News and Policies - Producer | Delta Dental of Washington
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News and Policies - Producer | Delta Dental of Washington

Affordable Care Act (ACA)

The ACA has already made significant healthcare changes to our state. While large businesses are impacted by some market reforms and notification requirements, small business and individuals have a variety of changes to navigate.

However employers decide to manage employee benefits, make sure dental is included:

  • Dental is a highly valued benefit and plays a key role in recruiting and keeping top talent.
  • Oral health impacts employees directly, especially if they are diabetic, have heart disease, are pregnant or have other systemic health related issues.
  • Keeping or adding dental can increases overall health, reduce medical costs, positively affect attendance and productivity and be an advantage to a business’s bottom line.

Keep employees smiles happy and healthy: Make dental a part of their overall benefits package.

Navigating the changes

Small Businesses (1-50 employees)

Small businesses are currently not required to offer health insurance, but if they do, they could be eligible for a Small Business Health Care Tax Credit if they have fewer than 25 FTEs making an average of $50,000 or less.

If a small business decides not to provide healthcare coverage, providing dental may still be a cost-effective benefit they can offer their employees. Delta Dental offers a variety of plan options to cover a number of different price points and family coverage needs. To find coverage that fits your client's budgertary needs, sign in or get appointed with us to begin using our online quoting tools.

Dental for individual and family plans are available and can be found at DeltaDentalCoversMe.com. Simply select “Washington” from the drop down and review the available plan options.

Many individuals may be eligible for subsidies on the public exchange. To check eligibility they should visit the Washington Health Plan Finder at wahealthplanfinder.org. There they can also find a number of plan options to fit their need and budget. Currently on the exchange, Delta Dental of Washington offers a pediatric benefit for families with children 19 years of age or younger. Offered as Delta Dental of Washington – Individual Kids, this pediatric benefit provides preventive coverage, restorative benefits and medically- necessary orthodontia coverage to uninsured children in Washington.

Private Exchanges: Delta Dental is currently moving forward to offer benefits through leading brokerage houses and establish a strong private exchange presence. These privately run, closed marketplaces will have a variety of health plans and insurance carriers. Employers will give workers a flat subsidy and then turn employees loose to choose their own benefits.

The drawback here however can include complicated enrollment process and possible disruption in coverage. Businesses need to check with their brokerage houses for more details.

There is also a risk that employees may choose to spend their entire allowance on healthcare not understanding the impact oral health has on overall health. Brokers and benefit managers have a key role in helping employees understand how to choose a benefits plan that focuses on overall health and includes dental.

The SHOP: Small business may have the option to find standalone dental benefits on the SHOP or Small Business Health Options Program. This option is only currently availing in SW Washington and is limited. This program plans to expand in 2015, but it is unclear how it will play out. Once fully operational, it will give employers with 50 or fewer full-time equivalent employees the opportunity to offer employees qualified health plans (QHPs) at a level of coverage/allowance chosen by the employer. The employer will control the coverage they offer and how much they pay towards premiums. Employees can compare plans and choose the options that work best for them or their family.

The drawback here again is a possible disruption in coverage and that employees may choose to not select a dental option and put their overall health at risk. As a trusted advisor, brokers and employers play important roles in emphasizing the significance of oral care to overall health.

Large Businesses (more than 50 employees)

Large employees will remain largely unchanged as long as they offer or continue to offer benefits. These groups will however pay a penalty, starting in 2015, if they don’t offer meaningful and affordable health insurance to their employees. It is possible some large groups may push employees onto an exchange. If this is the case, emphasize the importance of dental and the role it plays in overall health and managing healthcare costs.

  • A plan is considered unaffordable if it costs more than 9.5% of the employee’s household income or if it pays for less than 60% of covered health care expenses.
  • Large businesses can’t buy coverage through Washington’s Health Benefit Exchange

Stand Alone Dental Option:

  • Delta Dental is working hard with the Health Benefits Exchange and the Legislature to ensure there is a stand-alone adult dental option available on the public exchange in the future. Check back for more information as this option develops.

Effective date for new coverage

Provided we receive all of the required information within five business days prior to the end of a month, coverage will be effective the first day of the following month.

How to enroll a group

Provided we receive all of the required information within five business days prior to the end of a month, coverage will be effective the first day of the following month.

How to obtain a quote

Groups with five through 99 employees

Now there’s an easier way to get personalized proposals for smaller companies (five to 99 employees). The online proposal wizard walks you through easy steps to build a customized side-by-side proposal based on your particular needs. Proposals are generated in real-time and allow you to calculate annual costs of your plans, based on the levels and types of coverage you've chosen.

Groups with 100 or more employees

Groups of this size are experienced-rated and are required to submit census data in order to compute rates. Delta Dental will also quote administrative service contracts for groups of this size. A written proposal will be prepared based on the information provided.

How we control costs

At Delta Dental, managing costs is a primary focus. Our unique contractual arrangements with our participating dentists allow us to maximize the value of our clients’ dental benefits dollars. This unique relationship with nearly 9 out of 10 dentists in Washington State is the cornerstone of the “Delta Difference.”

Delta Dental uses a unique filed fee system, rather than a fee schedule, for claims reimbursement. Our contractual arrangements with our participating dentists protect employers and employees from unexpected fee increases for dental services. These dentists agree to pre-file their fees with us and receive payment directly from us based on their pre-approved fees. This not only helps control premium costs, but protects employees from out-of-pocket costs beyond stated deductibles and copayments.

As part of our overall cost-containment strategy, Delta Dental ties participating dentists' fee increases to the Seattle-area Consumer Price Index (CPI). Published by the Bureau of Labor Statistics, the CPI reflects annual changes in a "market basket" of goods and services. This tie has resulted in lower average fee increases for Delta Dental participating dentists over time, compared to the overall average of our competitors. Increases over the five-year period ending in October 2008 averaged just 3.5 percent.

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