An Overview of Delta Dental Insurance Essay Example for Free

An Overview of Delta Dental Insurance Essay This paper provides an overview of Delta Dental – one of the most successful health care companies in the United States. As good oral health becomes more essential of Americans’ healthy lifestyle, Delta Dental insurance plans help more than 59.5 million people to be covered on their plans. By describing the outline of Delta Dental’s history and current structure, this article focuses on how Delta Dental insurance has grown and improved access and overall health status. Also, this paper explores strengths and weaknesses (especially with healthcare delivery point of view) as well as makes comparison with other dental insurances companies to reveal that why Delta Dental is better and more successful than others. Finally, the future plans of Delta Dental about how to improve oral care delivery of services to clients and enrollees, as well as how it fared compare to its peer insurance companies are initialed at the end of the paper. Keywords: dental benefits programs, strengths and weaknesses, multiple types, expanding, effective benefits Many people in the world may have best access to oral health care, yet millions are unable to get basic dental care. Poor oral hygiene has significant impact on overall personal health. Researches show that poor oral hygiene increases the risk of diabetes, heart disease and poor birth outcome. That’s why nobody can deny the importance of oral health care. According to many statistics insurance companies that play a pivotal role in improving oral health care of the communities, we will focus on the Delta Dental insurance and how growth of the company improved access and overall health status. Delta Dental insurance was established in 1966. Over the years it faces many challenges to expand and increase access of dental care in community. The efforts paid the Delta Dental as widely accepted by community. This paper focuses on challenges Delta Dental had to face to build its pillar in the market. After evolution, Delta Dental insurance exponentially expanded due to its benefits and low primer. Over the years it has made strategies so that many people prefer Delta Dental over other insurances for maximum benefits, which helped improve oral health care. This paper will also highlight some of those strategies. Compare to other dental insurance company, Delta Dental insurance provide wide coverage and offer maximum benefits. This is a unique characteristic of the Delta Dental. We will talk about current structure of the Delta Dental and its future about how to improve oral care delivery of services to clients and enrollees, as well as how it fared compare to its peer insurance companies. Finally, the paper will mention about the future plan of the Delta Dental. In order to increase access to oral health care, in 1954, a group of dentists formed a dental service corporation in California, Oregon and Washington. It was lead by Washington Dental Service (WDS), and initiated by providing service to organized labor unions. Later, it expanded its services to all 50 states, the District of Columbia and Puerto Rico. Delta dental is now a fifteen billion dollar a year nationwide group providing dental insurance to 59 million Americans, making it one of the largest non-profits in the country (â€Å"Our Mission & History†, n.d.). Washington Dental Service was joined by more local organizations, which then created Delta Dental Plans Association (DDPA) in 1966. Shortly a year after, WDS partnered with the International Association of Machinists, which was the first step into creating a multi-state dental benefits program. There was a growing number of out of state subscribers, and therefore in order to meet their needs WDS worked with other Delta Dental member companies and Blue Cross/Blue Shield Association members, to continue serving its clients. It provided coverage until 1980’s this way (â€Å"Our Mission & History†, n.d.). The program continued as such until a bid was won by Delta Dental of California being chosen as the dental benefits carrier for the Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) program. In order for the administration of this very large account to be centralized, other member companies agreed to share its provider data with Delta Dental of California sharing the administrative income and risk. As a result of this change, the National Provider File (NPF), and the establishment in 1990 of Delta USA — was created, the company responsible for overseeing dentist data and enabling the administration of national business (â€Å"Our Mission & History†, n.d.). Currently, there are 39 independent Delta Dental member companies operating in all 50 states, the District of Columbia and Puerto Rico. As one of the largest dental benefits provider DDPA provides coverage to more than 59.5 million people enrolled in more than 97,000 groups. The company was named Dental Care until 1970’s and then it officially changed its name to Delta Dental (â€Å"About Us Home†, n.d.). All Delta Dental companies are