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Introducing… Dental (A-81000 Series). Field Sales Guide. Provides standard information only Available online via AFLAC University Review administrative guidelines for state- specific information. Section 1. Introduction. AFLAC Dental. First introduced in 2000 $60 million in 2001

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Introducing… Dental (A-81000 Series)


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    Presentation Transcript
    1. Introducing…Dental (A-81000 Series)

    2. Field Sales Guide • Provides standard information only • Available online via AFLAC University • Review administrative guidelines for state- specific information

    3. Section 1 Introduction

    4. AFLAC Dental • First introduced in 2000 • $60 million in 2001 • 2003 – reduced group size and participation requirements • 2004 – opened to nonpayroll sales Page 11

    5. People Want Dental Insurance • The ADA recommends two dental cleanings per year • Having dental insurance and getting the recommended cleanings allows policyholders to realize immediate benefits • Dental insurance consistently ranks high in employee benefit polls Page 11

    6. The Small Employer Market • Often don’t offer dental insurance because of the cost • Want a simple product that is not complicated by provider networks, pre- certification, etc. • Nonpayroll rates available if needed Page 11

    7. The Large Employer Market • Provider networks and pre-certification help to reduce costs • Often employer-paid • 90% of employers with at least 500 employees already offer dental benefits Page 12

    8. Focus on Small Businesses • Only 56% of all employers offer dental benefits • Small employers need dental insurance! Page 12

    9. What’s New with AFLAC Dental? • Fewer options • X-Ray Benefit • 3-month waiting period for fillings • Increased benefits • Orthodontic rider covers everyone Page 13

    10. What’s New with AFLAC Dental? • New Cosmetic Rider • Provider education tools • Enhanced brochures • Streamlined competitive replacement process Page 13

    11. Section 2 The Dental Insurance Market

    12. Medical Spread of risk; price is based on an estimate of how many people will use it Out-of-pocket expenses are capped for the policyholder Dental High utilization; most everyone will use it Yearly benefits are capped to control expenses Focus on preventive benefits Medical vs. Dental Insurance Page 17

    13. Types of Dental Insurance • Indemnity Plans • PPOs • HMOs • Table of Allowances • Direct Reimbursement • Discount Plans Page 18

    14. Indemnity Plans • “Traditional” dental insurance • Based on usual, customary, and reasonable (UCR) fees • 100% for preventive care • 80% for restorative services • 50% for major services • Annual maximums • Usually a deductible Page 18

    15. Preferred Provider Organizations (PPOs) • Provider network • Providers agree to pre-set fees and savings are passed to the insured • Usually no deductible • Patient can go out of network, but will incur higher costs • Exclusive Provider Organizations (EPOs) do not cover out-of-network treatment Page 18

    16. Health Maintenance Organizations (HMOs) • Capitation plans • Preventive and basic services usually performed at no charge • Patient may have a co-payment for major services • Raises concerns about the quality of treatment Page 18

    17. Table of Allowances • Similar to AFLAC’s definition of “indemnity” • Fixed benefit is paid for each procedure, regardless of charges • Patient chooses dentist • AFLAC Dental is a table of allowances plan Page 18

    18. Direct Reimbursement • Self-funded by employer • Patient pays dentist and files for reimbursement with employer • Reimbursement based on charges, not type of treatment • Patient chooses dentist • The ADA promotes direct reimbursement plans Page 19

    19. Discount Plans • Not a form of insurance • Requires a membership fee • Participating dentists provide discounted services • No benefit maximums • Typically quote a savings of 20%-50% Page 19

    20. Categories of Benefits • Preventive, Diagnostic, and Emergency • Oral examinations, cleanings, X-rays • Fluoride applications, sealants • Routine or Basic Care • Fillings • Routine oral surgery, periodontal care • Complex or Major Care • Crowns • Complex oral surgery, extensive care Page 19

    21. Section 3 Plan Structure

    22. Original AFLAC Dental • 6 levels of coverage • Too many options • Higher Wellness Benefit consistently outsold lower benefit • Level 4 – 38% • Level 3 – 3% Page 23

    23. New AFLAC Dental Options • Basic • $25 wellness • Lowest benefit schedule • Standard • $50 wellness • Mid-range benefits • Premier • $50 wellness • Higher tier of benefits Page 23

    24. Waiting Period • Period of time after effective date for which benefits are not payable • Controls costs by preventing immediate claims • Reduces the chance that a person will buy dental insurance because he or she needs a specific procedure • Compensates for little underwriting Page 24

