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Policy pops: Health care exchanges — 2019 enrollment results

3‑minute read

Join our guest blogger, Devin McBrayer, as she reviews the outcomes of the 2019 open enrollment period for health care exchanges. Devin is a Legislative and Policy Analyst based in Sacramento, California.

The open enrollment period to purchase Affordable Care Act (ACA)-compliant individual health insurance coverage off the health insurance exchanges for 2019 has come to an end. Sign-ups were off to a slow start at the beginning of the enrollment period, leaving many experts fearful that ACA plans would experience a significant decrease in enrollment. However, total enrollment only decreased by about 3.8% nationwide on Healthcare.gov, much of this due to a 15% reduction in new sign-ups. 

While the total enrollment drop in individual health insurance plans on the exchange may have been less drastic than expected, it is still worth exploring why new enrollment decreased considerably and why year-to-year enrollment continues to decline. Several 2018 policy changes, combined with a growing economy, could help explain the decrease in enrollment in ACA plans for the 2019 plan year. 

Are policy changes to blame?

In 2018, Congress reduced the tax penalty for not having an ACA-compliant health insurance plan to zero, effectively eliminating it. The federal government also shortened the open enrollment period and reduced marketing for open enrollment. Simultaneously, the federal government passed several rules that expanded the availability of cheaper and less comprehensive insurance plans such as short-term limited duration plans. No tax penalty for lack of coverage, combined with a shorter sign-up period and more plan options outside the exchanges, may help explain the enrollment decrease.

The impact of the economy

Another possible explanation for the drop in enrollment could be attributed to an improving economy. When open enrollment started on November 1, 2018, 2 million more jobs were added to the economy than were added at the same time in 2017. As more people head back to work, it’s possible that they’re gaining access to employer-sponsored health insurance, eliminating the need to renew their ACA plan. 

What does this mean for dental?

Any loss in enrollment for medical coverage also means less people enrolled in dental coverage on the exchange. (As a reminder, dental coverage is an essential health benefit for children but not for adults.) 

In the exchanges, dental coverage is included in some health plans or consumers can get a stand-alone dental plan and pay a separate premium. However, there is no way for consumers to purchase a stand-alone dental plan without also purchasing a medical plan on the health care exchange. Pushing for states and the federal government to allow for the independent purchase of stand-alone dental plans on state and federal health insurance exchanges is a top priority for the Public & Government Affairs team at Delta Dental.

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What to ask about leased dentist networks

Cars, houses, clothing, even dogs — the list of items Americans lease today continues to grow. The world of dental benefits is no exception to the trend. Oftentimes, to expand network size, a dental carrier will lease a dentist network from a third party (either another carrier or a company that aggregates dental networks). While the potential for more dentist access is tempting, it’s important to know if a leased network can truly deliver more value.

If you’re recommending a carrier who leases its dentist networks, ask these questions to see how it could impact your client.

1. Who holds the contract with the leased network dentist? The primary carrier or a third party?

Why it matters: In many cases, when a carrier leases a dentist network, there is no direct contract or relationship with the leased dentists. This may create difficulties in resolving disputes through a third party, which could mean unhappy enrollees. It may also cause confusion about which claims guidelines and processing policies apply. This could leave enrollees waiting longer for a claim to process or even cause an enrollee to be billed incorrectly.

2. Are leased network dentists held to the same credentialing and quality standards as non-leased dentists? Are they continually monitored by the primary carrier?

Why it matters: When portions of a dentist network are leased, there’s a possibility that their equipment, office cleanliness, treatment plans, safety measures and/or patient history have not been vetted as thoroughly as a carrier’s direct-contracted dentists. Furthermore, if the primary carrier is not involved in monitoring the leased network dentists, there may be no guarantee that these dentists are re-credentialed every three years or that they are credentialed to National Committee for Quality Assurance (NCQA) criteria.

3. How much of a carrier’s dentist network is leased?

Why it matters: Dentist turnover might be higher if a carrier leases dentists. Why? Because a leased dentist’s network agreement could end before a group’s benefits contract. This means, if a large part of a carrier’s dentist network is leased, there could be a greater chance enrollees will find their dentist is suddenly no longer in network.

4. Which fee schedule takes precedence when an enrollee visits a leased network dentist?

Why it matters: When a carrier leases a dental network from multiple companies or carriers, the same dentist could end up in more than one leased portion of the network. If this is the case, a group may end up with multiple fee schedules, which is known as stacking. This could cause inconsistent costs for the group if different fee schedules are applied across the network. Dentists may also be confused about how to bill enrollees, which could potentially increase claims costs depending on which fee schedule they apply.

