1 / 77

Introducing… Dental (A-81000 Series)

Introducing… Dental (A-81000 Series). Field Sales Guide. Provides standard information only Available online via AFLAC University Review administrative guidelines for state- specific information. Section 1. Introduction. AFLAC Dental. First introduced in 2000 $60 million in 2001

galia
Télécharger la présentation

Introducing… Dental (A-81000 Series)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Introducing…Dental (A-81000 Series)

  2. Field Sales Guide • Provides standard information only • Available online via AFLAC University • Review administrative guidelines for state- specific information

  3. Section 1 Introduction

  4. AFLAC Dental • First introduced in 2000 • $60 million in 2001 • 2003 – reduced group size and participation requirements • 2004 – opened to nonpayroll sales Page 11

  5. People Want Dental Insurance • The ADA recommends two dental cleanings per year • Having dental insurance and getting the recommended cleanings allows policyholders to realize immediate benefits • Dental insurance consistently ranks high in employee benefit polls Page 11

  6. The Small Employer Market • Often don’t offer dental insurance because of the cost • Want a simple product that is not complicated by provider networks, pre- certification, etc. • Nonpayroll rates available if needed Page 11

  7. The Large Employer Market • Provider networks and pre-certification help to reduce costs • Often employer-paid • 90% of employers with at least 500 employees already offer dental benefits Page 12

  8. Focus on Small Businesses • Only 56% of all employers offer dental benefits • Small employers need dental insurance! Page 12

  9. What’s New with AFLAC Dental? • Fewer options • X-Ray Benefit • 3-month waiting period for fillings • Increased benefits • Orthodontic rider covers everyone Page 13

  10. What’s New with AFLAC Dental? • New Cosmetic Rider • Provider education tools • Enhanced brochures • Streamlined competitive replacement process Page 13

  11. Section 2 The Dental Insurance Market

  12. Medical Spread of risk; price is based on an estimate of how many people will use it Out-of-pocket expenses are capped for the policyholder Dental High utilization; most everyone will use it Yearly benefits are capped to control expenses Focus on preventive benefits Medical vs. Dental Insurance Page 17

  13. Types of Dental Insurance • Indemnity Plans • PPOs • HMOs • Table of Allowances • Direct Reimbursement • Discount Plans Page 18

  14. Indemnity Plans • “Traditional” dental insurance • Based on usual, customary, and reasonable (UCR) fees • 100% for preventive care • 80% for restorative services • 50% for major services • Annual maximums • Usually a deductible Page 18

  15. Preferred Provider Organizations (PPOs) • Provider network • Providers agree to pre-set fees and savings are passed to the insured • Usually no deductible • Patient can go out of network, but will incur higher costs • Exclusive Provider Organizations (EPOs) do not cover out-of-network treatment Page 18

  16. Health Maintenance Organizations (HMOs) • Capitation plans • Preventive and basic services usually performed at no charge • Patient may have a co-payment for major services • Raises concerns about the quality of treatment Page 18

  17. Table of Allowances • Similar to AFLAC’s definition of “indemnity” • Fixed benefit is paid for each procedure, regardless of charges • Patient chooses dentist • AFLAC Dental is a table of allowances plan Page 18

  18. Direct Reimbursement • Self-funded by employer • Patient pays dentist and files for reimbursement with employer • Reimbursement based on charges, not type of treatment • Patient chooses dentist • The ADA promotes direct reimbursement plans Page 19

  19. Discount Plans • Not a form of insurance • Requires a membership fee • Participating dentists provide discounted services • No benefit maximums • Typically quote a savings of 20%-50% Page 19

  20. Categories of Benefits • Preventive, Diagnostic, and Emergency • Oral examinations, cleanings, X-rays • Fluoride applications, sealants • Routine or Basic Care • Fillings • Routine oral surgery, periodontal care • Complex or Major Care • Crowns • Complex oral surgery, extensive care Page 19

  21. Section 3 Plan Structure

  22. Original AFLAC Dental • 6 levels of coverage • Too many options • Higher Wellness Benefit consistently outsold lower benefit • Level 4 – 38% • Level 3 – 3% Page 23

  23. New AFLAC Dental Options • Basic • $25 wellness • Lowest benefit schedule • Standard • $50 wellness • Mid-range benefits • Premier • $50 wellness • Higher tier of benefits Page 23

  24. Waiting Period • Period of time after effective date for which benefits are not payable • Controls costs by preventing immediate claims • Reduces the chance that a person will buy dental insurance because he or she needs a specific procedure • Compensates for little underwriting Page 24