members, or affiliate of members, of the Delta Dental Plans Association – a network of 39 Delta Dental companies throughout the country. Delta Dental companies range from multi-state to single state (â€Å"About Us Home†, n.d.). The multi-state programs consist of the following: Started in 1969, it provides coverage to over 1.5 million residents of New Jersey and Connecticut (â€Å"Delta Dental of New Jersey†, n.d.). * Delta Dental Plan of Michigan Michigan Dental Service (MDS) was established in 1957, and in 1963 it received its non-profit status. In 1980 MDS expanded to Ohio and Indiana. In early 2006, Delta Dental of Michigan, with its affiliates in Ohio and Indiana, and Tennessee, signed an affiliation agreement under a new nonprofit holding company to strengthen their market positions and increase the number of Americans with dental benefits. In 2009, Delta Dental of Kentucky and Delta Dental of New Mexico affiliated with the family of companies. The newest affiliate, Delta Dental of North Carolina, joined the enterprise in 2010. Currently they cover 8.8 million individuals (â€Å"Delta Dental of Michigan†, n.d.). It was founded in 1969, and later expanded to North Dakota. It is the largest program in the upper Midwest, serving 7500 Minnesota based on purchasing groups and 3.8 million members nationwide (â€Å"Delta Dental of Minnesota†, n.d.). Delta Dental of Missouri started 50 years ago and has offered dental and vision benefits in the states of Missouri and South Carolina. More than 1,800 companies in Missouri and South Carolina have selected Delta Dental as their dental benefits carrier. The Delta-Vision plan started in 2011 (â€Å"Delta Dental of Missouri†, n.d.). Dentegra is not affiliated with Delta Dental Plans Association. However, this insurance company is authorized by Delta Dental Plans Association to market and underwrites certain national Delta Dental programs. This plan covers 23 million Americans. It serves the states of: Alabama, California, Delaware, District of Columbia, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania, Puerto Rico, Texas, Utah, Virgin Islands, West Virginia (â€Å"Why do more than†, n.d.). Hawaii Dental Service (HDS) is the first and largest nonprofit dental service corporation in Hawaii providing dental benefit plans to more than a half million members. This plan was incorporated on February 15, 1962, and soon 221 licensed dentists became charter members. HDS serves Guam, Hawaii and Northern Mariana Islands (â€Å"Caring, Visionary Dentists From HDS†, n.d.). NDD offers the states of Maine, New Hampshire, Vermont, providing quality dental care to millions of residents (â€Å"Northeast Delta Dental†, n.d.). This plan covers Alaska and Oregon. A research to find affordable dental health by Longshoremen’s and Warehousemen’s Union, led them to find Oregon Dental Service in 1955(â€Å"A trailblazer in health†, n.d.). * The single state companies include: Delta Dental of Arizona that started in 1972. Delta Dental of Arkansas, Delta Dental of Colorado began in 1958. Delta Dental of Idaho, Delta Dental of Illinois, Delta Dental of Iowa, Delta Dental of Kansas, Delta Dental of Massachusetts, Delta Dental of Nebraska, Delta Dental of Oklahoma, Delta Dental of Rhode Island, Delta Dental of South Dakota, Washington Dental Service, Delta Dental of Wisconsin, Delta Dental of Wyoming (â€Å"Delta Dental: Members†, n.d.). Delta Dental offers various plans for individuals, families and enrollees. There are 39 member companies of Delta Dental and each of them provides a variety of dental benefits programs. It also forms contacts with small and large business companies to provide dental insurance coverage for their employees (â€Å"Products and Plans†, n.d.). The various plans offered are the following: 1. Delta Dental Premier ®: This is their traditional fee-for-service plan with largest dentist network with more than four out of five nation’s dentist participating (â€Å"Delta Dental Premier ®Ã¢â‚¬ , n.d., p. 2). It allows patients to get treated by any licensed dentist and also can change dentists at any time without notifying Delta Dental. The main attraction for this plan is that you do not have to pay more than the co-insurance percentage specified by your coverage (â€Å"Delta Dental’s plans†, n.d.). The participating dentists agree to accept pre-negotiated fees and are prohibited from billing more. 2. Delta Dental PPOâ„  : This is a mid-priced fee-for-service plan with the secondary largest dentist network. It has an option to get treated by any dentists and still have lower out-of-pocket costs because the dentists in this network have agreed to do so (â€Å"Delta Dental’s plans†, n.d.). It also has a Delta Dental PPO plus Premier plan which includes all the benefits of Delta Dental PPO and also allows for a patient to see a Delta Dental Premier dentist with benefits of that dentist’s contracted fee (â€Å" Delta Dental PPOâ„   †, n.d.). 3. DeltaCare ® USA: It is a HMO-type prepaid plan with a large network of participating dentists. You must select a dentist from their network for this plan. The main features are there is no annual deductibles, no maximums for covered benefits and set copayments (â€Å"Delta Dental’s plans†, n.d .). 