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Articles
Delta Dental Launches Online Newsletter
for Subscribers
Order Custom Reports Online
Delta Dental Introduces New, Easy-to-Read Explanation
of Benefits Statement
WSJ Insurance Survey Results
Connecticut Gains New Account Executive: Desiree
Fusco
Delta Dental Launches Web Site Improvements
Web Site Improvements Benefit Companies, Subscribers,
Too
Register Now for Delta Dental Classic
HIPAA Q&A
Sign Our Guestbook for Regular Updates
Delta Dental in January launched a monthly online
newsletter for subscribers. Subscriber News is a
free publication for all Delta Dental Plan of New
Jersey members. Each issue contains valuable information
about how subscribers can make the most of their
Delta Dental benefits. Subscriber News stories cover
everything from how to find a participating dentist,
to where subscribers can get detailed explanations
about their family's benefits, and much, much more.
In addition, Subscriber News features the latest
news and breakthroughs in the areas of dental health
and wellness. Readers can find out what they can
do between dentist visits to keep their smiles healthy,
learn what they should do in a dental emergency,
and discover what dental science has in store for
the future.
Subscriber News headlines are delivered to their
e-mail inbox each month. They can just click the
link to read the full story. To sign up for a free
subscription, go to www.deltadentalnj.com and click
on "Subscribers."
Then enter your e-mail address in the "Subscriber
News" box on the right side of the screen. You
may unsubscribe to Subscriber News at any time.
Please note: We do not sell, rent, or disclose your
e-mail address to third parties. Therefore, you will
not receive unsolicited e-mail ("spam")
as a result of subscribing to Subscriber News.
Delta Dental helps companies save money on their
dental program. To find out how well a particular
program is working, order your free, customized Cost
Containment report and Network Utilization report.
Among the report features:
- Benefit Cost Containment
- Payment to Dentist by Classification
- Payment to Dentist by Participating Status
- Summary with Incidence by Procedure
- Payment to Group by Dentist License Number
For groups with 400 or more employees, reports can
be ordered online at www.deltadentalnj.com. Click
"Brokers" and then select "Reports." You
will be contacted by your account executive, who
will deliver the reports and review them with you.
Delta Dental's notification of benefits statement
recently received a new name - Explanation of Benefits
- and a new look. The redesigned statement includes
even more information than before, but presented
in a much more readable, user-friendly format.
The statement now includes:
- Up to three processing policies listed per procedure
(instead of one), so patients and dentists clearly
understand how the benefits payment was determined.
- The name of the patient's plan.
- The participating status of the dentist.
- A notice indicating whether the patient or the
dentist received the check.
- Plan allowance information, which shows not only
the annual allowance, but also what the patient
has used to date.
- Detailed definitions about what different Explanation
of Benefits terms mean.
The new Explanation of Benefits statement is mailed
to the patient and the patient's dentist (whether
a participating or non-participating provider). To
see what the new Explanation of Benefits statement
offers, visit our Web site at www.deltadentalnj.com
and go to the "What's New"
section at the center of the screen.
The Wall Street Journal recently commissioned a
national survey of corporate offices responsible
for their firm's insurance needs to determine how
businesses select insurance providers. Among the
findings:
- Health care cost containment continues to be
a major concern. Most deal with rising costs by
a combination of increasing the employee's share
of premiums, requiring higher deductibles and larger
out-of-pocket maximums for employees. PPOs seem
to lead the offerings, with HMOs and indemnity
with co-payments/deductibles following. Only 2.6%
of the respondents offer conventional indemnity
plans without co-payments/deductibles. Point-of-Service/Open-Ended
HMOs were offered in nearly 25% of the instances.
- Outside ratings often weigh heavily in deciding
upon a benefit provider. Nearly half of those surveyed
felt that a rating weighed 50% or more as a factor
in their decision (although this portion of the
survey is blended with all types of employee benefits,
including life insurance and pension products).
Standard & Poor's, Moody's and A.M. Best ranked
highest for credibility. (Delta Dental Plan of
New Jersey received a AA- counterparty credit and
financial strength rating for two years in a row.)
- Delta Dental ranked high in brand recognition.
