Big Changes to Pediatric Dental in 2020

Pediatric Dental has been with us since 2014. There are two sides of this coin. One side annoying, the other an opportunity to sell.

The first few years it took the carriers a bit of time to get up to speed but gradually all of our carriers were able to quote typical adult dental plans with all the normal moving parts (ie $50 deductible or $100 lifetime; annual max of $1000 to $2000; endo and perio in Type 2 or 3) and lay the approved pediatric portion either as an add on or a 'better of' plan behind it. This has worked rather well and it is what we are used to.

This summer we began to hear from our carriers that this paradigm is shifting a bit. In short, most of our carriers will have many less options for adult plans attached to pediatric dental plans for 2020. The good news is this will not affect current groups, only new business quoting.

Below is a list of our major carriers and how this new change affects both new and existing business:

Companion Life does not have a 2020 option filed. Their current groups however will be able to keep the adult plans they have currently as zero rate increase so that is good!

Delta is business as usual! We can quote any new business option for adults with any combination of benefit and the pediatric dental will remain rigid and static as it always has. Current groups will remain the same. Click here for Delta's stand alone options.

Similar to Companion, KCL will only offer one plan to go with pediatric dental. It will be 'canned' and we will not have the flexibility to change any of the coverage items. Current business is allowed to keep the adult plans they have.

Guardian has never fully been in the pediatric game. We don't have much if any pediatric dental but they largely business as usual with maybe a few less counties having access to these plans.

The MI Department of Insurance required that in the Dental Certificate, Met revise two of the covered services to include additional information. However, these revisions do not impact how they are administering these services. The revisions to the covered services are:

  • Oral examinations and problem focused examinations with a combined frequency limitation of 2 times per Year. Initial consultations are covered separately and are not included as part of the 2 times per year frequency limit.

  • Consultations, but not more than 2 times per 12 months. Consultations by a second Dentist is a covered service.

Additionally, the Department required Met to make a few minor edits in the:

  1. Section on filing a complaint with the director of the Michigan Department of Insurance and Financial Services; and

  2. The portion of the Certificate where we explain how alternate benefits work.

Again, these revisions are slight and do not change how Met is administering benefits under the plan.

After speaking with the Contracts team, it has been confirmed that the Department did not have an issue with our version of the “greater of” approach.

In short, Met/MMA are business as usual!

Unum has four filed plans for new business that will go with pediatric dental. Current business will not be affected.

Expect many less options for pediatric dental for 2020. For new business, we will mainly go to Delta Dental unless one of the canned plans from KCL, Companion or UNUM works. Luckily current groups will be able to keep the plans they have.

I expect within a year we will be back to offering many more options for the pediatric plans.

Don't forget Delta still maintains its stand alone pediatric plans as an option.

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