“the representative and recognized resource of the dental benefits industry”
OFFICERS & DIRECTORS April 13, 2007
Chairman JOHN P. FOLEY Members of the Committee on Insurance Guardian Life Insurance Co. Texas House of Representatives New York, New York The Capitol, EXT E2.150, P.O. Box 2910 Austin TX 78768-2910 Vice Chair GENE SHERMAN, DMD Sent via email to the individual Representatives
Starmount Life Insurance Company RE: In Support of HB 2135 Baton Rouge, Louisiana Dear Chairman John Smithee, Representative Todd Smith, Representative Secretary / Treasurer Larry Taylor, Representative Craig Eiland, Representative Kelly Hancock, BRUCE HENTSCHEL Representative Armando Martinez, Representative Senfronia Thompson, Principal Life Insurance Company Representative Hubert Vo, and Representative Beverly Woolley; Des Moines, Iowa I am writing on behalf of the National Association of Dental Plans (NADP) to provide comments on House Bill No. 2135, which allows the use of certain
GAIL M. GARCIA terms to describe benefits for dental care services.
CIGNA Dental and Vision Care NADP is the largest, national non-profit trade association focused exclusively Plantation, Florida on the entire dental benefits industry, including dental HMOs, dental PPOs,
KAREN GUSTIN, LLIF discount dental plans and dental indemnity products. NADP’s member companies provide dental benefits to 133 million of the 163 million Americans Ameritas Life Insurance Co. with dental benefits, and specifically an estimated 9.4 million Texans . Our Lincoln, Nebraska member companies include major commercial carriers, regional and single
JEANNE HENSEL state companies, as well as companies organized as Delta Dental and Blue Cross Blue Shield plans. NADP member companies are listed under HumanaDental Insurance Co. Attachment A. Green Bay, Wisconsin Background: RON INGE, DDS Under Texas insurance law, dental plans are prohibited from offering a Washington Dental Services traditional PPO in the state. As a result, plans are prohibited from: Seattle, Washington (a) preventing an enrollee from selecting the dentist of their choice to furnish dental care services offered by the plan or interfering with the enrollee’s BRENT WILLIAMS selection of a dentist; or Dental Select (b) denying any dentist the right to participate as a contracted provider as long Draper, Utah as the dentist is licensed to provide the dental care services offered by the plan.
DOYLE WILLIAMS, DMD In order to operate within the legal guidelines, the dental insurance industry has DentaQuest named this type of plan which provides for equal reimbursement for in and Boston, Massachusetts -next page-
Executive Director EVELYN F. IRELAND, CAE
National Association of Dental Plans
www.nadp.org 88111 LBJ Freeway Suite 935 Dallas, Texas 75251-1347 Ph 972-458-6998 Fax 972-458-2258 out–of–network providers, a ‘passive PPO.’ Due to the unique provision of Texas, verbiage explaining this type of ‘network’ has been ‘contracting providers.’
NADP is NOT suggesting a change to the Insurance Code allowing the usage of traditional PPOs, we are in full support of HB 2135 as it allows our plans to simplify their benefits to their enrollees with terminology they are comfortable with and understand.
Supporting HB 2135 allows :
• Eliminates Consumer Confusion : A passive PPO to a consumer is the same as a traditional PPO, the reimbursement of a provider has no affect on their dental plan, nor does it affect our main customers – the employers. The consumer understands what a traditional PPO means and how it works. They do not understand why it is labeled differently. A passive or traditionally self funded PPO is the plan most often chosen by Texas consumers or employers, as more than 54% of the 10.6 million residents with dental benefits, chose a PPO style plan 1. Additionally 3 out of every 4 dental benefit enrollees in Texas are enrolled under an employer funded/self funded plan , and due to an ERISA preemption are allowed to enroll in a traditional PPO plan within the state. Therefore, even though traditional PPOs are not allowed to operate in the state, passive PPOs and self funded PPOs are the vast majority of dental plans operating in Texas.
• Lowers Administrative Costs: Texas is one of the few states with a unique passive PPO provision. Therefore dental plans must reword and have state specific forms created for Texas sitused case enrollees. Allowing the terms as provided in HB 2135, would allow our members to utilize their printing, websites, databases in a more streamlined fashion, and eliminate costly administrative burdens, passing the savings onto the consumer.
• Does No Harm to Providers : HB 2135 does not change the PPO standards in Texas; nor does it change provider contracts or reimbursements. The vast majority of dentists are already participating in a traditional or passive PPO network; an estimated 10,352 dentists are practicing in Texas, with an 84% participating in a PPO style network 2. This bill does NOT affect providers.