Delta Dental scored a 62% familiarity with this
audience and 17.9% usage. The familiarity rating
is especially good considering the number, size
and types of other carriers noted. Those that outscored
Delta Dental were for the most part large, multi-line
carriers with vast advertising/marketing efforts.
- Companies consider key information sources when
making insurance decisions. Key sources include
insurance rating firms (81.5%), brokers (67%),
business/financial publications (56%) and Web sites
(45.8%).
Delta Dental recently added a new account executive
in Connecticut to better serve the needs of the broker
community. Desiree Fusco joins John Gumkowski, Marketing
manager, and Ed Maloney, account executive in the
Connecticut office.
Fusco previously served as our dental network coordinator
in Connecticut, where she was responsible for recruiting
dentists and served as the first point of contact
between dental offices and Delta Dental. Those efforts
last year earned Fusco two gold awards for network
recruitment achievement at the Delta Dental Plans
Association (DDPA) Professional Relations seminar
in Miami. DDPA includes 37 independent Delta Dental
Plans that operate in all 50 states, the District
of Columbia and Puerto Rico.
Fusco's background includes a bachelor's degree
in legal studies. She held positions in both law
firms and dental offices before joining Delta Dental.
The addition of Fusco to the Connecticut team will
allow Delta Dental to explore new business opportunities,
as well as increase the current quality of service
to the broker community. "I look forward to
building long-standing relationships with our brokers
and customers," she says.
Delta Dental's Web site, at www.deltadentalnj.com,
unveiled a new look in January. The redesigned site
makes it easier than ever to find the information
you need. The Web site also features several special-interest
areas, including sections for brokers, employers,
subscribers and dentists.
The navigation bar on the left-hand side of the
home page prominently highlights important features
such as:
- "Find a Dentist," which enables subscribers
to find a participating dentist in their area,
check to see if their dentist is a participating
dentist, and find directions to their dental office.
- "Products," which describes the various
Delta Dental programs in detail.
- "Forms," where subscribers can download
claim forms and other documents.
- "Our Company," where you can view press
releases, request our annual report, read executive
biographies and more.
To find information specific for brokers, click
on
"Brokers" on the right-hand side of the
Delta Dental home page. This will take you to a home
page designed for you. Some of the information you
can access includes:
- Cost Containment reports for a broad look at
Delta Dental's claims savings capabilities.
- Information on our broker incentive program.
- Information on how to order customized group-specific
reports on cost containment and network utilization.
- Listings and biographies of account executives.
If you have trouble locating the information you
need, click on "Site Map" at the top of
any page to see the contents of the entire site at
a glance. Or, go to the
"Search" box next to the "Site Map" and
type in what you're looking for.
Delta Dental's Web site also offers special features
for subscribers and employers. Subscribers (and their
dentists) have easy online access to dental benefits
information through Benefits Connection. Benefits
Connection enables subscribers to check their benefits
and eligibility, as well as the status of their dental
claims online. The claims inquiry feature gives subscribers
access to two years of detailed Delta Dental claim
history, including whether a claim is pending or
has been paid, the amount and date paid, and details
about procedures performed.
Benefits administrators can now make all their eligibility
changes online using our secure Online Eligibility
Submissions feature. This service has become increasingly
popular because of its ease of use, accuracy, speed
and additional capabilities that lighten the workload
and increase the effectiveness of benefits administrators.
Advantages of using Online Eligibility Submissions
over traditional means of submitting eligibility
changes include:
- Speed. It's the fastest way to make eligibility
changes, and changes go into effect within 24 hours.
- Accuracy. Online eligibility submissions
eliminate trying to decipher hard-to-read handwritten
changes, which often require follow-up phone calls
for clarification.
- Ease of use. The online system guides
users through the system, and even provides prompts
if they forget anything. The site also offers an
Online Submissions Demo so they can take a "test
drive." To access the demo, go to our Web
site at www.deltadentalnj.com and click on "Employers."
Then click on "Online Submissions Demo." There's
also an online Quick Reference Guide for additional
help.
- Simplicity. Users can use the system to
enroll and terminate subscribers, as well as perform
changes, transfers and reinstatements. It also
simplifies record keeping. Users can view subscriber
profiles online and view, print and save their
submissions log. They can review not only the effective
date of each change, but can also determine what
date the change was made and what type of change
was made. (Note that due to different family enrollment
plans, eligible family members may not display
if a claim has not yet been processed for them.)
