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How Does the Narrow Network Trend Play Out in Behavioral Health Networks?

Posted by Laura McMullen on Thu, Jan 11, 2018

A recent article from Kaiser Health News discussed a study from researchers at the University of Pennsylvania about narrow behavioral health networks. The researchers compared mental health provider participation in marketplace networks to primary care physician participation in the same networks using 2016 data from the Robert Wood Johnson Foundation for 531 provider networks offered by 281 insurance carriers in the marketplaces in every state plus the District of Columbia. 

Here’s what they found:mental healthcare.jpg

  • The average provider network includes 11% of all the mental health care providers in a given market while 24% of PCPs participate.
  • An average marketplace plan’s network includes just under 25% of all psychiatrists and 10% of all non-physician mental health care providers. Non-physician mental health care providers included psychologists, nurse practitioners and physician assistants, and behavioral specialists, counselors and therapists with master’s or doctoral degrees.

How do these counts compare to commercial behavioral networks? We looked at unique provider counts in the 5 largest behavioral health networks in NetMinder and here’s what we learned:

  • Total mental health care provider participation ranges from 18% - 27%. Total PCP participation ranges from 27% - 41% in medical networks from the same companies.
  • Commercial networks include 12% - 34% of psychiatrists and 16% - 42% of psychologists who participate in at least one network.

While more behavioral health providers participate in commercial networks, the trend is similar. The study went on to consider reasons for the gap:

  • Low levels of network participation among mental health care providers. Among physician specialties, psychiatrists are least likely to join networks, according to a 2014 study in JAMA Psychiatry. While this research was limited to psychiatrists, other private-practice mental health providers have similar participation levels.
  • Reimbursements drive behavior. Many plans don’t reimburse providers for case management and other non-physician services. Psychiatrists prescribe medication which is reimbursed at a higher rate than therapy and often covered in medical plans leading them to participate in those networks instead of behavioral health networks.
  • Shortage of mental health providers. While psychology is consistently one of the top 10 college majors, there is a shortage of psychiatrists and psychologists, as we noted in a 2016 post. In 2017, psychiatrists are ranked #17 and psychologists are ranked #30 in US News and World Reports list of 100 Best Jobs based on demand, salary, job satisfaction, and other factors.

The decade-long push for mental health parity in insurance coverage has provided incentives to fill this gap. Primary care physicians, physician assistants, and other non-physicians are providing mental health services. In fact, NPR and Kaiser Health News reported that a recent Milliman study found that “insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.”

How is your network adapting to the changing market?

Tags: narrow networks, healthcare benefits, healthcare providers, behavioral health, mental health care, behavioral health networks

The Fine Line Between Differentiation and Disruption

Posted by Laura McMullen on Thu, Nov 16, 2017

Switching networks can be rough, as the Texas Employees Retirement System found out when they switched to a Blue Cross Blue Shield of Texas HMO plan after using United Healthcare for several years. The Texas Blues plan uses the HealthSelect network which was designed for large groups offering ample coverage in Dallas, Houston, and other big cities. In rural areas, the Blue Advantage network, designed for small groups and individual plans, would have been a better fit, according to local experts. Blue Cross Blue Shield of Texas has moved quickly to address the network gaps. Members who are more than 30 miles from an in-network PCP or more than 75 miles from an in-network specialist can request network gap exceptions. Click here to read the Health Business Daily story that has more details from November 6, 2017. (registration required)

This type of situation happens all the time in the employee benefits industry. A network looks like it matches a group’s locations but when members start making appointments there are gaps. Minimizing network disruption to avoid employee dissatisfaction is often a big factor in making changes to the overall benefits package. Estimating disruption is one of the most common uses of NetMinder.

disruption.jpgCarriers have taken different approaches to managing the inevitable disruption that comes with changing benefit plans and networks.

  • Dental benefits companies frequently “stack” multiple lease partners on top of their direct contract network. Since many lease partners are working with multiple carriers, these networks are very similar which reduces disruption.
  • Vision benefits companies are starting to work with multiple lease partners which reduces disruption when moving between networks as well. Additionally, vision networks rely heavily on retail chains such as Target, Wal-Mart, and JCPenney which also reduces disruption.

Broad medical networks are alike due to the nature of employer-sponsored medical insurance: very few people decline it when offered and virtually all doctors accept insurance because costs are high and utilization is virtually guaranteed over a lifetime. Narrow networks, however, have introduced a new element of disruption into the medical network marketplace. As they continue to evolve, it will be interesting to see what tools and strategies are developed to minimize disruption and dissatisfaction caused by changing plans and doctors while keeping costs down.

