Aetna announced that it has just launched two new dental plans designed to encourage members to seek appropriate dental care. Aetna Dental Care RewardSM is a plan that rewards members with more coverage each year simply by visiting the dentist for regular preventive care. Aetna DMO Access® is an innovative and lower-cost Dental Maintenance Organization (DMO®) plan with additional access to Aetna’s discount network, Aetna Dental Access®.
“We understand people have different dental needs and may want different types of dental benefits,” said Alan Hirschberg, vice president and head of Aetna Dental. “Our goal is to create a broader range of options in our dental plans that will make it easy to go to the dentist and in some cases even provide an incentive to seek oral health care.”
The two new plans are:
Aetna Dental Care Reward
By simply going to the dentist for preventive services, such as a cleaning, in one plan year, Aetna will cover a greater percentage in the following plan year for services like fillings and crowns, thereby lowering members’ out of pocket costs. Aetna will reward members with up to three annual increases, not to exceed 100 percent of coverage for preventive, diagnostic and basic care and not to exceed 70 percent for major care. This plan design is available in either a PPO or indemnity plan, and at a variety of benefit levels. In the PPO plan, members have access to over 95,000 available dental PPO practice locations and, on average, typically save 35 percent or more off dentist average charges when receiving services from a participating dentist.
“The Aetna Dental Care Reward plan is part of our commitment to educating members on the importance of preventive dental care to their overall health,” said Hirschberg. “This plan complements our industry-leading Aetna Dental/Medical IntegrationSM program which educates and encourages members with certain medical conditions to seek preventive care.”
Research conducted by Aetna and Columbia University College of Dental Medicine shows that individuals with certain chronic conditions who sought earlier, regular dental care lowered the risk or severity of those conditions and subsequently, lowered their overall medical costs.
Aetna DMO Access®
DMO Access has the advantages of a DMO plan such as lower out-of-pocket expenses when compared with most traditional indemnity plans. There are also no out of pocket deductibles for the member to pay and no claim forms. It also includes the Aetna Dental Access discount network, which provides members access to more dentists and discounts for non-covered services like bleaching.
Other features of this plan include:
Access to over 35,000 available DMO dental practice locations nationwide Access to more than 56,000 additional available dental practice locations through Aetna’s discount network, Aetna Dental Access $0 copay for preventive and diagnostic services No annual limit on benefits DMO non-covered services, such as cosmetic procedures like bleaching, available at discounts of 15 to 50 percent “Because this product provides comprehensive affordable coverage with predictable out of pocket expenses, it has broad appeal to both employers looking to balance benefit offerings with their bottom line, and employees across all different life stages,” Hirschberg added. “The discounts are another great perk that consumers have told us they would like.”
Keeping Members Informed
With a focus on educating employers and members on the importance of good oral health and overall health, Aetna provides dental health information through its website, Simple Steps to Better Dental Health, which offers articles, illustrations, interactive tools, information on dental conditions and treatments. Members can also register on Aetna Navigator™, Aetna’s secure member website, where they can review family members also covered by the plan, check claims, review statements, request replacement ID cards and have access to member services.
About Aetna Dental®
Celebrating its fiftieth anniversary (1957-2007), Aetna Dental is one of the nation’s leading providers of integrated and standalone dental products, serving 13.4 million total dental members. Aetna also offers some of the largest dental networks available in the industry today.
About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 34.9 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans. www.aetna.com
Maintenance Organizations, also known as HMOs, and Preferred Provider Organizations, also known as PPOs, are just two types of health insurance plans that belong to a larger spectrum of health insurance plans called Managed Care Insurance.
The characteristic that all health insurance plans categorized as managed care insurance have in common is that they provide policy holders with a list of doctors and other health care providers that they would prefer the policy holders to visit when in need of medical attention. The doctors and other health care providers are contracted to work with the health care plan’s network, which means the policy holder will be able to pay less money to visit them that he or she would pay to visit a doctor not on the list, or “out-of-network.”
So, what’s the difference between HMOs and PPOs?
Health Maintenance Organizations, or HMOs, require their policy holders to pay a monthly insurance bill in order to see a doctor or health care provider, regardless of whether or not the policy holder actually seeks medical attention during that month. This may not sound like a very good deal, but HMOs do tend to provide a vast array of medical services for their policy holders under the HMO health insurance plan.
Preferred Provider Organizations, or PPOs, include a network of doctors and other health care providers that cover only a specific group of policy holders, such as the employees of a company. Policy holders pay a co-payment at the time of service, and the rest of the bill is either sent to the insurance company, or paid by the policy holder who is then reimbursed by the insurance company.