    25. Waiting Periods: • Start over on the date of reinstatement • Begin on the effective date of a dependent’s addition to the policy • Apply to increased benefit amounts for conversions • Run from the original effective date for downgrades Page 24

    26. Waiting Periods Page 24

    27. Waiting Periods Page 24

    28. Policy Year Maximums • Maximum benefits payable per covered person per policy year • Does not include Wellness and X-rays • Basic - $1,200 • Standard - $1,400 • Premier - $1,600 Page 25

    29. Section 4 Policy Benefits and Provisions

    30. Wellness Benefit • Pays for one listed treatment per visit • Visits must be separated by 150 days or more • Payable twice per person, per policy year Examples: • Oral evaluations • Cleanings • Fluoride applications Page 29

    31. X-Ray Benefit (new!) • Pays for one listed X-ray procedure per visit • Payable once per person per policy year • Basic - $10 • Standard - $25 • Premier - $25 Page 29

    32. Schedule of Dental Procedures • Benefit amounts are listed by ADA code • If ADA codes change, we will pay an amount comparable for the procedure • Procedures may fall under more than one category • Only the schedule varies among the different plans – waiting periods, limitations and exclusions, etc. are the same Pages 29-44

    33. Orthodontic Benefit Rider • Applies to all covered persons (new!) • After 24 month waiting period, pays: • $600 for initial orthodontic treatment • $200 every third month for continued treatment • Covered treatments listed by ADA code • $1,200 lifetime maximum per person • $2,400 maximum per policy year • Payroll sales only Page 45

    34. Cosmetic Benefit Rider (new!) • Applies to all covered persons • After 24 month waiting period, pays for specific procedures at benefit amounts listed • Examples: bleaching teeth, veneers, etc. • $1,800 lifetime maximum per policy • $600 maximum per policy year • Payroll sales only Page 46

    35. Limitations and Exclusions • Procedures not listed in the schedule • Services not recommended by a dentist or not required for oral health • Repairs to dental work within six months of initial work • Replacement prosthetics within five years of last placement • Treatment involving crowns within five years of last placement Page 47

    36. Limitations and Exclusions (continued) • Replacement for inlays or onlays within five years of last placement • Treatment received while outside the U.S. • Sealants: • Secondary molars for children under 16 • Not more often than every five years • Replacement of teeth missing before the effective date of coverage Page 47

    37. Section 5 Administrative Guidelines

    38. Eligibility Requirements • Issue ages: • 1865 on payroll • 1864 on nonpayroll • No minimum group size for payroll • Dependent ages 19/23 • Optional riders available for payroll sales only • If supplementing existing dental insurance, only the Basic policy may be offered Page 67

    39. Administrative Guidelines • Flex: • Base policy and Ortho Rider eligible for pre-tax • Cosmetic Rider is after-tax only • Advanced Effective Date (new!) • Up to 90 days from enrollment date • More than 60 days requires Statement of Understanding Page 67

    40. Additional Forms • Replacement Notice • if replacing another carrier’s dental policy • Outline of Coverage • if required in your state • Guide to Health Insurance for People with Medicare • if applicant is eligible for Medicare Page 68

    41. Renewable/Portable • Guaranteed-renewable for the policyholder’s lifetime • Payroll rate may be retained after one month’s payment through payroll deduction • Changes once on direct billing will be subject to direct rates, underwriting, and eligibility rules Page 68

    42. Missed Payments • Dental uses a shorter lapse cycle • Status 13 (no premiums received) • Will be notified after the second missed invoice and will lapse in 30 days • Status 22 (active) • Will be notified after the first missed invoice and will lapse in 30 days • No claims paid on policies more than 90 days in arrears, regardless of policy status Page 69

    43. Section 6 Sales Support Materials

    44. Brochures • Brochure folder A81075 • Insert for each policy: • Basic A81175 • Standard A81275 • Premier A81375 • Inserts list every covered procedure and benefit amount (new!) Page 73

    45. Additional Pieces • Rider inserts: • Orthodontic A81076 • Cosmetic A81077 • Mailer A81090 • Suitable for both payroll and direct prospects • Employer Flyer MMC-00-236 • Intended for employers - also used with Dental A-80000 Series Pages 73-74

    46. Provider Education Tools (new!) • Tent card M1078 • www.aflacdental.com • Both provide tips for completing the ADA claim form and filing claims electronically • Web site allows provider to enter policy number and ADA codes to retrieve benefit information • Active policies only • Only when policy record is available Page 73

    47. Aflac_Project Name_Date

    48. Aflac_Project Name_Date

    49. Aflac_Project Name_Date

    50. Section 7 Applications/Underwriting