How are your networks different from your competition? How do you measure and track the differences?

Tags: disruption reporting, Vision insurance, healthcare benefits, employee benefits, dental benefits, network disruption, medical networks

Six Synergies That Make Selling Dental and Vision Plans Together Smart

Posted by Susan Donegan on Wed, Jul 19, 2017

Beyond their similar relationship to medical plans, dental and vision plans have several other synergies.

The same components are evaluated during the dental and vision benefits sales processes: benefit, price, and network. Both products have defined benefit structures that can be compared on specific points. Rates are presented in tiers based on job classifications and number of people covered. Networks are less complex than medical plans and specific tools and processes have evolved to compare apples to apples.

The same network analysis tools can be used for both products to differentiate between networks. The sales process requires size comparisons, accessibility measurements, overlap/disruption analysis, and sometimes re-pricing analysis. network analysis pyramid.jpg

Beyond the departments that all companies have such as IT and facilities management, dental and vision plans can share functions like pricing, sales, marketing, and underwriting. Many multiline carriers have shared sales forces that use a single point-of-contact as a selling advantage. There are also departments that perform similar functions like recruiting and credentialing, where process synergies can come into play.

And, distribution strategies, like whether or not to be on an exchange, broker marketing strategies, and voluntary/worksite programs, since both products are voluntary-friendly, can be leveraged across both lines of business.

Download our whitepaper,  Exploring How Dental and Vision Work Together to learn more about the synergies that help the dental and vision insurance markets work together. 

Tags: dental network, health insurance, healthcare benefits, vision networks

Extending Your Reach with Telehealth Services

Posted by Laura McMullen on Mon, Dec 12, 2016

Medicare seems to be proceeding cautiously with telemedicine. Traditional Medicare reimburses healthcare providers for 37 services in specific circumstances when they are delivered using telemedicine, which is defined by the Medicare Learning Network as “an interactive audio and video telecommunications system that permits real-time communication between you … and the beneficiary.” These services range from consultations to education and training sessions to psychotherapy and smoking cessation programs.

Employer groups, on the other hand, are embracing telehealth benefits. Typical telehealth services are accessible 24/7 via smart phone, tablet, computer, or telephone. A recent article in CFO Magazine discusses the results of the latest Mercer National Survey of Employer-Sponsored Health Plans. Here are the highlights:

  • Nearly 60% of employers offered telehealth benefits in 2016. Nearly four times as many as (16%) offered them in 2014 and double the percentage (30%) that offered them in 2015.
  • Three-quarters of employers that offer telehealth share in the cost of each visit by offering plans with visit copays of $25 vs. the retail cost of a telehealth visit of $40.
  • More than one-quarter (28%) of large employers that offer telehealth also offer cost transparency tools to help employees make cost-effective choices.

This strong interest in telehealth is another method to help employees better manage their healthcare costs. As more and more workers (29% in 2016 vs. 25% in 2015) have high-deductible health plans, they are looking for lower-cost alternatives to access care.

cost of care.jpg

Source: Smart Business News,

Retail Clinics and Telehealth Services Stretch Networks

Narrow networks are more common each year. Members report longer appointment wait times in HMO networks and other networks that have gatekeepers. And in open access narrow networks there are fewer available providers requiring many members to change doctors when they first join the plan and change again as doctors move in and out of the networks.

Employee Benefit News (registration required) noted that “82% of respondents [to the Mercer survey] cover visits to a retail clinic as another lower-cost and convenient option for their health plan members. Such a visit typically costs about $60 before the annual deductible is met.” With lower costs and convenient hours, many people find that these clinics, like telehealth services, are a good option to supplement plans with narrow networks.

Telehealth services also enable faster communication with a primary care doctor, shorter wait times, and no travel time when compared to an ER or urgent care center visit.

Has telehealth become a viable substitute for in-office care for your members? How are you using telehealth services to expand your network?

Tags: narrow networks, healthcare benefits, healthcare providers, telehealth services, HMO networks

ACA Impact on Employer Plans, Challenges Facing Public Exchanges, and Premium Increases in 2017.

