Family Dental Plans and Rates for 2015

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Bennett Barton
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1 Family Dental Plans and Rates for 2015 August 20, 2014 updated Aug. 26, 2014

2 About Covered California TM Covered California is the state s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits. In addition to helping consumers who are eligible for federal premium assistance, Covered California seeks to improve the insurance options for all Californians in the individual market. All of the health insurance plans with embedded children s dental are available both through Covered California and in the individual market at the same price. In addition, every health insurance company that sells an insurance product to individuals must sell one that matches Covered California s standard benefit designs. This means that all consumers can now make true apple-to-apples comparisons of their health insurance options. Table of Contents About the Covered California Family Dental Plans...3 Dental Companies by Pricing Region...8 Pricing Regions...13 Profiles of Participating Dental Companies...50 Glossary...56 Covered California is an independent part of the state government whose job is to make the new market work for California s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information on Covered California, please visit This booklet does not include pediatric dental rates for the Small Business Health Options Program (SHOP) Covered California Covered California Family Dental Plans and Rates updated Aug. 26,

3 About Covered California s Family Dental Plans California families will get expanded opportunities for improved dental health, through Covered California s offerings of family dental plans. The plans offer comprehensive coverage for both children and adults. Purchase of the plans is optional, at an additional cost. Adults can choose to enroll in family dental plans without enrolling the entire family. In the individual exchange, the participating dental carriers are: Plan. Anthem Blue Cross. of California. of California... There are two different product types available, depending on where the family lives. The dental preferred provider organization () product offers a wide variety of provider choice within a network of participating dentists, as well as coverage for some out-of-network services. The dental health maintenance organization () limits coverage to services provided by a dentist within a network and generally requires a referral to be seen by a specialist. Covered California family dental plans feature standard copayments, deductibles and coinsurance requirements. The children s benefit designs have an actuarial value of 85 percent. An actuarial value is the percentage of total average costs for benefits that a dental plan will cover. These premiums are for stand-alone plans, dental benefit products that can be purchased by themselves to cover a specific service. Dental plans must follow Covered California standard benefit designs. Standardizing benefits ensures that the selected plans define what the consumers get and limit the consumer s out-of-pocket costs. 2 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

4 Family Dental Plan Standard Benefit Designs ENROLLEE PAYS Coverage category Adult Child Diagnostic and preventive * 0% 0% Amalgam filling one surface 20% 20% Root canal molar 50% 50% Gingivectomy per quad 50% 50% Extraction single tooth, exposed root or erupted 50% 50% Extraction complete bony 50% 50% Crown porcelain with metal 50% 50% Medically necessary orthodontia not covered 50% Enrollee costs Deductible (waived for diagnostic and preventive) $ 50 $ 65 Annual benefit limit $ 1,500 none Notes on Family Dental Plan Standard Benefit Designs Children s dental benefit notes (only applicable to the pediatric portion of the family dental plan) 1. In a coinsurance plan, each child is responsible for the individual deductible unless the family deductible has been met. Once a child s individual deductible or the family deductible is reached, cost-sharing applies until the child s out-ofpocket maximum is reached. 2. Cost-sharing payments made by each individual child for in-network services accrue to the child s out-of-pocket maximum. Once the child s individual out-ofpocket maximum has been reached, the plan pays all costs for covered services for that child. 3. In a plan with two or more children, cost-sharing payments made by each individual child for in-network services contribute to the family deductible, if applicable, as well as the family out-of-pocket maximum. 4. Only enrollees in a Covered California Platinum, Gold, Silver or Bronze health insurance plan are eligible to purchase a standalone family dental plans. Adult dental benefit notes (only applicable to the family dental plan) 1. Each adult is responsible for an individual deductible. 2. Families that wish to purchase a family dental plan must include at least one adult who has purchased a Platinum, Gold, Silver or Bronze insurance plan through Covered California. 3. If a child is enrolled in the family dental plan, all children in the family under age 19 must be enrolled in the same family dental plan. Individual out-of-pocket maximum N/A $ 350 Family out-of-pocket maximum (two or more children) N/A $ 700 Office copay $ 0 $ 0 Waiting period 6 months for major services ** none * Diagnostic and preventive services include X-rays, exams, cleanings and sealants. ** Waived with proof of prior coverage. The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan s Policy or Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services. 4 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

