Pediatric Dental--the subject we now all know and love. Who knew when the ACA passed in 2010 that the small market would be so dominated by such a tiny detail. The reality is Pediatric Dental is a real issue here in Michigan and by now most of you have a few sound strategies for navigating it with your clients.
Whether you like to embed the Blues stand alone into the medical or wrap pediatric into the dental rates or even just go with a Delta Dental 'shell' plan, Benefit Profiles is your back room shop for all things pediatric!
Here is our rundown for the carriers and how they're handling pediatric dental in 2018:
1. Delta Dental--
Delta has updated their 2-9 product to where they offer the same rate whether your group chooses pediatric dental or not. This is a nice shift and you can access those plan designs and rates here for 2018.
In addition, Delta has released the stand alone pediatric plans for 2018 for groups with Priority Health. We are awaiting the rates for non-PH groups and we will post them as soon as they come available.
Remember we can still do 'shell' plans by which Delta will create a group number and a plan on file for when a group should need to add a member to a the pediatric plan down the line. This happens quite often when groups are moving to an EHB small group medical plan but have no children quite yet to add.
Delta is approved in every county in Michigan and does not offer medically necessary orthodontia in its coverage.
2. Kansas City Life--
Kansas City Life has the ability to do pediatric dental in every county in Michigan. We request those quotes directly from KCL and they do a 'better of' plan. In this case they administer the benefit that most works for the patient between the adult dental plan and the pediatric.
KCL does not offer stand alone pediatric dental.
3. Companion Life--
Companion Life's pediatric plan is also approved for every county in Michigan but they do more of a split option where the children have the pediatric plan and the adults have the base dental plan. This overlaps a bit when we do a traditional orthodontia benefit. In this instance the children revert back to the base dental plan for claims purposes. It can get a bit messy and there are times when we have to talk the orthodontist office's billing department through it.
Companion Life does not offer stand alone pediatric dental.
Met continues to be approved and certified for pediatric dental in every county of the State. Met does a 'better of' option and they include medically necessary ortho in their plan. Met does not offer a stand alone option in Michigan.
Guardian is an odd one where they don't have every county approved for pediatric dental. This most affects our agents in Isabella, Muskegon and Kalamazoo counties. If you have groups who already have pediatric dental with Guardian in Muskegon and Kalamazoo, they can continue to renew their plans. We can't quote or write new business in these counties. Guardian utilizes a 'better of' option and they don't offer a stand alone pediatric plan.