Posted by Susan Donegan on Fri, Jun 03, 2016

ACA is beginning to have an impact on employer plans. Both employers and employees have changed their behavior in response to the ACA, research shows these changes are directly related to cost. (Employee Benefit Adviser, 5/31/16)

25% ... of Medicare Advantage enrollment would reside in the combined firm formed by Aetna Inc.'s planned purchase of Humana Inc., if no divestitures are required, according to a new report from the Kaiser Family Foundation. (AIS Health Business Daily, 5/30/16, From MEDICARE ADVANTAGE NEWS)

One of the biggest challenges facing the public exchange system according to Dr. Jonathan Gruber, Ford Professor of Economics at Massachusetts Institute of Technology, is “adverse selection,” a phenomenon that occurs when healthy people switch to more affordable insurance plans when their premiums rise, while those with more serious or persistent health issues remain on the richer plans. As a result, the members who remain on the richer plan experience exorbitant premium hikes in order to offset the unhealthier group’s rising medical costs. (Northwestern Kellogg MacEachern Symposium. 5/27/16)

Employers are searching for solutions to meet their health plan needs, reduce costs and provide the optimal benefits to their employees. Healthcare regulations are making quite an impact on employers when it comes to picking the right health plan solutions, especially when it comes to the employer mandate and the Cadillac Tax. Employers are searching for options that would reduce their overall spend. (HealthPayer Intelligence, 5/27/16)

Losses during the first few years of the ACA are driving some health plans to seek substantial premium increases in 2017 for individual plans sold through the exchanges of more than a dozen states, according to The Wall Street Journal. The proposed increases made public so far illustrate how insurers are responding to the ways the ACA has changed how healthcare coverage is priced and sold in the U.S., according to the report. (Becker’s Hospital Review, 5/26/16)

Nearly 25% ... of the people who purchased 2015 health coverage through a public exchange stopped paying their premiums at some point during the year, yet most repurchased an exchange plan for 2016, according to a McKinsey & Co. report. (AIS Health Business Daily, 5/24/16, Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. Free for HEX subscribers; $17 for non-subscriber)

Tags: healthcare benefits, ACA, healthcare exchanges, HIX, Employer Plans

Pros and Cons of Health Insurer Mergers for Employers

Posted by Laura McMullen on Wed, Aug 05, 2015

mergerAetna acquires Humana. Anthem acquires Cigna. Centene acquires Health Net. Assurant Health is bought by National General. These are big moves that are creating bigger companies in an already huge $2.9 trillion industry. There’s been lots of analysis about the acquisitions, like this Modern Healthcare article from July 2015 that explains how gaining more Medicare Advantage business is the purpose of these mergers, but the perspective that I’m finding most interesting is what employers are saying.

Consolidations Are a Mixed Blessing

A Business Insurance article published after the Aetna/Humana and Centene/Health Net deals were announced described the results of an Aon Hewitt employer survey of nearly 100 employers. Jim Walker, Aon Hewitt’s global chief innovation officer for health and benefits consulting, wasn’t surprised at the results. “On the one hand, consolidation will give insurers more clout in negotiating with health care providers. On the other hand, employers are concerned that fewer and bigger health insurers will mean they have less leverage in negotiating with insurers.” Here are some of the top line results of the survey:

  • Three-quarters of the employers surveyed thought the impact would reduce options or have no effect.
  • More than half said they were considering changes to their health plan strategies.
  • More than three-quarters said the industry consolidation would not affect their short-term decision-making about retiree options.

Another Business Insurance article published a week later, after the Anthem/Cigna deal was announced to result in the nation’s biggest health insurer, offered similar perspective. Here are a few quotes:

“From the employer side, the deal can be ‘good news,’ if the much larger Anthem can ‘cut better deals with medical providers,’ concurs Dave Osterndorf, a partner and chief health care actuary at Health Exchange Resources in Mequon, Wisconsin.”

“Adding Cigna's book of business ‘may rebalance provider negotiation leverage in Anthem's favor after years of provider consolidation that has gone pretty much under the radar screen,’ says Brian Marcotte, president of the National Business Group on Health in Washington. “Large employers will have concerns about the merger between Anthem and Cigna because employers will be left with only three major insurers who can support large multi-state employers on a nationwide basis.”

PricewaterhouseCoopers predicts medical cost trend to increase 6.5% in 2016, with a projection of 4.5% after benefit design changes, in their Behind the Numbers 2016 report. The trend is increasing more slowly than in years past although healthcare costs continue to outpace inflation so employers are understandably still interested in reducing the impact of healthcare costs in their bottom lines.

Balancing Cost and Choice

I’ve written that headline a million times in my healthcare career. Most of the time, I’ve been describing benefit options to employees but it applies to the choice facing employers as well. They want to offer health insurance for a variety of reasons – the other companies in their industry offer it, they’ve always offered it, healthy employees are more productive than sick employees, etc. As the costs continue to rise, employers hold the line on their costs and shift more to the employees through higher deductibles and more premium cost-sharing.