Being a policy holder of an HMO or PPO doesn’t always mean you have to see a doctor or other health care provider included in the network. Sometimes HMOs and PPOs allow you to seek out-of-network medical attention at an increased price.
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The biggest difference in managed care insurance policies and the more common group health plans of the past is the freedom to select your own physician or specialist without this decision impacting your coverage. The growth of managed care health insurance policies can be directly attributed to rising medical costs and the attempts to control them. Under a managed care program, a system of health care networks was established. Within the network, there would be standard and customary charges.
A Preferred Provider Organization, or PPO, is a type of managed care insurance plan that addresses this desire to retain some say in the choice of a physician or specialist. The PPO gives you a choice to use their network, but allows you to select a physician of your own choice also. The costs of using the network would be much less and this is the incentive to do so. If you go out of the network, you will pay much higher costs. These would be in the form of higher deductibles and co-insurance payments.
The PPO supports preventive care as do most insurance plans today. However, even with preventive care, there may be a co-payment required. This co-payment would be higher outside the network and much lower inside it. This is the whole thrust of the rate structure in a PPO. It attempts to make the option of seeking all your medical care within the network the most attractive. At the same time, it allows you to exercise your own choice as long as you are willing to pay the extra costs.
When considered a PPO, it is important to understand the size and the location of the network. If the network appears large enough and local enough to meet your medical needs, the PPO might be a very good option. When you have a PPO, however, and are estimating your yearly cost of health insurance, make sure that you remember that the cost may be more than just your yearly premium should you opt to go out of the network for care.
Despite what may sometimes be a higher yearly cost, the PPO is extremely popular. The freedom to choose just the right doctor is important to many people. At the same time, the costs are lower when staying within the network. This double approach makes the PPO a good choice. A PPO is often the best selection for a small business owner or self-employed worker because of its flexibility.
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PPO basically means Preferred Provider Organization. A PPO health insurance plan is offered by an organized health care plan that offer its member a limited choice of hospitals, doctors and specialists and also the ability to seek the services of a doctor or specialist outside the network. The health net PPO member will be reimbursing only 70% of the cost which the member will have to do all the paper work for his claims.
The PPO health insurance plans is similar to an indemnity plan in that a PPO enters into an agreement with medical doctors and hospitals to provide medical care to their members which these doctor or hospitals will charge them for a lesser fee for the service they render. Another unique feature of a PPO is the freedom of the insured to consult with any doctor they wish, even from outside the network of the PPO. So if you consult a doctor outside the PPO network you stand to pay more than if you have consulted from within the network also the insured member can make referrals to doctors and also will need to meet the different in charge between what the health insurance plans offers and what the provider of this services charges.
The PPO health network provides a wide network of doctors that is very similar to that of HMO. In order to enroll as a proffered provider organization health insurance plan, you will have to pay a monthly premium part of the annual membership expenses and for those who are in PPO health insurance plan through their employer would fund their premiums debited direct from their monthly salaries, and this kind of deduction is from their gross pay before the removal of taxes. Many employers also pay a small portion of their employee medical premium these is a part of the total compensation package offered to their employees, which help to off set the cost of the health insurance plan.
Based on the geography location and the insurance company providing the health individual insurance PPO you will find that your own primary health care medical services provider is also a member of the PPO network Office visit and prescription made by the doctor is not as costly as hospital co payment because of hospital or emergencies associated.
Why should I choose a PPO health care provider?
PPO differ from Health maintenance organization (HMO's) in the sense the insured who do not use participating health care providers receive little or no benefit from their health insurance plans.
Being a Hybrid between traditional indemnity plans and health maintenance organizations, the PPO aims to strike a balance between the two.
PPO can also create efficiencies in the health care business. However, PPO require insurance to pay a claim within a certain time frame in order to obtain the PPO discount, and calculating the PPO discount and the insurer paying the PPO’s access fee is an opportunity for delay and mistake in the already complex situation for paying for health care in the United State. PPO have more strength in their relationship with providers, and can still provide benefit to their insured members, but uninsured patient may not be able to obtain their discount even if they pay cash to the insurance company.
What are the cost advantages and disadvantages of this plan?