NADP’s mission is to promote and advance the dental benefits industry to improve consumer access to affordable, quality dental care. We carefully examine each piece of legislation we lend our support, making sure it supports our mission. NADP strongly supports HB 2135 and believes it will definitely assist your constituents on better understanding their dental benefits.
We need the Texas legislature’s support on this issue as oral health is systemic to overall health and in The Surgeon General’s Report “Oral Health 2000” found that the top barrier to seeking -next page-
1 2006 NADP/DDPA Network Statistics Report . Note: The 10.6 million residents with dental benefits does not include Medicaid or Medicare dental benefit recipients. 2 2006 NADP/DDPA Network Statistics Report .
- - 2 - -
“the representative and recognized resource of the dental benefits industry” 8111 LBJ Freeway Suite 935 Dallas, Texas 75251-1347 Ph 972-458-6998 Fax 972-458-2258 www.nadp.org
dental care was cost and that dental benefits overcame that barrier. In fact, the report states that dental benefits increase the percentage of people visiting a dentist on an annual basis by 20%. 3
Thank you in advance for your review and consideration of NADP’s comments. If you have questions on these comments or would like additional background information, please contact me at [email protected] or (972)458-6998x111.
Sincerely,
Kris Hathaway Director of Government Relations National Association of Dental Plans Dallas, TX
3 The Surgeon General’s Report “Oral Health 2000” indicates that 70.4% of individuals with private dental insurance reported seeing a dentist in the past year, compared to 50.8% of those without dental insurance
- - 3 - -
“the representative and recognized resource of the dental benefits industry” 8111 LBJ Freeway Suite 935 Dallas, Texas 75251-1347 Ph 972-458-6998 Fax 972-458-2258 www.nadp.org
“the representative and recognized resource of the dental benefits industry”
Attachment A: NADP Members
1. Advantage Dental 41. Great West Healthcare 2. Aetna Dental 42. Group Dental Service 3. Affordable Family Health Svcs. 43. Group Health Inc. 4. Altus Dental Ins Company 44. GroupLink, Inc. 5. American Dental Alliance, Inc. 45. Guardian Life Ins Co. of America, 6. American Dental Professional Svcs. 46. Health Resources, Inc. 7. AmeriPlan USA Corp. 47. HealthPartners, Inc. 8. Ameritas Life Insurance Corp. 48. HIP Health Plan of New York 9. Assurant 49. Horizon Healthcare 10. Atlantic Dental 50. Humana Dental 11. Avesis 51. Kaiser Permanente Dental Care Program 12. Avia Dental Plan 52. Liberty Dental Plan of CA 13. Best Life and Health Insurance Co. 53. Lincoln Financial Group 14. Blue Cross Blue Shield of MA 54. MetLife 15. Blue Cross Blue Shield of MI 55. National Guardian Life Ins. Co. 16. Blue Cross Blue Shield of NC 56. Nippon Life Ins. Co. of America 17. Blue Cross Blue Shield of RI 57. Premera Blue Cross 18. Blue Cross Blue Shield of TN 58. Principal Financial Group 19. Blue Shield of California 59. Security Life Ins. Co. of America 20. CIGNA Dental & Vision Care 60. Shenandoah Life Insurance Co. 21. Citizens Security Life Ins. Co. 61. Southland National 22. Community Dental Svcs. (Smile Care) 62. Standard Insurance Company 23. CompBenefits Corporation 63. Starmount Life Insurance Co. 24. CareFirst Blue Cross 64. Southwest Dental Plan 25. Delta Dental of CA, NY, PA & 65. Total Dental Administrators Affiliates 66. Trustmark 26. Delta Dental of MI, OH, IN 67. United Concordia Companies, Inc. 27. Delta Dental of MO 68. UnitedHealthcare Dental 28. DENCAP Dental Plans 69. Venture Health Group 29. Denta-Chek of Maryland, Inc. 70. Washington Dental Service 30. Dental Care Plus Group Inc. 71. Wellpoint Dental Services 31. Dental Health Svcs. of America 72. Willamette Dental Insurance, Inc. 32. Dental Network of America, Inc. 33. Dental Select 34. DentalPlans.com 35. DentaQuest 36. Dentist Direct 37. Dominion Dental Svcs., Inc. 38. First Dental Health 39. Florida Combined Life Ins Company 40. GEHA
“the representative and recognized resource of the dental benefits industry” 8111 LBJ Freeway Suite 935 Dallas, Texas 75251-1347 Ph 972-458-6998 Fax 972-458-2258 www.nadp.org