The mergers and acquisitions we’re seeing now are bringing that choice to the forefront again for employers. Which way are your customers leaning?

Tags: health insurance, healthcare reform, healthcare benefits, health insurers, medicare, medical insurance, health insurance mergers

Focusing on vision networks

Posted by Laura McMullen on Tue, Jul 07, 2015

A few years ago, we published a whitepaper called Clearing Up the Vision Market. Since then, the demand for vision networks has increased significantly with the number of people who take a vision plan when it’s offered growing from 78% in 2012 to 83% in 2013 in a 2014 SHRM study on vision care, so we decided to take another look.

As of March 2015, there are 48,000 optical locations in the top 10 national vision networks. They fall into two categories: independent eye care professionals (ECPs) and retail chains.

  • ECPs are defined by VisionWatch as having three or fewer locations with an ophthalmologist, optometrist, an optician, or an optical retailer on site. Nearly all ECPs are small businesses.  According to a whitepaper sponsored by Vision Source, ECPs are typically single location operations with less than $1.5 million in annual revenue and 12 or fewer employees. They have been in practice on average for 20 years.
  • Retail chains have 4 or more locations and may or may not have an ophthalmologist or an optometrist on site. The best-known brands in this category are widely available, such as LensCrafters, Pearle Vision, Walmart, and Costco.

ECPs make up two-thirds of locations and 45% of market share while retail chains are the rest. A recent Bain and Company study shows the second most influential factor (after cost) in selecting a managed vision care plan is the retail network the plan provides. This helps explain why retail chains account for 55% of vision sales, with only one-third of the locations.

A Consolidating Market

In a recent Wall Street Journal blog post, Optometrists Catch FFL’s Eye, Thomas Puckett of merger and acquisition advisory firm HPC Puckett & Co., said “There aren’t many operators with over 100 locations, but there are quite a few independents with under 50 locations. It is logical for businesses to consolidate in a geographic area.”

Private equity firms are projecting that the number of retail outlets will drop by half over the next five years through consolidation. Investors are most interested in firms valued at $10 to $50 million and the expected growth from the Affordable Care Act and the aging US population makes the industry even more attractive.

Other Vision Network Trends

A recent review of the top 10 national vision networks in NetMinder found some interesting trends:

  • Vision networks are growing. The number of unique providers in these networks grew about 8% annually from 2011 to 2015. Unique locations grew more slowly (3% annually) and access points grew more quickly (11% annually). This is most likely because retail chains, such as Pearl Vision or Lenscrafters, generate more revenue with fewer locations.
  • Some ECPs practice at many locations. On average, ECPs are listed in provider directories at 2.4 locations with a range of 1.6 to 3.2 locations. This could be the beginning of a trend toward overstated access in vision networks. We see about 25% access point inflation in dental PPO networks and have put a validation process in place using claim data to adjust counts. We are watching vision networks closely to see if a similar filter is needed. 
  • vision_networksECPs are joining more networks. In March 2011, the average ECP participated in 2.5 networks. By March 2015, that count was up to 3.7 networks. This shift is quite dramatic: five years ago 75% of eye care providers in these networks were in 1-3 networks and now only 53% are while 15% are in 7-10 networks.

Are you seeing these trends play out in your network? Are vision benefits in demand among your customers and their employees?

Tags: network providers, Affordable Care Act, optical retail, Vision, Vision insurance, healthcare benefits, Managed Care, employee benefits, vision networks, practicing locations

Guest Blog: The Affordable Care Act Part 2 – What’s Ahead for Small Businesses?

Posted by Louis Balbirer on Wed, Sep 24, 2014

Louis BalbirerLouis Balbirer of Kaufman Rossin writes a guest blog post for NetMinder about changes related to healthcare reform. This is the second post in a two-part series discussing opportunities and challenges of the Affordable Care Act. The first part of this series focused on large businesses.

In the four years since the passage of the Affordable Care Act (ACA), there have been a number of changes that can make it difficult for small businesses to interpret their responsibilities under the law. 

At the latest C-Suite Breakfast Series, co-sponsored by Kaufman Rossin and Vistage, a panel of experts discussed changes for small and large businesses brought on by the Affordable Care Act. Specifically, panelists told us what’s better, what’s worse and what’s ahead for small business owners.

Panelists included:

What are some opportunities for small businesses?