5 Family Dental Plan Standard Benefit Designs ENROLLEE PAYS Coverage category Adult Child Diagnostic and preventive * $ 0 $ 0 Amalgam filling one surface $ 25 $ 25 Root canal molar $ 300 $ 300 Gingivectomy per quad $ 150 $ 150 Extraction single tooth, exposed root or erupted $ 65 $ 65 Extraction complete bony $ 160 $ 160 Crown porcelain with metal $ 300 $ 300 Medically necessary orthodontia not covered $ 350 Enrollee costs Deductible (waived for diagnostic and preventive) $ 0 $ 0 Annual benefit limit none none Notes on Family Dental Plan Standard Benefit Designs Children s dental benefit notes (only applicable to the pediatric portion of the standalone or family dental plan) 1. In a coinsurance plan, each child is responsible for the individualdeductible unless the family deductible has been met. Once a child s individual deductible or the family deductible is reached, cost-sharing applies until the child s out-ofpocket maximum is reached. 2. Cost-sharing payments made by each individual child for in-network services accrue to the child s out-of-pocket maximum. Once the child s individual out-ofpocket maximum has been reached, the plan pays all costs for covered services for that child. 3. In a plan with two or more children, cost-sharing payments made by each individual child for in-network services contribute to the family deductible, if applicable, as well as the family out-of-pocket maximum. 4. Only enrollees in a Covered California Platinum, Gold, Silver or Bronze health insurance plan are eligible to purchase a standalone family dental plans. Adult dental benefit notes (only applicable to the family dental plan) 1. Each adult is responsible for an individual deductible. 2. Families that wish to purchase a family dental plan must include at least one adult who has purchased a Platinum, Gold, Silver or Bronze insurance plan through Covered California. 3. If a child is enrolled in the family dental plan, all children in the family under age 19 must be enrolled in the same family dental plan. Individual out-of-pocket maximum N/A $ 350 Family out-of-pocket maximum (two or more children) N/A $ 700 Office copay $ 0 $ 0 Waiting period none none * Diagnostic and preventive services include X-rays, exams, cleanings and sealants. The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan s Policy or Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services. 6 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

6 Dental Companies by Pricing Region Region Counties Companies 1 Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne 2 Napa Sonoma Solano Marin 3 Sacramento Placer El Dorado Yolo Anthem,, Premier Anthem,, Premier Anthem,, Premier 4 San Francisco Anthem,, Premier Dental Companies by Pricing Region Region Counties Companies 5 Conta Costra Anthem,, Premier 6 Alameda Anthem,, Premier 7 Santa Clara Anthem,, Premier 8 San Mateo Anthem,, Premier 9 Santa Cruz Monterey San Benito Anthem,, Premier 8 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

7 Dental Companies by Pricing Region Region Counties Companies Dental Companies by Pricing Region Region Counties Companies 10 San Joaquin Stanislaus Merced Mariposa Tulare 11 Fresno Kings Madera Anthem,, DPP Premier Anthem,, Premier 15 Los Angeles (partial) Anthem,, Premier 16 Los Angeles (partial) Anthem,, Premier 12 San Luis Obispo Ventura Santa Barbara Anthem,, Premier 17 San Bernardino Riverside Anthem,, Premier 13 Mono Inyo Imperial Anthem,, Premier 18 Orange Anthem,, Premier 14 Kern Anthem,, Premier 19 San Diego Anthem,, Premier 10 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

