Dental Dental

2013 Annual Report
Mastering Change

Our adaptability supports our customers

President’s Message

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.

Gary Radine President and CEO

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:

  • Introducing a new set of online tools for dentists to help make administration easier for them, and for enrollees by extension.
  • Gaining new federal business.
  • Launching a new technology platform to support our exchange partners.

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

Health Care Reform is Here

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:

  • Interacting with various exchanges to smooth out transactional processes so enrollees can enjoy streamlined implementation of their dental plan.
  • Taking an advocacy role in proposing and responding to continuing rule changes and lobbying with a strong voice for consumer-oriented decisions.
  • Evaluating our products to ensure they are meeting the needs of the marketplace.

Technology: Faster, Easier, Better

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.

Prevention is Key

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.

Healthy eating is part of prevention

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.

Risk assessment tool

Our new risk assessment tool

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 Business is Growing

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.

Commercial programs

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.

Small Business Program (5–99 employees)
217,000 enrollees
14,000 groups
AARP
330,000 enrollees
Mexico Dentist Network
4,500 dentists
255 cities

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.

Government programs

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.

FEDVIP
45,000 new enrollees
VADIP
7.4 million eligible enrollees
PHS ADDP
6,500 new enrollees

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).

Statistics

Brokers vote Delta Dental “The Best Dental Carrier”

2013 Benefits Selling magazine Readers’ Choice Awards: brokers vote on industry favorites

5th consecutive win

8th win overall in 9 years


PPO is our most popular plan design (% of enrollees)

  • Delta Dental PPO1
    84%
  • DeltaCare USA2
    9%
  • Delta Dental Premier1
    7%

Large networks mean easy access to in-network dentists (dentist locations)

  • Delta Dental Premier
    307,000
  • Delta Dental PPO
    220,000
  • DeltaCare USA
    63,000

Low turnover preserves enrollee-dentist relationships

  • Delta Dental Premier: 1.1%
  • Delta Dental PPO: 2.3%
  • DeltaCare USA: 2.3%

Enrollee satisfaction with Delta Dental dentist

93.4%


A.M. Best ratings reaffirmed

A− Excellent
Delta Dental of California
Delta Dental Insurance Company
B++ Good
Delta Dental of Pennsylvania
Delta Dental of New York

Sample of new valued clients

  • City of Birmingham
  • Danone Group North America (The Dannon Company, Inc.)
  • DHL (DPWN HOLDINGS – USA)
  • Diocese of Orange County
  • Fair Isaac Corporation (FICO)
  • GEICO
  • Graton Resort & Casino
  • Jackson State University
  • Kimberly-Clark Corporation
  • Margaritaville Casino
  • Niagra Bottling
  • Northwestern Energy
  • Rensselaer County
  • Rexel Holdings USA
  • rue21
  • South Nassau Communities Hospital
  • The University of Southern Mississippi
  • Weatherford International

Our enrollment growth remains steady

Enrollment change from 2010 to 2014

We processed a record number of claims

39 million claims processed in 2013

4 days average claim turnaround

99.6% accuracy rate

We’re here when you need us

17 million calls answered

99% resolved on first contact

Clients and their enrollees report high levels of satisfaction

99% satisfied clients3

93% satisfied enrollees4

Our cost management techniques demonstrate real savings

Total Submitted
$12.2 billion
Savings
$3.1 billion
(25% of submitted)
Savings
$3.1 billion
Dentist Fee Agreements
$2.3 billion
Non-Covered Services
$375 million
Other
$231 million
Eligibility Verification $195 million

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

Financials

Balance Sheets

Condensed Combined Balance Sheets (unaudited)
December 31, 2013 and 2012
(In thousands)

  2013 2012
Assets
Cash and cash equivalents $ 358,826 $ 456,135
Marketable securities 822,444 508,288
Receivables 463,763 461,421
Property and equipment, net 250,685 310,725
Other assets 68,691 67,131
  $ 1,964,409 $ 1,803,700
     
Liabilities and general reserves
Liabilities
Accrued professional services $ 424,401 $ 461,912
Accounts payable and accrued expenses 377,808 336,128
Deferred revenue 70,939 36,412
Refundable customer balances 159,965 167,612
Accrued retirement benefits 67,240 83,788
Other liabilities 64,219 71,737
  1,164,572 1,157,589
General reserves 799,837 646,111
  $ 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.

Income Statements

Condensed Combined Statements of Income and Expense and General Reserves (unaudited)
December 31, 2013 and 2012
(In thousands)

  2013 2012
Revenues
Commercial customers $ 6,012,103 $ 5,724,845
State and federal programs 1,129,384 1,454,956
Investment income 19,710 18,314
Other income (expense), net (12,464) (37,170)
  7,148,733 7,160,945
     
Expenses
Professional dental services 6,257,169 6,351,517
Administrative 780,596 719,990
  7,037,765 7,071,507
     
 
Net income 110,968 89,438
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

About Us

Our enterprise companies comprise one of the nation’s largest dental benefit delivery systems, with 26+ million enrollees.

Structure

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.

Enterprise companies

Puerto Rico,the U.S. Virgin Islandsand Barbados Enterprise Map
  • Delta Dental Insurance Company (AL, FL, GA, LA, MS, MT, NV, TX and UT)
  • Delta Dental of California
  • Delta Dental of Delaware, Inc.
  • Delta Dental of the District of Columbia
  • Delta Dental of New York, Inc.
  • Delta Dental of Pennsylvania (PA and MD)
  • Delta Dental of West Virginia, Inc.
  • Delta Dental of Puerto Rico (PR and VI)
  • Delta Reinsurance Corporation
  • Alpha Dental of Alabama, Inc.
  • Alpha Dental of Arizona, Inc.
  • Alpha Dental of Nevada, Inc.
  • Alpha Dental of New Mexico, Inc.
  • Alpha Dental of Utah, Inc.
  • Alpha Dental Programs, Inc.

Enterprise operations

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

*DeltaCare USA

Delta Dental Plans Association has granted our enterprise the exclusive right to underwrite multi-state and national DHMO business under the DeltaCare USA brand.

Dentegra companies

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.

  • Dentegra Group, Inc.
  • Dentegra Insurance Company*
  • Dentegra Insurance Company of New England*
  • Dentegra Seguros Dentales, S.A.
  • Servicios Dentales Dentegra, S.A. de C.V.

Leadership

>Steve F. McCann
Steve F. McCann
Chair of the Board
Enterprise
Delta Dental of California
Thomas H. Wysmuller
Thomas H. Wysmuller
Chair of the Board
Delta Dental of New York
James S. Wilson, DDS
James S. Wilson, DDS
Chair of the Board
Delta Dental of West Virginia
Glen F. Bergert, CPA
Glen F. Bergert, CPA
Chair of the Board
Delta Dental of Pennsylvania
Alan H. Singer, DDS
Alan H. Singer, DDS
Chair of the Board
Delta Dental of the District of Columbia
Gary D. Radine
Gary D. Radine
President and CEO
Enterprise
Delta Dental of California
Delta Dental of New York
Delta Dental of Pennsylvania
Delta Dental of the District of Columbia
Delta Dental of West Virginia

Contact Us

Sales offices and contact information

Seawell Photography

President’s Message and About Us, Gary D. Radine