4. Delta Dental Individual and Family: Individual and its family can get the same quality dental benefits as provided by the employers under this plan. Delta Dental offers different plans in different states (â€Å"Delta Dental Individual and Family†, n.d.). 5. Delta Dental Legion ®: It is also known as TRICARE Retiree Dental Program. â€Å"The first and only dental benefits plan created by Congress especially for Uniformed Services retirees and their family members and administered by Delta Dental of California.†(â€Å"TRICARE Retiree Dental Program†, n.d.). 6. Delta Dental Patient Direct ®: It is a dental discount plan for individual, families and groups that do not have dental benefits. The patients choose dentists from the network and pay them directly with the discount price at the time of their treatment. No paper work is required and it is available in the selected markets only (â€Å"Delta Dental Patient Direct ®Ã¢â‚¬ , n.d.). 7. DeltaVision ®: This is vision benefit plan, which is offered in the selected markets only. It includes various pre-negotiated pricing eye-care services, such as professional eye exams, eyewear, contact lenses and laser vision correction (â€Å"DeltaVision ®Ã¢â‚¬ , n.d.). 8. Delta Dental Member Companies: â€Å"They serve nearly one-third of the estimated 173 million Americans with Dental insurance, providing dental insurance coverage to more than 54 million people in more than 93,000 groups across the nation.†(â€Å"Delta Dental Member Companies†, n.d.). There are other plans which are available in few selected populations and states like the American Association of Retired Persons (AARP) Dental Insurance Plan which is exclusively for AARP members and the Costco Group Dental Plan for the Individuals and Families, which is available only in California (â€Å"Delta Dental’s plans, n.d.). Strengths and weaknesses (especially with healthcare delivery point of view): Delta Dental is the largest dental care carrier in the United States, and they provide coverage to more than 59.5 million people enrolled in more than 97,000 groups. The strengths are obviously regarding to the high level access of the dental care. Many years ago, most of people lost their teeth by middle age, but now many Americans have very good oral health because of the various Delta Dental Plans. They may keep their teeth throughout the lifetime. There are some strengths of Delta Dental according to a recent study (â€Å"Delta Dental by the Numbers†, n.d.): * Delta Dental’s nationwide dentist networks offer unprecedented access: * Delta Dental Premier ® offers the largest network of dentists in the country — encompassing more than 142,000 dentists and more than 251,000 office locations. * Delta Dental PPOSM has a national network of more than 83,900 dentists practicing in more than 168,000 locations. * DeltaCare ® USA provides more than 39,800 dentist office locations. * Delta Dental’s PPO Plan delivers the industry’s best effective discount — averaging 19 percent nationally — resulting in nearly $3 billion in annual savings compared to dentists’ average charges. * Delta Dental posted approximately $17 billion in premium revenue during fiscal year 2011, our 32nd consecutive year of financial gains. * Delta Dental’s unique cost-control measures and contractual agreements with dentists help to ensure quality care at moderate fees, collectively saving subscribers with group dental coverage more than $9.0 billion in 2011. * In 2011, Delta Dental member companies processed more than 90 million dental claims or approximately 1.7 million every week, with an accuracy rate of 99.7 percent. Delta Dental focuses on the practice shari ng, best services, performance guarantees, brand name recognition and reputation, whereas, it still have weaknesses such as geographic limitations, innovative practices. Through the numbers above, people might think that we have more and more dentists in large networks so that we would get easy access to dental care, but how do these dentists located? Low-income patients still feel hard to get access to meet one dentist regularly due to the inconvenient transportation, difficulties on appointments, and so on. The president and CEO of Delta Dental, Radine (2011) wrote on â€Å"Annual Report 2011†, â€Å"Delta Dental takes pride in being a single-line carrier with unparalleled expertise in dental benefits, our specialty.