Our adaptability supports our customers
Some organizations flourish during times of change, others struggle. With health care reform front and center, this is a transformational time for our industry, requiring ongoing adaptability.
On a very tight schedule, we launched products on every state exchange in our enterprise (plus additional states through our affiliates) as well as on the federal exchange.
Being adaptable to changing conditions serves a company’s customers better than being rigid and struggling.
Gearing up for the Affordable Care Act this past year meant designing pediatric and family dental plans based on different sets of rules for the federal and state exchanges, stand-alone versus bundled scenarios and with differing market conditions.
As rules continue to shift and technical issues are ironed out, being nimble becomes critical to responding to this ever-changing landscape. Working with the government sometimes requires a different experience level. In fact, selling to the individual rather than the group market requires different approaches also. Happily, Delta Dental has a track record with both.
On a very tight schedule, we launched products on every state exchange in our enterprise (plus additional states through our affiliates) as well as on the federal exchange. The result of those efforts in the first somewhat confusing three months of enrollment won us over 300,000 new enrollees.
At the same time, we kept other parts of our business growing. This report highlights some of those efforts:
Despite all the changes in today’s world, you can be certain that one thing will stay constant at Delta Dental: our dedication to you, our customer.
Gary D. Radine
President and CEO
We mobilized staff in every part of our organization to prepare for the federal and state exchange open enrollment starting this past October 1.
Complex operational, compliance, regulatory, marketing and product development processes were necessary to meet the requirements of these marketplaces. We surmounted big challenges and tight deadlines to implement and launch pediatric and adult dental benefit plans in 27 health exchanges around the country.
We formed strategic alliances with a variety of medical carriers, which helped us serve markets where selling stand-alone dental policies was problematic. We also participated in a number of private exchanges set up by brokers. The enrollment gained validated these efforts.
But gaining new enrollment was just the first part. We continue to harness extensive resources to help make our connection to the Affordable Care Act a success:
In 2013, we introduced new technology platforms, tools and functionality to make dental benefits administration easier for customers and partners.
We launched Provider Tools, an assortment of online tools that enable dental offices to focus on the patient instead of paperwork in their dealings with us. With Provider Tools, dental offices can quickly access comprehensive patient records, take advantage of real-time claims submission and enroll in direct deposit. Real-time claims submission allows dentists to obtain many pre-treatment estimates and have claims for many procedures processed while the patient is in the office. Within days of its launch, Provider Tools was deemed a success by enthusiastic dental offices that appreciated the efficiency these online services offer.
To support the implementation of the Affordable Care Act and private exchange business, we launched a new data exchange platform in 2013. This platform enables successful transactions with federal, state and private exchanges, expeditiously transferring enrollment, billing and provider information.
We also introduced new self-service tools for brokers, including an online appointment process and a resource toolkit to help them better serve their clients.
In conjunction with other Delta Dental member companies throughout the country, we have been developing a set of Oral Health Care Measures to help determine the risk level for disease and corresponding preventive treatment.
This is a new concept in the dental industry. Our most recent Preventive Dental Care Study, based on data from 90 million claims, found that more than a third of children ages 6 to 18 were at higher risk of tooth decay based on past claim history, yet 70% of them had not received preventive therapy of two annual fluoride treatments. We hope this multi-year study will serve as a model for evidence-based care and help those most at risk avoid the consequences of dental disease.
Our SmileWay® Wellness Program provides a range of educational tools for enrollees in the form of articles, videos, interactive quizzes, a newsletter and social media. We added a new component to our website in 2013, a clinically validated risk assessment tool that enrollees can use to evaluate their teeth, gums and oral cancer risk. After answering a series of questions, enrollees receive an oral health risk score and a report they can bring to their next dental appointment.
In 2013, we added a clinically validated risk assessment tool that evaluates the user’s teeth, gums and oral cancer risk.Visit
In 2013, our Hispanic outreach efforts focused on educating public school children about the importance of dental health. Ratoncito Pérez, the Hispanic culture’s tooth fairy equivalent, visited school systems in South Florida, Atlanta and Houston, discussing the importance of good dental health and handing out “Las Aventuras del Ratoncito Pérez” (The Adventures of Ratoncito Pérez) educational coloring books (PDF, 1.4 MB).
Our enrollment continues to climb and our enrollee retention remains high. With a 98% retention rate and expected new business, we should cover more than 27 million enrollees by the end of the year.
We have administered the AARP Dental Insurance Plan for more than 10 years, now covering more than 330,000 enrollees. We are leading efforts to encourage a healthy dental lifestyle through education and plan design enhancement. After studying root caries (decay at a patient’s gum line) in this population, we are considering the addition of an adult fluoride benefit sometime in the future. Helping AARP enrollees prevent tooth decay and improve oral health can also positively impact their overall health and well-being.
Our Small Business Program for groups of 5–99 employees has experienced continued growth since its launch in 1996, ending 2013 with more than 217,000 enrollees in 14,000 groups. The program is expanding to businesses with 2–4 enrollees, and we are offering exchange-certified plans for those who want to retain all of their dental benefits with Delta Dental.
