Labor Fund Dental Network Program A Dental PPO National Network for Taft-Hartley Health and Welfare Funds
Program Overview <ul><li>Allows Taft-Hartley Health and Welfare Funds access to a National Dental PPO Network </li></ul><u...
 
Top States in Total Network Providers As of 01/2006 547 583 393 630 473 458 819 2,484 Other Specialists 3,031 400 2,084 Te...
Labor Fund Dental PPO Network <ul><li>This program provides nationwide access to providers through both the Dental Network...
Features of the Program <ul><li>Fund </li></ul><ul><li>Fund maintains control of key member functions </li></ul><ul><li>Ad...
How the Program Works The member receives dental services. The provider submits the claim to the Fund office. The Fund off...
Benefits of the Program <ul><li>To the Fund </li></ul><ul><li>Access to national PPO dental network </li></ul><ul><li>In-n...
Dental Options for Cost Savings <ul><li>Benefit levels remain the same for both in-network or out-of-network services </li...
A Commitment to Delivering  Value to Fund Accounts <ul><li>The Labor Fund Dental Network Program gives you… </li></ul><ul>...
Next Steps <ul><li>If you are interested in further analysis of your Fund, we can provide: </li></ul><ul><ul><li>Claims re...
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Labor Fund Dental Network Program Presentation

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  • To The Member Convenient options for finding network providers coast to coast: - One Toll Free Phone Number: (800) XXX-XXXX - One Web Site: www.BCBSIL.com
  • Labor Fund Dental Network Program Presentation

    1. 1. Labor Fund Dental Network Program A Dental PPO National Network for Taft-Hartley Health and Welfare Funds
    2. 2. Program Overview <ul><li>Allows Taft-Hartley Health and Welfare Funds access to a National Dental PPO Network </li></ul><ul><li>Easy access to nationwide providers for members </li></ul><ul><li>Utilizes the National Dental PPO Network of contracting providers to realize valuable savings for dental services with discounts ranging from 25-40% below the usual and customary charges </li></ul><ul><li>Claim administration may be handled by the Fund office </li></ul><ul><li>Access Fee charged per member per month (PMPM) based on group size </li></ul>
    3. 4. Top States in Total Network Providers As of 01/2006 547 583 393 630 473 458 819 2,484 Other Specialists 3,031 400 2,084 Texas 3,295 299 2,413 Pennsylvania 2,163 182 1,588 Ohio 5,118 258 4,230 New York 2,693 352 1,868 Michigan 2,507 117 1,932 Illinois 5,952 253 4,880 Florida 22,872 2,309 18,079 California Total Ortho General
    4. 5. Labor Fund Dental PPO Network <ul><li>This program provides nationwide access to providers through both the Dental Network of America (DNoA), a subsidiary of Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield of Illinois, and DenteMax, a wholly owned subsidiary of Blue Cross and Blue Shield of Michigan. </li></ul>
    5. 6. Features of the Program <ul><li>Fund </li></ul><ul><li>Fund maintains control of key member functions </li></ul><ul><li>Adjudicates claims per its benefit plan </li></ul><ul><li>Verifies eligibility </li></ul><ul><li>Handles member contact and inquiries </li></ul><ul><li>Issues EOBs </li></ul><ul><li>Can create ID Cards </li></ul><ul><li>BCBSIL </li></ul><ul><li>Provides access to national dental PPO network </li></ul><ul><li>Network manager handles provider inquiries about fee schedules </li></ul><ul><li>Provides member education communications for Funds to distribute </li></ul><ul><li>Integrated account management </li></ul><ul><li>Can create ID Cards </li></ul><ul><li>For an additional fee, can provide dental claim review, and actuarial and dental plan design consultation </li></ul>
    6. 7. How the Program Works The member receives dental services. The provider submits the claim to the Fund office. The Fund office verifies eligibility and benefit level, adjudicates the claim based on the network file and fee schedule, sends the member EOB and pays the provider. The Fund office responds to member inquiries.
    7. 8. Benefits of the Program <ul><li>To the Fund </li></ul><ul><li>Access to national PPO dental network </li></ul><ul><li>In-network utilization delivers plan savings </li></ul><ul><li>One ID card may be used for medical and dental </li></ul><ul><li>Ease of implementation </li></ul><ul><li>To the Member </li></ul><ul><li>Nationwide provider access </li></ul><ul><li>Customer service by the Fund’s administrative office </li></ul><ul><li>No balance billing when PPO providers are utilized </li></ul><ul><li>ID card recognized nationwide </li></ul><ul><li>Can find network providers coast-to-coast through www.dnoa.com </li></ul>
    8. 9. Dental Options for Cost Savings <ul><li>Benefit levels remain the same for both in-network or out-of-network services </li></ul><ul><li>There is no disruption to the member </li></ul><ul><li>When PPO providers are utilized, there is no balance billing </li></ul><ul><li>Out-of-network claims are paid at usual and customary (U&C) charges </li></ul>Passive PPO: <ul><li>Benefits are paid at the highest level and member out-of-pocket costs are lower when services are received from in-network dentists </li></ul><ul><li>When members use in-network dentists, there are no claims to file and no balance billing </li></ul><ul><li>When out-of-network providers are used, benefits are paid at the lower benefit level and non-network dentists can be paid at the same discounted rate as network dentists </li></ul>PPO :
    9. 10. A Commitment to Delivering Value to Fund Accounts <ul><li>The Labor Fund Dental Network Program gives you… </li></ul><ul><ul><li>Member access to a broad national network of dental PPO providers </li></ul></ul><ul><ul><li>Savings realized by the Fund and members through network utilization and competitive fee schedules </li></ul></ul><ul><ul><li>Competitive Access Fee pricing arrangements </li></ul></ul><ul><ul><li>Easy program start-up and maintenance </li></ul></ul><ul><ul><li>Integrated account management </li></ul></ul>
    10. 11. Next Steps <ul><li>If you are interested in further analysis of your Fund, we can provide: </li></ul><ul><ul><li>Claims re-pricing </li></ul></ul><ul><ul><li>Estimate of cost savings </li></ul></ul><ul><ul><li>Geo Access reports </li></ul></ul><ul><ul><li>Disruption analysis </li></ul></ul><ul><li>For more information, please contact the Labor Affairs department at 312/653-8635 </li></ul>
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