Small businesses, defined under the healthcare law as having 50 or fewer full-time equivalent employees, are exempt from many ACA requirements. The Affordable Care Act presents many small business owners and their employees with opportunities for tax credits, lower insurance rates and more extensive coverage.

The following are some of the ways the ACA could benefit smaller businesses:

  • The Federal Small Business Health Options Program (SHOP) marketplace allows small business owners to control the coverage they offer to employees and the premiums they pay for coverage.
  • According to the panelists, the quality of insurance coverage and healthcare are expected to increase because the Affordable Care Act mandates a broadened scope of coverage for certain conditions that were previously uninsured.
  • The lack of penalties for dropping insurance and the availability of the Exchange for employees make it easier for small employers to save by choosing not to offer health insurance for their employees.
  • Additional delivery systems allow employers to choose how they offer insurance to their employees. SHOP, the Marketplace and private exchanges allow employers to veer from the traditional model (or continue with it) when selecting health insurance options for their business.
  • Small businesses with 25 or fewer full-time equivalent employees are eligible for a maximum 50% tax credit if they pay premiums on behalf of their employees enrolled in a qualified healthcare plan through SHOP.

What has the Affordable Care Act made more challenging for small business?

Although they are exempt from parts of the healthcare law, small businesses still face some challenges as a result of the ACA.

The following have been made more challenging since the passage of the Affordable Care Act:

  • Employers must participate by buying and paying SHOP fees even if only one employee participates in an insurance plan.
  • Some small business owners will need more resources (including more employees) to properly comply with the tracking and reporting requirements under the ACA.
  • Some employers are discouraged from hiring because they do not want to have to comply with the pay or play mandate required of businesses with more than 50 full-time equivalent employees. Employees who work 30 or more hours per week are considered full-time under the ACA.

What’s ahead for small business owners?              

Small business owners should prepare to comply with the upcoming reporting requirements under the healthcare law and consult their broker and accountant with any questions, including how ACA-related tax changes may affect their tax bill.

I spoke with Joy Batteen, director of human resources at Kaufman Rossin and a panelist at the C-Suite Breakfast Series, about important next steps for small business owners.

“If a small business is considering hiring a broker, but is concerned about the cost, now is the right time to make that move,” said Batteen. “Hiring a knowledgeable broker – someone you can trust – makes dealing with ACA changes much easier. The law will affect different employers in different ways; the most important thing businesses can do is be prepared.”

Louis Balbirer, CPA, is a director of tax services with Kaufman Rossin, one of the top CPA firms in the U.S He has 20 years of experience providing tax and accounting services to clients and can be reached at


Tags: NetMinder, health insurance, Affordable Care Act, Healthcare, healthcare reform, health reform, healthcare benefits, ACA, healthcare exchanges, insurance companies

Network Emerges as Key Differentiator in Health Insurance Purchasing Process

Posted by Laura McMullen on Tue, Jul 08, 2014

As intended, the consumer demand created by the Affordable Care Act is expanding the insurance marketplace, as reported in Inside Health Insurance Exchanges and reprinted in Health Business Daily (free registration required) on June 24, 2014. Some examples of new entrants include:

  • Co-ops in states where Blue Cross Blue Shield plans dominate, like Kentucky Health Cooperative in West Virginia and Montana Health Co-op in Idaho
  • Local plan expansions from nearby states like Harvard Pilgrim and Minuteman Health in Massachusetts moving into New Hampshire
  • Health system-based networks in densely populated areas like North Shore-Long Island Jewish Hospital and Health System in New York

With more plans to choose from that offer the same mandated benefits and guaranteed issue requirements, the provider network is a key decision point for consumers and employers. “Many carriers’ rates ‘look good on paper, but when you pull back the layers,’ consumers are wary. In the end, ‘it really comes down to the network,’ since consumers don’t want to give up existing providers when they switch insurers,” said Kyle Kautzman, GBA, an insurance broker with EBNY Insurance Services, Inc., in a Health Plan Week article reprinted in Health Business Daily on May 12, 2014 (N.Y. Small-Group Market Isn’t Suiting United’s State of Mind (with Table: Top 10 Health Plans in New York's Commercial Risk Market). Mr. Kautzman was commenting on the New York State small-group market but the observation applies to any area in the US.

narrow networks definedEmployer groups and consumers are grappling with the term “narrow networks.” What are they really? McKinsey & Co. define narrow networks as “having at least 30 percent of the 20 largest hospitals in a geographic area not participating in the exchange’s silver plan.” Perhaps a simpler way of looking at it is typical narrow networks include providers who agree to lower prices with the expectation that patient volume will grow. Insurers then pass some of the savings on to consumers. Starting to sound similar to an HMO, right? Carriers have been using network size to reduce rates for quite some time; the ACA rules simply accelerated the trend.