  25. Waiting Periods: • Start over on the date of reinstatement • Begin on the effective date of a dependent’s addition to the policy • Apply to increased benefit amounts for conversions • Run from the original effective date for downgrades Page 24

  26. Waiting Periods Page 24

  27. Waiting Periods Page 24

  28. Policy Year Maximums • Maximum benefits payable per covered person per policy year • Does not include Wellness and X-rays • Basic - $1,200 • Standard - $1,400 • Premier - $1,600 Page 25

  29. Section 4 Policy Benefits and Provisions

  30. Wellness Benefit • Pays for one listed treatment per visit • Visits must be separated by 150 days or more • Payable twice per person, per policy year Examples: • Oral evaluations • Cleanings • Fluoride applications Page 29

  31. X-Ray Benefit (new!) • Pays for one listed X-ray procedure per visit • Payable once per person per policy year • Basic - $10 • Standard - $25 • Premier - $25 Page 29

  32. Schedule of Dental Procedures • Benefit amounts are listed by ADA code • If ADA codes change, we will pay an amount comparable for the procedure • Procedures may fall under more than one category • Only the schedule varies among the different plans – waiting periods, limitations and exclusions, etc. are the same Pages 29-44

  33. Orthodontic Benefit Rider • Applies to all covered persons (new!) • After 24 month waiting period, pays: • $600 for initial orthodontic treatment • $200 every third month for continued treatment • Covered treatments listed by ADA code • $1,200 lifetime maximum per person • $2,400 maximum per policy year • Payroll sales only Page 45

  34. Cosmetic Benefit Rider (new!) • Applies to all covered persons • After 24 month waiting period, pays for specific procedures at benefit amounts listed • Examples: bleaching teeth, veneers, etc. • $1,800 lifetime maximum per policy • $600 maximum per policy year • Payroll sales only Page 46

  35. Limitations and Exclusions • Procedures not listed in the schedule • Services not recommended by a dentist or not required for oral health • Repairs to dental work within six months of initial work • Replacement prosthetics within five years of last placement • Treatment involving crowns within five years of last placement Page 47

  36. Limitations and Exclusions (continued) • Replacement for inlays or onlays within five years of last placement • Treatment received while outside the U.S. • Sealants: • Secondary molars for children under 16 • Not more often than every five years • Replacement of teeth missing before the effective date of coverage Page 47

  37. Section 5 Administrative Guidelines

  38. Eligibility Requirements • Issue ages: • 1865 on payroll • 1864 on nonpayroll • No minimum group size for payroll • Dependent ages 19/23 • Optional riders available for payroll sales only • If supplementing existing dental insurance, only the Basic policy may be offered Page 67

  39. Administrative Guidelines • Flex: • Base policy and Ortho Rider eligible for pre-tax • Cosmetic Rider is after-tax only • Advanced Effective Date (new!) • Up to 90 days from enrollment date • More than 60 days requires Statement of Understanding Page 67

  40. Additional Forms • Replacement Notice • if replacing another carrier’s dental policy • Outline of Coverage • if required in your state • Guide to Health Insurance for People with Medicare • if applicant is eligible for Medicare Page 68

  41. Renewable/Portable • Guaranteed-renewable for the policyholder’s lifetime • Payroll rate may be retained after one month’s payment through payroll deduction • Changes once on direct billing will be subject to direct rates, underwriting, and eligibility rules Page 68

  42. Missed Payments • Dental uses a shorter lapse cycle • Status 13 (no premiums received) • Will be notified after the second missed invoice and will lapse in 30 days • Status 22 (active) • Will be notified after the first missed invoice and will lapse in 30 days • No claims paid on policies more than 90 days in arrears, regardless of policy status Page 69

  43. Section 6 Sales Support Materials

  44. Brochures • Brochure folder A81075 • Insert for each policy: • Basic A81175 • Standard A81275 • Premier A81375 • Inserts list every covered procedure and benefit amount (new!) Page 73

  45. Additional Pieces • Rider inserts: • Orthodontic A81076 • Cosmetic A81077 • Mailer A81090 • Suitable for both payroll and direct prospects • Employer Flyer MMC-00-236 • Intended for employers - also used with Dental A-80000 Series Pages 73-74

  46. Provider Education Tools (new!) • Tent card M1078 • www.aflacdental.com • Both provide tips for completing the ADA claim form and filing claims electronically • Web site allows provider to enter policy number and ADA codes to retrieve benefit information • Active policies only • Only when policy record is available Page 73

  47. Aflac_Project Name_Date

  48. Aflac_Project Name_Date

  49. Aflac_Project Name_Date

  50. Section 7 Applications/Underwriting

More Related