Northeast Delta Dental’s Marketplace Plans “ What’s in it for my N onprofit?” May 13, 2014 Brian Staples Senior Sales

1. Northeast Delta Dental’s Marketplace Plans “What’s in it for myNonprofit?”May 13, 2014Brian StaplesSenior Sales Executive

2. Northeast Delta Dental’s Marketplace Plans Essential Health Benefits (10 categories of services): • ambulatory patient services • emergency services • hospitalization • maternity and newborn care • mental health and substance use disorder services, including behavioral health treatment • prescription drugs • rehabilitative and habilitative services and devices • laboratory services • preventive and wellness services and chronic disease management, and • pediatric services, including oral and vision care

3. Northeast Delta Dental’s Marketplace Plans How the Pediatric Dental Benefit (PDB) is available: • PDB can be either embedded in a medical plan or covered in a stand-alone dental benefit plan. • Medical plans do not have to offer the PDB in its plan if a stand-alone dental plan is available on the state’s Marketplace and is offering a plan covering the PDB (“the dental carve out” or “9 out of 10 plan”).

4. Northeast Delta Dental’s Marketplace Plans What/who does Maine’s PDB cover? • The services covered are the same (minor differences possible) for all carriers offering PDB coverage and mirror the Federal Employee Dental and Vision Insurance Program (FEDVIP) plan. • Dental “pediatric” age on Federally Facilitated Marketplace is up to age 19.

5. Northeast Delta Dental’s Marketplace Plans Plan design requirements for the PDB: • No annual plan maximum • (New) Out-of-Pocket Maximum (OOPM) • No deductible applied to preventive services • Out-of-network expenses do not count to the OOPM • Actuarial Values of 70% or 85% • Medically necessary orthodontics

6. Northeast Delta Dental’s Marketplace Plans • Adult coverage is not impacted by ACA. • No requirement for adults to purchase dental coverage. • ACA plan requirements do not apply so adult coverage will look similar to coverage in existing plans. • Because market reforms only apply to the Pediatric Dental Benefit (as an Essential Health Benefit), family dental plans can have different plan designs for kids and adults.

7. Northeast Delta Dental’s Marketplace Plans Delta Dental’s 2014 ME Marketplace Plans: • Pediatric (only) Low Plan • Pediatric (only) High Plan • Family Low Plan • Family High Plan All four available to small groups orindividuals at the same price.

8. Northeast Delta Dental’s Marketplace Plans Marketplace Dental Benefit Plan Design PEDIATRIC Coverage (ME) • Up to age 19 • 100/80/50/50 (85% actuarial value) or 100/60/50/50 (70% AV) • Office visit co-pay $15 / $30 (high/low); Deductible $50/ $150 • No deductible on any preventive services • OOPM $700, $1400 family maximum for 2+ children • 100/100/100/100 after OOPM reached • Only covered services apply to OOPM • Medically necessary orthodontics

9. Northeast Delta Dental’s Marketplace Plans Marketplace Dental Benefit Plan Design ADULT Coverage (ME) • 100/80/50 (High) or 100/60/50 (Low) • Office visit co-pay $15 / $30 (High/Low) • Deductible $50/ $150 (High/Low) • No deductible on any preventive services • No orthodontics covered • Plan annual maximum $1000 • Waiting periods: 3 months Basic, 6 months Major

10. Northeast Delta Dental’s Marketplace Plans Delta Dental’s Maine Marketplace Plans’ Network: • Marketplace plans use the Delta Dental PPO network, a national network (think: kids on the family’s plan who are away at college). • Only costs for such services performed by Delta Dental PPO dentists accrue to the pediatric Out-of-Pocket Maximum.

13. Northeast Delta Dental’s Marketplace Plans Factors to Consider When Looking at Dental Coverage Options: • Insurance carriers reputation for quality & service (ask your dentist!) • Provider Network • Value: Cost / Benefits • Confirm which deductible and OOPM applies to the pediatric dental benefit (the medical plan’s if the dental is embedded, or the stand-alone dental benefit plan’s if not).

14. Northeast Delta Dental’s Marketplace Plans Questions?