Narrow networks seem to be most successful in areas where providers are plentiful so that carriers can choose providers with lower rates and better outcomes. For example, Health Net is seeing success in California. They offer narrow, or tailored, networks in five southern California counties and use their existing PPO network everywhere else. According to Health Net spokesperson Brad Kiefler, in an AIS’s Health Reform Week article reprinted in Health Business Daily on May 5, 2014, entitled Calif. MD Supply Concerns May Boost Networks, Reimbursements, enrollment in tailored networks is 38% of the commercial total enrollment reflecting demand from employer groups as well as consumers from Covered California, the state exchange.

Kiefler went on to say, “So in Southern California, where there is significantly more competition among providers – there are 80 hospitals in LA County – insurers have been able to create these narrow networks and demand relatively lower reimbursements from providers. In the parts of the state that are dominated by a particular provider system, the rates are consequently higher.” In densely populated places with many providers, like Los Angeles, market forces drive costs and rates down so even though networks are narrow by choice, consumers still see reduced costs. In sparsely populated areas with fewer providers, like central California, networks are naturally narrow and competition doesn’t exert pressure on costs or rates.

What do narrow networks mean for you and your customers? How will you monitor changes in the network landscape on the exchanges and off?  

Tags: narrow networks, Affordable Care Act, healthcare reform, health reform, healthcare benefits, ACA, healthcare exchanges, provider networks

How the Affordable Care Act (ACA) is Influencing Adult Dental Insurance Coverage

Posted by Laura McMullen on Thu, May 15, 2014

Adult dental insurance is a hot topic thanks to the Affordable Care Act (ACA) and Under the new healthcare law, dental coverage for children 18 and younger is considered an essential health benefit that must be included in all plans sold on exchanges. For adults, it’s a different story: insurers don’t have to offer adult dental coverage, nor do adults have to purchase it.

dentistsThis situation could lead to fewer healthy adults purchasing dental coverage because their health insurance budget is committed to the mandated ACA coverage. This effect may drive up dental premiums for everyone if the pool of prospective purchasers consists only of those needing more extensive and costly dental treatments. From a network perspective, dentists may find themselves joining more networks to fill in the gaps and gain new patients.

Nancy Smith lays out the ramifications of ACA on adult dental coverage and concerns from dentists in this Sunshine State News article “Obamacare Leaves Gaping Cavity in Adults’ Dental Health”.

Individual Adult Dental Insurance Plans

Consumers may start looking for individual adult dental insurance plans. This is an opportunity to promote a variety of dental plans, ranging from discount plans to stand-alone insurance plans to dental benefits that are embedded in qualified health plans on exchanges. These plans can differ significantly from traditional, employer-sponsored dental plans and may require education to ensure member satisfaction.

dentist toolsFor example, “annual maximum” is an important term when talking about adult dental insurance. The annual maximum, or benefit cap, limits the maximum amount the insurer has to pay, making the consumer responsible for any additional costs beyond the maximum. Due to ACA, new health insurance policies do not include a benefit cap. However, for consumers looking for both health and dental insurance, benefit caps can still exist in adult dental plans under the name “annual maximum.”

Read more on this topic in the article “What is the Problem with Adult Dental Insurance Plans on” by Naomi Mannino on Of course, consumers should check that their providers are in the network.

Voluntary Group Plans

In some cases, another option is voluntary group dental insurance. Caitlin Bronson, in Insurance Business America, reports that some groups are dropping health insurance plans so that their employees can use the exchanges but adding voluntary ancillary benefits, like dental and vision plans. She writes, “Roughly 80% of voluntary sales are dental coverage, with a projected 2% increase in 2014, Towers Watson found in its 2013 Voluntary Benefits Survey.”

These plans allow employers to offer a popular benefit and pass the cost along to their employees via payroll deduction, which in some cases eases the sting of changes in health insurance benefits. Some believe that voluntary plans don’t offer enough coverage for the cost to satisfy commercial clients and their employees.

With several options to choose from, will healthy adults opt for dental coverage?  

Tags: compare networks, dental network, network providers, health insurance, Affordable Care Act, dental providers, dental insurance, healthcare benefits, ACA, dental benefits, dental insurer





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