dental underwritten by: delta dental insurance company marketed by: vision administered by:
TRANSCRIPT
Dental Underwritten by:Delta Dental Insurance Company
Marketed by: Vision Administered by:
Dental for Everyone Dental for Everyone HistoryHistory In 2002, MorganWhiteGroup (MWG) was given the
opportunity to pilot Dental for Everyone in 7 states, Alabama, Florida, Louisiana, Mississippi, Texas, Utah, and Georgia. The Premier plan was the only option available in 2002. The agreement was that MWG would assume 100% of the risk, and provide all administration services with the exception of eligibility and claims which was handled by DDIC.
In mid 2006 MWG presented the results to Delta Dental and asked for approval to add the PPO option, and make Dental for Everyone available in all 16 enterprise states. The results proved promising and Delta Dental agreed to MWG’s requests and now shares in 50% of the risk.
Dental for Everyone Dental for Everyone History History (cont.)(cont.)
The first available effective date for the 16 state enterprise rollout was February 1, 2007. In 1 1/2 years MWG has tripled the total block of business that it took almost 4 years to build.
The success achieved in the first year can be attributed to the implementation of an online enrollment system created by MWG, the addition of the PPO option, the plan being available in more states, and internet marketing.
Who is Who is MorganWhiteGroupMorganWhiteGroup MorganWhiteGroup (MWG) is the name given to the
holding company, Morgan-White Group, Inc. Consisting of six wholly owned subsidiaries, MWG is a licensed insurance broker in 50 states, and has the ability to assume all, or part of the risk associated with the various Life, Accident, and Health insurance policies.
Morgan-White Administrators, Inc. (MWA) is licensed or exempt in 50 states and the U.S. Virgin Islands.
MWA provides services to over 50 different insurers, and over 1,000 employer groups comprising over 140,000 individuals.
1. Issue ID cards
2. Bill and Collect premium
4. Collect Issue Certificates of Coverage
5. Eligibility information
6. Pay Broker commissions and GA overrides
7. Program Marketing
8. Provide customer service related to services listed above (DDIC handles issues related to eligibility and claims)
Morgan-White Administrators, Inc., (MWA) one of MWG’s subsidiaries, provides the following TPA services for the Dental for Everyone plan:
Who is Who is MorganWhiteGroup MorganWhiteGroup (cont.)(cont.)
Plan FeaturesPlan Features
Two plans to choose from:Two plans to choose from:
1.1. Delta Dental Premier® (Premier)Delta Dental Premier® (Premier)2.2. Delta Dental PPO (PPO)Delta Dental PPO (PPO)
Free choice of dentist Benefits increase after the first and second years Benefits of$1,200 per calendar year $100 lifetime deductible on Ortho 6 month waiting period for Basic Ortho benefits for dependents included at no extra charge 12 month waiting period for Major and Ortho Keep your dental plan regardless of age
Your Deductible Plan Pays 1st Year
Plan Pays 2nd Year
Plan Pays 3rd Year
Services Covered
$50 per person per calendar year for Types 1, 2, and 3 Procedures
80% 90% 100%
Diagnostic and Preventive Procedures Diagnostic: Routine periodic examination once in a 6 month period. Preventive: Dental prophylaxis (teeth cleaning) once in a 6 month period. Radiography: Bitewing and full mouth x-rays.
Services Services Covered: Covered:
Type 1Type 1
Your Deductible Plan Pays 1st Year
Plan Pays 2nd Year
Plan Pays 3rd Year
Services Covered
$50 per person per calendar year for Types 1, 2, and 3 Procedures
60% 70% 80%
Basic Procedures (6 month waiting period) Restorative: Amalgam fillings. Other: Space maintainers, recementation of crowns.
Services Services Covered: Covered:
Type 2Type 2
Your Deductible Plan Pays 1st Year
Plan Pays 2nd Year
Plan Pays 3rd Year
Services Covered
$50 per person per calendar year for Types 1, 2, and 3 Procedures
0% 40% 50%
Major Procedures (12 month waiting period) Endodontics: Pulpal therapy and root canals. Periodontics: Treatment of diseases of the gums. Oral Surgery: Extractions and other oral surgery, including pre and post operative care. Prosthetics: Gold restorations, crowns, bridges, partials and complete dentures. Other: Pontics, repair of crowns and bridges, repair of full and partial dentures.
Services Services Covered: Covered:
Type 3Type 3
Your Deductible Plan Pays 1st Year
Plan Pays 2nd Year
Plan Pays 3rd Year
Services Covered
$100 Lifetime 0% 40% 50%
Orthodontia Procedures (12 month waiting period) ($350 calendar year maximum) ($1000 lifetime maximum per person for this benefit) Orthodontic benefits are only available for eligible dependent children.
Services Services Covered: Covered:
Type 4Type 4
RatesRates
If an individual or group becomes effective January through June – they will have a rate guarantee until January.
If an individual or group becomes effective July through December – they will have a rate guarantee until July.
After the first year, rates may be increased every 12 months.
Rates are regional by zip codes and dependent upon where the enrollee resides not where the company is headquartered.
All billing, administration, and association fees are included in the stated rates.
Participation can be 100% voluntary, but if Employer wants to contribute they can.
Underwriting Underwriting GuidelinesGuidelines Employees can mix and match programs
No out of state participation requirements. Plan can not be sold outside of enterprise locations.
If a dependent is added mid year they will be treated as if they were on the plan from day one.
Adding an employee does not have to be a qualifying event.
Employee can only switch plan options at renewal. i.e. from PPO to Premier or vice versa.
Maximum age for College students as dependents is 26 in all states.
EnrollmentEnrollment
Individual members must be enrolled online.
Groups can enroll by filling out a paper application and sending it to MorganWhite along with the List Bill form and the Bank Draft Authorization if the group prefers to have the premium drafted. The option of enrolling groups online is also available should that method of enrollment be preferred.
All applications must be received by MorganWhite no later than the 20th of the month to receive a 1st of the following month effective date.
MWG will provide GA’s and Brokers with coded links for online enrollments. When an enrollment occurs via a coded link it will ensure that both GA and Broker receive proper credit.
BillingBilling
The group will be billed directly and can pay by check, bank draft, or credit card.
Drafts from bank accounts and credit cards will take place between the 18th and 23rd of each month.
List Bill is available for groups of 2 or more.
If a member is on a list bill and leaves the group, he/she has the option to keep their coverage and be set up on a monthly bank or credit card draft, or any other billing option available at that time.
CommissionCommissionss
A Broker commission of 10% first year, and 7% for renewals is also built into the rates.
The discount plan provides significant savings to you on eye care and eyewear. By showing your Delta Dental ID card to any EyeMed provider, you can obtain your discount. You can choose from a nationwide network of optometrists, ophthalmologists and opticians, as well as the nation’s leading optical retailers such as LensCrafters, Sears Optical, Target Optical and most Pearle Vision locations.
Member will receive 20% discount on items purchased at participating Providers not included under the plan coverage. 20% discount may not be combined with any other discounts or promotional offers, and the discount does not apply to EyeMed provider’s professional services, or contact lenses. Retail prices may vary by location.