8 Pricing Region 1 Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne $ $ Anthem $ $ $ $ 8.00 * $ $ * $ $ Premier $ $ * Partial = not available in every ZIP code in the region. 12 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

9 Pricing Region 2 Napa, Sonoma, Solano, Marin $ $ Anthem $ $ $ $ 8.00 * $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 14 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

10 Pricing Region 3 Sacramento, Placer, El Dorado, Yolo $ $ Anthem * $ $ $ $ 8.60 * $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 16 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

11 Pricing Region 4 San Francisco $ $ Anthem $ $ $ $ 8.60 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

12 Pricing Region 5 Contra Costa $ $ Anthem $ $ $ $ 8.00 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

13 Pricing Region 6 Alameda $ $ Anthem $ $ $ $ 8.00 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

14 Pricing Region 7 Santa Clara $ $ Anthem * $ $ $ $ 8.60 $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 24 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

15 Pricing Region 8 San Mateo $ $ Anthem $ $ $ $ 8.60 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

16 Pricing Region 9 Santa Cruz, Monterey, San Benito $ $ Anthem $ $ $ $ 8.00 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

17 Pricing Region 10 San Joaquin, Stanislaus, Merced, Mariposa, Tulare $ $ Anthem $ $ $ $ 8.00 * $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 30 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

18 Pricing Region 11 Fresno, Kings, Madera $ $ Anthem $ $ $ $ 7.60 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

19 Pricing Region 12 San Luis Obispo, Ventura, Santa Barbara $ $ Anthem $ $ $ $ 7.60 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

20 Pricing Region 13 Mono, Inyo, Imperial $ $ Anthem $ $ $ $ 8.00 * $ $ * $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 36 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

21 Pricing Region 14 Kern $ $ Anthem $ $ $ $ 8.00 * $ $ * $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 38 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

22 Pricing Region 15 ZIP Codes Pricing Region 15 Los Angeles The county of Los Angeles is made up of two Pricing Regions by ZIP code. (Regions 15 and 16). Refer to the table on the left to find out if this region includes your ZIP code. $ $ Anthem * $ $ $ $ 8.00 $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 40 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

23 Pricing Region 16 ZIP Codes Pricing Region 16 Los Angeles The county of Los Angeles is made up of two Pricing Regions by ZIP code. (Regions 15 and 16). Refer to the table on the left to find out if this region includes your ZIP code. $ $ Anthem * $ $ $ $ 8.00 $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 42 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

24 Pricing Region 17 San Bernardino, Riverside $ $ Anthem * $ $ $ $ 7.60 $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 44 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

25 Pricing Region 18 Orange $ $ Anthem $ $ $ $ 7.60 $ $ $ $ $ $ $ $ Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

26 Pricing Region 19 San Diego $ $ Anthem * $ $ $ $ 8.00 $ $ $ $ $ $ $ $ * Partial = not available in every ZIP code in the region. 48 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

27 Participating Dental Companies Participating Dental Companies Plan About the company: Plan was founded by a practicing dentist in 1989 in an effort to make quality dental care available at an affordable cost. In less than 25 years, the organization has grown to include multiple companies, all of which are related to promoting good oral health. Network General Dentist: 3,814 Pediatric Dentist: 538 Specialist: 1,963 Website: Phone: Anthem Blue Cross About the company: As an independent licensee of Blue Cross Association, Anthem Blue Cross is a major U.S. health insurance company, with more policyholders in California than any other insurer. Network General Dentist: 62,629 Pediatric Dentist: 3,632 Specialist: 27,652 Website: Phone: Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