Benefits administrators can get started using Delta
Dental's Online Eligibility Submissions by calling
973-285-4119 or 973-285-4065 to request a password.
The Twelfth Annual Delta Dental Classic will be
here before you know it. The annual golf event and
dinner, which benefit Special Olympics New Jersey,
will take place Tuesday, June 4, at the Cherry Valley
Country Club in Skillman, New Jersey.
Brochures and registration information were mailed
in January to past participants. If you did not receive
a brochure, please visit our Web site (www.deltadentalnj.com)
and click on Schedule of Events in the Brokers section.
Registration is accommodated on a first come, first-served
basis. Last year's event drew 126 participants and
raised $50,000 for Special Olympics New Jersey, raising
the event's lifetime total to more than $300,000.
We hope you'll join us for a great day to benefit
a worthy cause!
The Health Insurance Portability and Accountability
Act (HIPAA) requires health care plans (including
Delta Dental and self-funded plans), health care
clearinghouses and certain health care providers
(including dentists) to establish standards that
protect the privacy of individually identifiable
health information (IIHI). The Privacy Rule requires
compliance by April 14, 2003 (or April 14, 2004,
for small health plans).
Delta Dental developed the following Q&A to:
explain HIPAA; provide information about how the
legislation will affect the relationship that companies
and their employees have with Delta Dental; and explain
how the privacy rules could affect relationships
between Delta Dental and brokers. Note: At press
time, Health and Human Services announced it would
be issuing additional clarifications shortly.
What is the Privacy Rule and who must comply
with it?
The Privacy Rule applies to three types of "covered
entities": a health plan (including dental plans
such as Delta Dental's); health care clearinghouses;
and health care providers (including dentists) who
transmit certain health information electronically.
In addition, Delta Dental's
"business associates," including brokers,
must also comply with it.
The Privacy Rule protects independently identifiable
health insurance (IIHI) that is transmitted or maintained
in
"any form or medium" (known as "protected
health information" or "PHI"). This
appears to include virtually all communications -
whether paper, electronic or oral. IIHI includes
health information (including demographic information)
that:
- is created or received by Delta Dental;
- relates to the past, present or future physical
or mental health condition of an individual, as
well as the provision of health care to an individual
or the past, present or future payment for the
provision of health care to an individual; and
- identifies the individual or there otherwise
exists a reasonable basis to believe that the information
can be used to identify the individual.
What type of transactions are covered under the
Privacy Rule?
Transactions covered under the Privacy Rule include
the following types of information:
- Health care claims or equivalent encounter information
- Health care payment and remittance advice
- Coordination of benefits
- Health care claims status
- Enrollment and dis-enrollment in a health plan
- Health plan premium payments
- Referral certification and authorization
- First report of injury
- Health claims attachments
What Delta Dental programs must comply with HIPAA's
Privacy Rule?
When conducting risk business, Delta Dental Plan
of New Jersey, Inc., is considered a health plan
(i.e., covered entity) under the Privacy Rule and,
as such, must comply with the Privacy Rule. When
conducting ASO business, Delta Dental may be a business
associate of the group health plan (i.e., ERISA plan)
and, as such, must comply with the Privacy Rule.
The Privacy Rule applies to all programs of Delta
Dental, including DeltaPremier, DeltaPreferred Option
and DeltaCare (as well as the national account applications
of these programs).
What types of restrictions does the Privacy Rule
place on the use of protected health information?
With the exception of health plans' use or disclosure
of PHI for its treatment, payment or health care
operations, covered entities may not use PHI internally
or disclose PHI externally without an individual's
consent or authorization. (Other exceptions may apply,
such as in the case of public health emergencies.)
"Consent" and "authorization" apply
in different contexts under HIPAA. "Consent" is
given for the use or disclosure of PHI for the purposes
of
"treatment," "payment" or "health
care operations" (as these terms are defined
under the Rule). "Authorization" is given
for any use or disclosure of PHI for purposes other
than treatment, payment or health care operations.
The basic rules of consent and authorization are
as follows:
- Dentists who are covered under HIPAA must obtain
consent from a patient in order to use PHI for
treatment, payment or the dentist's health care
operations. For example, a dentist must obtain
a written consent from the patient in order to
treat the patient or submit claims to Delta Dental.