Some of the advantages of the PPO plans include the following:
Being a client of a PPO enables you to receive great savings due to the agreements entered between the PPO and the wide network of doctors and hospitals, these doctors and hospitals reduce their fees which is then passed on to insured. Individuals also enjoy a tax cut; this is so because the premiums due to the PPO are deducted as source to the account of the PPO thereby reducing their taxable income. Most times a PPO health care subscriber discovers that his own primary care health care provider is also a member of the PPO network. Disadvantages of the PPO plans are listed below:
Although a PPO subscriber can use the services of any physician of his choice, he still is liable to pay a larger portion of the bill if he chooses to visit a doctor of his choice who is not a member of the PPO's health insurance plan. PPO's create inefficiencies in the health care system. There is great room for delays and mistakes in health care delivery due to the several steps involved in insurance payment process. Irrespective of the few flaws of the health individual insurance PPO, the PPO health insurance plan is a good investment for those who care for their wellbeing and the well-being of their family and dependants. So avail yourself today to Health net PPO systems that enable individuals to select the best PPO health insurance plan well suited to their own unique circumstances.
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If cost is key, consider an HMO. Members of those plans typically pay lower premiums and out-of-pocket costs, but choice of doctors can be more restricted.
Consider a PPO for choice. Those plans provide greater ability to choose any doctor, although reimbursement rates might be lower if you go out of the provider list.
Check Consumer Reports' ratings on http://www.consumerreports.org . CR reader score is based on overall satisfaction with the health plan. CR also measured several factors that its experts have found to be related to overall patient satisfaction.
Be cautious with a chronic condition. In CR's survey, HMO patients who were ill faced more problems with their plans than did PPO members, especially in getting care they believed they needed. But more PPO members who said they had a serious illness had billing issues and spent lots more on out-of-pocket expenses. Look for plans with disease-management programs for your condition.
When you've narrowed your list to a few plans, call your state department of insurance. The department can tell you whether it has received complaints about specific plans. For information, go to http://www.naic.org/state_web_map.htm . For Pennsylvania's insurance department, go to http://www.ins.state.pa.us/ .
USEFUL INFO Pennsylvania's insurance department -- http://www.ins.state.pa.us/ -- can give you information on companies doing business in the state.
Several PPOs received high marks from survey respondents for choice of doctors. Those also scoring well for care from doctors were Anthem Blue Cross Blue Shield of Connecticut, Mutual of Omaha, Blue Cross Blue Shield of Tennessee, Independence Blue Cross (Pennsylvania), Excellus Blue Cross Blue Shield (western New York) and Blue Cross Blue Shield of Nebraska. Anthem Blue Cross Blue Shield of Connecticut, Excellus Blue Cross Blue Shield and Blue Cross Blue Shield of Nebraska also rated high for access to doctors.
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In advance of the annual open-enrollment period-when millions of people who obtain health care insurance through their employer or through Medicare have the opportunity to switch plans-Consumer Reports National Research Center studied the experiences of 37,000 CR subscribers enrolled in HMO and PPO health plans.
CR found that one out of every five respondents was sufficiently disappointed with their plans that they wanted to switch. The survey found that among readers who were not seriously ill, complaints about gaining access to care typically hovered in the single digits. But the complaints were nearly three times greater for those with a serious illness.
Only 67% of CR's readers were completely or very satisfied with their HMO or PPO. Twenty one percent complained about billing errors, while 25% said they had a problem with their primary care provider and 36% said they had problems when they contacted their insurance company. Fourteen percent of respondents in HMOs complained they had to wait a long time to get appointments, versus 8 percent in PPOs.
CR also found that people who weren't in the top rated HMOs had a much tougher time getting needed care, especially for the seriously ill. PPOs have their limitations as well. Members of PPOs not only have to pay for their coverage, they also report more difficulty receiving the reimbursements they're owed. Among those who contacted their health plan, 62% in the PPOs said it was due to a problem with their bill or claim, compared to only 30% of HMO members. The health plan ratings are available online along with tips for choosing the right HMO or PPO.
Among the higher rated HMOs was Tufts Health Plan (MA, NH, RI), which has made noted progress in the past two years, since CR's last survey in 2004. Kaiser Permanente Northwest (OR, WA), Independent Health (Western NY), Kaiser Permanente Northern California and Capital District Physicians' Health Plan (NY, VT) were also among the top rated. Of the PPOs, which tend to provide a greater range of doctor choices, Anthem Blue Cross Blue Shield of Connecticut, CareFirst Blue Cross Blue Shield (DC, MD, VA), Blue Cross Blue Shield of Alabama, Blue Cross Blue Shield of Illinois, and Mutual of Omaha, which is leaving the PPO industry, were among the top rated.
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