† Indeed, they against larger, multi-line insurance companies, and they use competitive strategies to survive during the worst of the economic downturn. However, this kind of single-line model can also be a weakness of dental health care, because coordination of dentists needed to reinforce to increase the quality of companies health care performance. Single-line service may hinder such coordination in between the large dentist network, although they meet the needs for restraining the continuous increased costs. As each program have dissimilar strengths and weaknesses and according to Access to Dental Care/Oral Health Care (American Dental Association, 2012), there are still barriers to getting oral health care: * The dental sections in Medicaid and the State Children’s Health Insurance Programs (SCHIP), which are supposed to provide health care to disadvantaged Americans, rarely have enough money budgeted to do so. Federal law requires that Medicaid cover basic dental services. But many state programs fail to deliver care to even half of their eligible children. * Adult dental coverage through public health programs is even worse; many states simply don’t provide it. It’s not just about the money. Patients covered under public programs still face hurdles, such as transportation to dental appointments and the difficulty of missing work to keep the appointments. Taking care of ourselves is the key to good oral health, and too many Americans lack a basic understanding of how to brush, floss, eat a healthy diet and drink water with fluoride in it. * About one-third of public water systems are not fluoridated, even though that is the single most effective public health measure to protect against tooth decay. And also, people need to treat what form of coverage they require most and make sure the selected plan provides a low price for the needed processes. Comparison of Delta Dental with all other dental insurances: There are many essential things to keep in mind when deciding on a dental insurance plan, such as prices and co-payment options, local dentist availability, actual coverage, whether it meets your needs and more (â€Å"Dental Insurance Review†, n.d.). Delta Dental Insurance ranking at number three after United Concordia and Ameritas Group Dental is one of the top ten insurance plans in the United States (â€Å"2013 Dental Insurance Comparison†, n.d.). As one of the largest dental coverage plans, founded by dentists, it creates dental coverage plans based on current research and designed to keep people their healthiest and most productive (â€Å"Choosing the Right Dental Plan†, n.d.). Delta Dental Insurance pursues their mission by increasing access to benefits, offering the largest national network of dentists, adding innovative new plan features, aggressively working to keep costs down, and supporting p hilanthropic programs that encourage better overall oral health. Delta Dental Insurance plans offer top of the line features and programs to make insurance services more accessible and convenient for its members. Some of the features that Delta Dental Insurance consists are secure and accessible sites for online enrollment, finding dentists and getting information about available plans. It offers Group/Employer plans, which is important as it gives companies information on the cost of getting dental insurance for their employees. This is important as well for families who wish to enroll other members of the family into the insurance plan. Also Delta Dental Insurance offers individual plans, provides up-front cost information for customers and has Better Business Bureau (BBB) accreditation (â€Å"Dental Insurance Review†, n.d.). Better Business Bureau accreditation is definitely a plus, because they provide ratings based on customer service and satisfaction of members. In addition, Delta Dental Insurance offers multiple types of different plans for its consumers. There is Delta Dental Preferred Provider Organization (PPO), DeltaCare ® USA (Health Maintenance Organization (HMO) option), Fee-for-Service (FFS) Plan, and they also used to offer Discount Plans. But the Discounted Plans are no longer offered by Delta Dental since majority of the members prefer PPO, HMO and FFS plans. The Delta Dental PPO plan is offered worldwide, and for that reason it is more accessible even if the customer relocates (â€Å"Choosing between a PPO and HMO†, n.d.). When choosing a PPO dentist, the out of-pocket costs of customers are often lower because PPO dentists have agreed to charge Delta Dental PPO patients reduced fees. The plan also pays enhanced benefits when patients visit a PPO dentist, so they pay only 20 percent of the PPO dentist’s contracted fee after their deductible for such services as fillings, oral surgery, root canals and treatment of gum disease in addition to other benefit enhancements (â€Å"Types of Dental Plans†, n.d.). Delta Dental PPO does not cover teeth bleaching and other cosmetic procedures (â€Å"University of California†, 2009). The good thing about a PPO plan is that customers have the freedom to choose any licensed dentist, anywhere in the world, each time the member or a family member requires treatment. And there is no referral required for specialty care. On the other hand, DeltaCare ® USA (HMO option) customers must be residents of California to enroll. It provides individuals and their families with inclusive plans and easy referrals to specialists and even has a benefit for teeth bleaching. The plan emphasizes preventive care; so many services are provided at no cost. There is no annual plan maximum for DeltaCare ® USA (â€Å"Types of Dental Plans†, n.d.). As an HMO member, customers are assigned to