 Cigna
27
Slide28What 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)
Slide29The 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
Slide31Disruption
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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
Slide32A 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
Slide33Trends 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
Slide34Product 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?
Slide35Product 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
Slide36Membership 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
Slide37SESSION 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
Slide38Thank you
38
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2017 Cigna