However, the United States Department of Health
and Human Services recently published a proposed
rule change to eliminate this requirement. A future
issue of Broker News will update you with respect
to HHS' decision whether to delete the consent
requirement.
- Health plans (including Delta Dental) generally
do not need to obtain consent in order to use PHI
for treatment, payment or Delta Dental's health
care operations purposes.
- An authorization is generally needed by all covered
entities (including Delta Dental) for the use or
disclosure of PHI for purposes other than treatment,
payment or health care operations.
How will Delta Dental proceed?
The details are currently being developed. Delta
Dental will be providing subscribers with a notice
that describes, among other items, the types of uses
and disclosures that Delta Dental is permitted to
make for treatment, payment and health care operations,
as well as a description of each of the other purposes
for which Delta Dental may proceed to make disclosure
without the patient's written consent or authorization.
Delta Dental will make reasonable efforts to limit
use or disclosure of PHI to the minimum necessary
to accomplish the intended purpose. This "minimum
necessary" rule, however, does not apply if
the use or disclosure is for treatment purposes,
the request comes from the patient or Health and
Human Services (for compliance reviews), or is required
by law.
What types of rights does HIPAA grant to patients?
The Privacy Rule provides patients with various
rights, including the right to receive an accounting
of certain uses and disclosures, request restrictions
on certain uses and disclosures, receive confidential
communications under certain circumstances, inspect
and copy their records, and amend PHI in their records.
(However, a covered entity may refuse to amend the
information if it is accurate or was not created
by the covered entity.) Any request for access must
generally be granted within 30 days.
How will Delta Dental comply with the Privacy
Rule?
Delta Dental will implement a comprehensive compliance
program. The basic elements of a privacy compliance
program under the Privacy Rule are:
- Appointing a privacy official;
- Implementing appropriate administrative, technical,
and physical safeguards to protect the privacy
of PHI;
- Developing detailed privacy policies and procedures;
- Training all workforce members on privacy policies
and procedures;
- Establishing a system to report privacy complaints;
- Responding quickly to investigate potential privacy
breaches;
- Disciplining individuals and business associates
who are found to have breached the privacy policies;
and
- Ongoing auditing and monitoring of the privacy
initiative workforce training program.
How will HIPAA affect my company's relationship
with Delta Dental?
Despite some of the challenges imposed by HIPAA,
Delta Dental Plan of New Jersey, Inc., believes the
Act will bring about positive changes by helping
control certain administration costs while increasing
satisfaction among our subscribers. These benefits
will be achieved through:
- Improved claims processing - Required standardization
of claim and eligibility data should result in
claims being processed with more speed and accuracy.
- Improved privacy and security - Patients will
know that people handling their health information
are held to strict rules and guidelines.
- Improved patient care - Standards for data collection
and storage will create opportunities for precise
tracking of the outcomes of various dental procedures,
ultimately helping bring more effective techniques
and cost management to patients.
- Improved administration for employers and groups
- Those offering dental benefits can use the standard
enrollment transactions offered through HIPAA to
send a single enrollment record to all of their
health plans.
Where can I get additional information about
HIPAA?
A copy of the final rule is published in the Federal
Register. In addition, the preamble and rule along
with
"Frequently Asked Questions" can be read
at http://aspe.hhs.gov/admnsimp/.
This information is for instructional and educational
purposes only. It does not constitute legal advice.
Recipients are urged to contact their legal counsel
for advice with respect to the interpretation of
the HIPAA Privacy Rule and its applicability to the
recipient and the facts and circumstances of the
situation at hand. It is also strongly recommended
that individual Plan attorneys review all such communications
before they are disseminated.
Delta Dental can deliver information on a variety
of subjects right to your e-mail inbox! To sign up
for this service, just visit our Web site at www.deltadentalnj.com,
and click on "Guestbook" on the left side
of the home page screen. You can request immediate
information on benefits and services for brokers.
Once you register, you will receive periodic updates
in your e-mail box on the topics you have selected.
It's the easiest way to stay up to date about what's
happening at Delta Dental that affects you!
Please note: We do not sell, rent, or disclose your
e-mail address to third parties. Therefore, you will
not receive unsolicited e-mail ("spam")
as a result of signing our Guestbook.
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