network dentist that accept the plans and they must be referred specialist by their assigned dentists. Fee-for-service plans, also known as indemnity or traditional plans, typically offer the greatest choice of dentists. It is up to the customer what dentist to choose or procedure they would like to purchase. Like PPO plans, when you visit a network dentist, you typically pay a certain percentage for each service (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage, such as diagnostic and preventive, major services, etc. (â€Å"Types of Dental Plans†, n.d.). However with FFS plan the member might pay a little extra than the PPO plan. And finally, the Discounted Plans are insurance plans that are offered at reduced rates. There is generally no paperwork, annual limits or deductibles, but you must visit a participating dentist to receive the discount. Also, you may be responsible for a greater portion of the treatment cost compare to PPO or HMO plan. The downside of this plan was the fact that there was a possibility of the dentists being changed annually, and new dentists would be assigned to the customers. But on the plus side, the rates that the customers would receive would be unbeatable. Figure 1 shows the continued growth in enrolment throughout the recession. This also proves that Delta Dental is the largest dental carrier in the United States and it has more than 26 million enrollees at present (â€Å"Delta Dental: Annual Report2011†, n.d., p. 10). Figure 1: Shows the increase in the enrollment of Delta Dental plans by the population. The Y-axis shows the number of enrollees in increasing order and the X-axis shows the years starting from 2008-2012. Adapted from: â€Å"Delta Dental: Annual Report 2011.† (n.d., p. 10). Why is Delta Dental better and more successful than other insurances? Delta Dental offers some of the best dental insurance plans in the United States and around the world since 1954 and as the first company exclusively specializing in dental benefits, Delta Dental has been working hard to improve oral health around the world by providing access to the largest network of dentists, great service, top of the line care plans and developing relationships that emphasize prevention and positive oral health care results over the long term (Delta Dental, 2010). Over 56 million enrollees trust Delta Dental Insurance plans with their oral health and the numbers of satisfied members keep growing (â€Å"Why do more than†, n.d.). â€Å"In 2011, the vast majority of surveyed enrollees from our open network plans said they would recommend Delta Dental to a family or friend. That loyalty is also evident in our exceptionally high enrollee retention rate.† (â€Å"Delta Dental 2011 Annual Report†, n.d., p. 11). Figure 2 which is adapted from the â€Å"Delta Dental: Annual Report 2011† (n.d., p. 11) shows the percentage of enrollee satisfaction and enrollee retention in 2011. Figure 2: The percentage of Enrollee satisfaction and Enrollee Retention. 95% of the Enrollees were satisfied with their Delta Dental Plan and 99% of the Enrollees retained their Delta Dental plan. Adapted from: â€Å"Delta Dental: Annual Report 2011† (n.d., p. 11) Delta dental has proven itself as one of the good companies in the market but still they are working diligently to make it better. Delta Dental supports projects in conjunction with major universities and other leading research organizations that are designed to advance scientific knowledge and improve health. Among the projects, recently supports are: a study on the potential for dentists to play a greater role in the detection of health conditions such as diabetes; the cost impact of oral cancer; the application of salivary diagnostics to dentistry; and the development of biotechnology to advance health (Carruth, 2012). All these are the major projects of Delta Dental. Delta Dental is trying to identify ways to improve offerings in ways that will reduce costs while still covering the treatment our subscribers need to stay healthy. Delta Dental will focus on expanding their network in remote places and provide oral care. They are planning continue creating dynamic product lines that provide effective benefits to improve oral health–and overall health – while reducing costs. Delta Dental would concentrate on providing good customer service staff as well as an automated phone line for inquiries. Delta Dental has received many awards in improving oral health care. Their current plans are focused on expanding their network and providing good care for the patients. Delta Dental’s strategies are such that not only patients but also dentist and employees are benefitted. They also focus on many researches to improve quality of care. Moreover, their future plans are focus on reducing cost and providing quality of care for patients. They are providing funds for incurable diseases like cancer and other malignancy. References: A trailblazer in health. n.d.). and your family. r local member companies. Retrieved form: http://www.deltadental.com/Public/PlanInfo/planAddressStart.jsp Delta Dental (n.d.). DeltaVision ®.