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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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field sales guide
Field Sales Guide
  • Provides standard information only
  • Available online via AFLAC University
  • Review administrative guidelines for state- specific information
section 1

Section 1

Introduction

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

Page 11

people want dental insurance
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

the small employer market
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

the large employer market
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

focus on small businesses
Focus on Small Businesses
  • Only 56% of all employers offer dental benefits
  • Small employers need dental insurance!

Page 12

what s new with aflac dental
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

what s new with aflac dental1
What’s New with AFLAC Dental?
  • New Cosmetic Rider
  • Provider education tools
  • Enhanced brochures
  • Streamlined competitive replacement process

Page 13

section 2

Section 2

The Dental Insurance Market

medical vs dental insurance
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

types of dental insurance
Types of Dental Insurance
  • Indemnity Plans
  • PPOs
  • HMOs
  • Table of Allowances
  • Direct Reimbursement
  • Discount Plans

Page 18

indemnity plans
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

preferred provider organizations ppos
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

health maintenance organizations hmos
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

table of allowances
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

direct reimbursement
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

discount plans
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

categories of benefits
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

section 3

Section 3

Plan Structure

original aflac dental
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

new aflac dental options
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

waiting period
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

waiting periods
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

policy year maximums
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

section 4

Section 4

Policy Benefits and Provisions

wellness benefit
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

x ray benefit new
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

schedule of dental procedures
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

orthodontic benefit rider
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

cosmetic benefit rider new
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

limitations and exclusions
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

limitations and exclusions continued
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

section 5

Section 5

Administrative Guidelines

eligibility requirements
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

administrative guidelines
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

additional forms
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

renewable portable
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

missed payments
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

section 6

Section 6

Sales Support Materials

brochures
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

additional pieces
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

provider education tools new
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

section 7

Section 7

Applications/Underwriting

applications
Applications
  • Payroll A81001
  • Nonpayroll A81002D
  • Applicant’s section includes a space for the dental provider’s name
  • Replacement questions:
    • Only Basic plan allowed if keeping other dental insurance
    • Must convert an existing AFLAC policy
    • Replacement Notice may be required

Page 77

dependent information
Dependent Information
  • Dependents must be listed on application
  • Complete Supplement Form A-80005
    • if more than eight dependent children and provide proof of dependent status
  • Use form A81003 to add newborns and adopted children within 31 days

Page 77

underwriting
Underwriting
  • No underwriting for payroll applications
  • Nonpayroll applications have one question:
    • Have you or has anyone to be covered been diagnosed with or treated for any gum disease such as gingivitis within the last 24 months?
  • Any such person will not be covered

Page 78

conversions
Conversions
  • Use new business applications
  • Check conversion box and provide current policy number
  • For increased benefits, new waiting periods apply only to the increase in coverage
  • For reduced benefits, waiting periods run from the original effective date

Page 78

continuous coverage
Continuous Coverage
  • Spouse’s coverage terminates at divorce; may apply for equal or lower coverage without evidence of insurability
  • If primary dies, spouse becomes primary insured
  • Dependent children must apply within 31 days of losing dependent status to avoid interruption in coverage

Page 78

section 8

Section 8

Rates and Commissions

rate comparison
Rate Comparison

Aflac_Project Name_Date

forms
Forms
  • Rate sheet
    • M-RS069-1
  • Premium work sheet
    • A90137-1
  • Field Sales Guide includes standard rates only

Page 93

commissions
Commissions

Aflac_Project Name_Date

section 9

Section 9

Competitive Replacements

requirements
Requirements
  • Competitive replacements allow reduced waiting periods under the following conditions:
    • Fifty or more eligible employees
    • Replacing a group dental plan that has been in place for at least one year
    • At least 70% participation in AFLAC Dental
  • Conversions of existing AFLAC Dental policies do not count toward participation requirements.

Page 101

reduced waiting periods
Reduced Waiting Periods
  • Available only during the initial enrollment period.
  • Anyone applying after this time, including new employees, will receive standard waiting periods.
  • All competitive replacement requirements must be met to receive reduced waiting periods.

Pages 101-102

request form
Request Form
  • Competitive Replacement Checksheet Form M0978R
    • Submit with paper applications
    • Submit at least seven days prior to SmartApp® enrollments, then download group update to access the applications
  • Form M0978R is available on Associate Services

Page 101

application new process
Application (new process!)
  • Form A8101T
  • Applicant must indicate whether or not standard waiting periods are acceptable, in case all requirements are not met.
  • This prevents you from having to go back and obtain standard applications.
  • Advise applicants to check their Policy Schedule for waiting periods.

Page 102

commissions1
Commissions

Page 103

filing instructions
Filing Instructions
  • ADA Claim Form HF004
  • Electronic claims preferred
  • Typed claim forms should be mailed
  • Claim checks will not be mailed to the associate
  • Most payments will be made to the provider; if an overpayment, the provider should reimburse the insured

Page 111

claims guidelines
Claims Guidelines
  • ID cards are contained in the policy and reference the provider Website
  • No claims paid on policies more than 90 days in arrears
  • Please do not send X-rays
  • ADA code revisions may be requested from the Customer Call Center

Page 111

section 11

Section 11

Marketing AFLAC Dental

key features
Key Features
  • No:
    • Provider network
    • Pre-certification
    • Deductible
    • Coordination of benefits
  • Simple plan design
  • Individually owned
  • Rate stability

Page 117

understanding group dental
Understanding Group Dental
  • UCR charges do not necessarily reflect what an individual provider will charge
  • Percentages cannot easily translate to a benefit amount until charged
  • High participation requirements, may also require employer contribution
  • Policy owned by the group

Page 118

the aflac advantage
The AFLAC Advantage
  • Table of allowances makes benefit determination easy!
  • Freedom to choose any dentist
  • Individually owned
  • Portable
  • Rates not tied to group experience
  • Contract is between AFLAC and individual

Page 118

how much coverage is needed
How Much Coverage is Needed?
  • Highest level not always appropriate
  • Dental treatment unlikely to cause catastrophic financial consequences
  • Benefits should reduce out-of-pocket expenses, not necessarily eliminate them
  • Overselling may take premium dollars from other AFLAC products

Page 119

saving for rider benefits
“Saving” for Rider Benefits
  • Ortho Rider
    • 34 months to receive full individual benefits
    • Individual benefits = $1,200
    • 34 individual monthly premiums = $918
  • Cosmetic Rider
    • 49 months to receive full benefits
    • Full benefits = $1,800
    • 49 monthly premiums = $1259.30
  • Ortho Rider also has pre-tax advantage

Aflac_Project Name_Date

section 12

Section 12

Dental Terminology

(self study)

section 13

Section 13

Forms List

(self study)

thank you and good luck
Thank you and Good Luck!

Aflac_Project Name_Date