28 Participating Dental Companies Participating Dental Companies of California About the company: As a California-based not-for-profit health plan, of California is driven by a single mission: to ensure all Californians have access to high quality care at an affordable price. We are offering a dental preferred provider organization () plan and a dental health maintenance organization () plan that gives Covered California customers a choice of high-quality dentists at an affordable price. We ve been serving California for more than 70 years and have consistently been a leader in developing new and better ways of delivering dental care. Network General Dentist: 20,026 Pediatric Dentist: 1,075 Specialist: 8,021 General Dentist: 11,758 Pediatric Dentist: 736 Specialist: 6,466 Website: Phone: of California About the company: of California, a not-for-profit dental benefits administrator, is headquartered in San Francisco. Along with its affiliated companies, it is the state s and nation s largest dental health plan. We cover approximately 27 million people. of California is part of the national Plans Association, whose member companies collectively cover more than 63 million people in the U.S. of California is committed to advancing dental health and access through exceptional dental benefits service, technology and professional support. Network General Dentist: 20,536 Pediatric Dentist: 966 Specialist: 13,940 General Dentist: 9,915 Pediatric Dentist: 604 Specialist: 4,817 Website: Phone: : DMHO: Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

29 Participating Dental Companies Participating Dental Companies About the company: Founded in Long Beach, California by a practicing dentist, Dental Health Services was established in 1974 as one of the first organizations to specialize in prepaid dental plans. We have been serving the dental health needs of individuals, families, unions, groups, associations, and municipalities in California for more than 40 years. members have access to an exclusive network of participating dentists, all of whom must meet our rigorous, 107-point Quality Assurance program that ensures and guarantees members receive only the highest care possible. As an independently owned and operated dental benefit solutions company, we take pride in being the only employee-owned dental plan in the country. Our employee-owners are your neighbors and friends who work, live, shop, and play right here. When you work with us, you work with real people who continuously advocate for a happier, healthier you! About the company: was founded by a practicing dentist in 1989 in an effort to make quality dental care available at an affordable cost. In less than 25 years, the organization has grown to include multiple companies, all of which are related to promoting good oral health. Network General Dentist: 9,718 Pediatric Dentist: 556 Specialist: 2,176 Website: Phone: Network General Dentist: 4,391 Pediatric Dentist: 305 Specialist: 1,629 Website: Phone: Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

30 Glossary Actuarial Value A health insurance plan s actuarial value is the percentage of total average costs for benefits that a health insurance plan covers. These expenses are usually incurred at the point of receiving health care services when you visit the doctor or the emergency room, for example. Dental plans come in two actuarial value options: 85 percent, which features higher premiums but lower average out-of-pocket costs; and a 70 percent value plan with lower premiums and higher average out-of-pocket costs. An actuarial value is the percentage of total average costs for benefits that a dental plan will cover. Coinsurance Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service, is called coinsurance. You pay coinsurance plus any deductible you may owe. For example, if the health insurance plan s allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health insurance plan pays the rest of the allowed amount. The allowed amount is the amount the doctor or hospital has agreed to accept for the care provided. Copayment A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. Dental Preferred Provider Organization () A type of dental plan product that delivers dental services to members through a network of contracted dental care providers and includes limited coverage of out-of-network services. Dental Health Maintenance Organization () A type of dental plan product that delivers dental services by requiring assignment to a primary dental care provider who is paid a capitated fee for providing all required dental services to the enrollee unless specialty care is needed. DMHOs require referral to specialty dental providers. These products do not include coverage of services provided by dental care providers outside the dental plan. 56 Aug. 20, 2014 Covered California Family Dental Plans and Rates Covered California Family Dental Plans and Rates updated Aug. 26,

31 Out-of-Pocket Maximum The most you pay during a policy period (a calendar year) before your health insurance plan begins to pay 100 percent of the cost of covered services. This limit never includes your premium, balance-billed charges or health care your health insurance plan doesn t cover. Some health insurance plans don t count all out-of-network payments toward this limit. 58 Aug. 20, 2014 Covered California Family Dental Plans and Rates

32 CoveredCA.com

Children s Dental Insurance Plan Rates 2014

Children s Dental Insurance Plan Rates 2014 June 25, 2013 About Covered California TM Covered California is charged with creating a new insurance marketplace in which individuals and small businesses can