5. How does the carrier ensure the accuracy of its leased dentist directory?

Why it matters: If a carrier does not hold a direct contract with its leased network dentists, it may be hard to ensure the accuracy of the dentist directory. This could create an unpleasant surprise for an enrollee if they’re billed for an out-of-network visit when they thought the dentist was in network. It could also lead to overstatement of network size.

6. How much is the network access fee when an enrollee visits a leased network dentist?

Why it matters: A bigger network does not always mean bigger savings for the group. If a carrier leases dentist networks to increase their network numbers, groups need to consider how much they’re being charged for access to the additional dentists. These fees may differ between portions of the network.


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10 scientifically-supported ways to celebrate your employees

3‑minute read

Most businesses organize some sort of employee appreciation event every year. Why do we do it? Because other companies do it? Because social media tells us we should? Or maybe there’s a science behind it?

There actually is some science behind it. Here are ways you can boost employee happiness and productivity while going easy on your budget.

Employees smiling and talking in the office

Pay attention to these four brain chemicals, their positive effects, and some ways to get them pumping:

Endorphins

Endorphins are chemicals meant to ease pain and stress, but they are also proven to boost happiness. Since physical activities help produce endorphins, here are a range of activities that can get your employees moving:

  • Organize an intramural-style sport activity for your company. Popular sports include basketball, softball, volleyball and kickball. ZogSports coordinates leagues in major metro areas, and many smaller areas have local leagues.
  • Encourage members of your team to start a running group and run a race. Bonus points if you’re benefitting a charity or cause!
  • Look into getting a reduced group rate for fitness classes. There are plenty of cycling, strength training, yoga, barre and other studio fitness classes to choose from.

Dopamine

A lift in dopamine can kick-start some serious motivation and productivity, because it targets the reward center of the brain. Low levels of dopamine have been linked to procrastination and self-doubt, which is the opposite of how you want your employees feeling. Some motivation-boosting activities include:

  • Coordinate goal-setting meetings with specific rewards. If you plan out small milestones and celebrate each one, you’re encouraging continuous productivity and rewarding motivated behavior each time. Rewards can be as big or small as you want.
  • Play music at some points during the day, as long as it’s not distracting. Hearing music that you like is proven to boost dopamine levels. And it wouldn’t hurt if your team also got up and moved to the beat!
  • Encourage learning new skills or being creative. Set up a class at a local craft shop, share a video on the basics of drawing, or give your employees access to adult coloring books.

Serotonin

Serotonin is the chemical perhaps most closely linked to your mood. It contributes to feelings like calmness, and a lack of serotonin is linked to anxiety. Thankfully, there a lot of natural ways to boost serotonin levels and improve your employee’s moods, including:

  • Soaking up some sun. Plan your next team event around being outside —organize a team lunch at a local restaurant with a great patio, or simply relocate your weekly brownbag to a picnic table near the office.
  • Think positively and spread positivity. One of the easiest ways to boost serotonin levels is to recall positive experiences from the past. And try creating positive experiences for your employees going forward with a recognition program.

Oxytocin

The “trust hormone” is crucial in corporate culture. It helps us build working relationships and create positive interactions with one another. Here are a few things you can try in the workplace to build relationships and trust:

  • Try a trust- and team-building experience, like an escape room or obstacle course.
  • Give (and receive) small gifts! It’s been proven that giving a gift can often feel just as good as receiving one. Take this CEO for instance, who wrote each of his employees a birthday card (and received cards in return for his!).

Take a challenge and try integrating each of these happy chemicals into your employee engagement strategy throughout the year.

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The three R’s, and why dental shouldn’t be left out

Repeal, replace or repair? These are the three R’s dominating the news in recent weeks about how U.S. Congressional Republicans want to overhaul the Affordable Care Act.

Republicans, who represent the majority in both the House and Senate, have an opportunity to rewrite the health care law, but are generally split into three camps on how to do so: Repeal the whole law now and replace later, perhaps incrementally; repeal once a complete replacement is ready; or repair the ACA for now, then determine what to do next.

Regardless of which strategy they select, something new is on the horizon, and Delta Dental is working to ensure dental benefits aren’t left out of the discussion.

About 1 million previously uninsured Americans today have affordable dental coverage as a result of dental benefits sold in public health exchanges, while employer-sponsored plans continue to enjoy tax-exempt coverage. Since our mission is to advance dental health and access to care, we want to preserve this progress in whatever legislation may come.

To this end, here’s what we’re telling lawmakers:

  • Allow people with exchange dental coverage to renew those policies with the carriers they’ve selected—whether or not those marketplaces continue—to minimize disruption.
  • If a new law includes tax credits to help eligible Americans purchase benefits, let those credits be used for dental as well as medical coverage.
  • Keep the tax-exempt status for employer-sponsored dental benefits; expand that exemption to allow individuals to pay dental premiums with tax-free dollars.

Whether repeal, replace, or repair, the key “r” word for Delta Dental is ready.

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