Our affiliate company in Mexico continued its successful growth, surpassing three quarters of a million enrollees by year’s end. This provides us with rare experience in marketing and providing our coverage in a country with national health insurance. We also offer a vision product that serves almost 80,000 enrollees. Supporting this growth is the steady increase in our networks – almost 4,500 dentists in 255 cities and 900 optical branches in 176 cities throughout all of the Mexico states. Our ongoing effort to visit and evaluate dental offices for quality, just as we do in the U.S., is of singular value to prospective purchasers.
We renewed the contract for a long-standing federal program and welcomed three new programs in 2013.
We were awarded a new contract for the TRICARE Retiree Dental Program (TRDP) by the Department of Defense TRICARE Management Activity (TMA). We have administered this program for retirees of seven uniformed services and their families for 15 years. The new contract provides increased benefit maximums and a third yearly cleaning for enrollees with diabetes. With more than 1.4 million enrollees, TRDP is one of the nation’s largest voluntary, enrollee-paid dental programs.
Delta Dental was one of seven carriers selected by the Office of Personnel Management to offer the Federal Employees Dental and Vision Insurance Program (FEDVIP) to federal civilian employees, retirees and their families. We enrolled our first 45,000 in the dental program during the 2013 open enrollment period.
The Department of Veterans Affairs designated Delta Dental as one of two carriers to participate in the Veterans Affairs Dental Insurance Program (VADIP), a three-year pilot program to provide dental coverage to eligible veterans and family members. An estimated 7.4 million veterans enrolled in the Veterans Affairs (VA) health care system and beneficiaries of the Civilian Health and Medical Program of the VA (CHAMPVA) are eligible to enroll.
Delta Dental was also awarded a three-year contract to provide dental services and claims processing for the 6,500 members of the Public Health Service Commissioned Corps through the Public Health Service Active Duty Dental Program (PHS ADDP).
2013 Benefits Selling magazine Readers’ Choice Awards: brokers vote on industry favorites
5th consecutive win
8th win overall in 9 years
39 million claims processed in 2013
4 days average claim turnaround
99.6% accuracy rate
17 million calls answered
99% resolved on first contact
99% satisfied clients3
93% satisfied enrollees4
1 Delta Dental PPOSM and Delta Dental Premier® are open networks that allow enrollees to visit any licensed dentist, either in the lower cost PPO network, the moderate cost Premier network or outside the networks, where there are no cost protections. Enrollees who visit a network dentist receive the advantages of no billing beyond the charges allowed by the plan and the submission of claims by dentists. In Texas, Delta Dental Insurance Company offers Dental Provider Organization (DPO) plans.
2 DeltaCare® USA is a closed network plan that features set copayments, no annual deductibles and no maximums for covered benefits. Enrollees select a primary care dentist in the DeltaCare USA network from whom they receive treatment, as in a traditional dental HMO. In some states, DeltaCare USA is offered as an open access plan where enrollees can obtain treatment from any licensed dentist; however, deductibles and maximums may be applied for services provided by an out-of-network dentist.
3 Represents responses from more than 2,800 surveys
4 Represents responses from more than 45,000 surveys
Condensed Combined Balance Sheets (unaudited)
December 31, 2013 and 2012
|Cash and cash equivalents||$ 358,826||$ 456,135|
|Property and equipment, net||250,685||310,725|
|$ 1,964,409||$ 1,803,700|
|Liabilities and general reserves|
|Accrued professional services||$ 424,401||$ 461,912|
|Accounts payable and accrued expenses||377,808||336,128|
|Refundable customer balances||159,965||167,612|
|Accrued retirement benefits||67,240||83,788|
|$ 1,964,409||$ 1,803,700|
The financial statements of the companies in our enterprise (including Delta Dental of California and subsidiaries, Delta Dental of Pennsylvania and subsidiaries, Delta Dental of Delaware, Delta Dental of the District of Columbia, Delta Dental of West Virginia and Delta Dental of New York) as of, and for the years ending, December 31, 2013 and 2012, were audited by an independent Certified Public Accountant firm. These audited financial statements are available upon request.
Condensed Combined Statements of Income and Expense and General Reserves (unaudited)
December 31, 2013 and 2012
|Commercial customers||$ 6,012,103||$ 5,724,845|
|State and federal programs||1,129,384||1,454,956|
|Other income (expense), net||(12,464)||(37,170)|
|Professional dental services||6,257,169||6,351,517|
|Unrealized gains on securities||25,955||3,598|
|Pension liability and post-retirement adjustments||16,803||9,985|
|General reserves at beginning of year||646,111||543,090|
|General reserves at end of year||$ 799,837||$ 646,111|
Our enterprise companies comprise one of the nation’s largest dental benefit delivery systems, with 26+ million enrollees.
The following companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies that together provide dental coverage to 60 million people around the country.
Alabama, California, Delaware, District of Columbia, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania, Puerto Rico, Texas, U.S. Virgin Islands, Utah, West Virginia
Delta Dental Plans Association has granted our enterprise the exclusive right to underwrite multi-state and national DHMO business under the DeltaCare USA brand.
The Dentegra companies below are not affiliated with Delta Dental Plans Association. However, the two U.S. insurance companies* are authorized by Delta Dental Plans Association to market and underwrite certain national Delta Dental programs.
President’s Message and About Us, Gary D. Radine