Delta Dental's Ed Choate on Changes Happening in Family Dental Insurance

Delta Dental's Ed Choate on Changes Happening in Family Dental Insurance
Ed Choate

Ed Choate had worked 20 years in the managed health care industry before joining Delta Dental of Arkansas as president and CEO in July 2000.

In 2006, Choate was named the Arkansas Business Executive of the Year and in 2007, he was named a Distinguished Alumnus at Southern Arkansas University.  He is president of Fifty for the Future and on the Executive Committee of the Little Rock Regional Chamber of Commerce.

Choate graduated with a business management degree from Southern Arkansas University in 1975. Since then, he has completed executive education courses at Stanford University and Harvard University.

Q: How does the Affordable Care Act affect dental insurance for Arkansas employers?

A: Beginning on Jan. 1, 2014, most individuals and small groups (up to 50 full-time employees) will be required to have dental coverage for their children. The Affordable Care Act will give individuals and small groups the opportunity to purchase pediatric dental insurance through the Health Insurance Marketplace (also known as the health insurance “exchange”). Individuals and small groups buying insurance outside of the marketplace, in the private market, will be required to purchase a plan with all 10 “essential health benefits” (EHB), including pediatric benefits for each person enrolled. As a result, many more Arkansas children will have access to affordable dental care.

How does the act affect your business?

The new EHB-certified pediatric dental plans must have average overall benefit payments of 70 percent or 85 percent and will have maximum out-of-pocket expenditures of $700 for one child and $1,400 for two or more children, with no annual maximum benefit limits. For instance, consider a family with three children under the age of 19. Once the family has accumulated $1,400 in out-of-pocket expenditures, the pediatric benefit for each child would be paid at 100 percent. And if your child needed a costly procedure, such as removal of his wisdom teeth, there would be no annual maximum on benefits paid.

What are you doing to prepare for health care reform?

Our benefit plans and systems are being modified to include the new features and requirements of the EHB plans. All individual and small-group customers will be provided with information about 2014 ACA requirements along with benefit plan options and rates.

What are the biggest challenges the dental industry is facing?

One of our biggest challenges is keeping our dental providers, brokers and customers educated about the ACA changes and how the changes may affect each of them. We will provide communication through our corporate website, social media and traditional correspondence. To provide efficient and timely communication, our staff must stay informed of current federal and state regulations and guidance and then share that often complicated information in a way that is easy for each audience to understand.

What types of advancements are coming to the dental insurance industry?

The dental industry is developing risk-based dental plans for employer consideration. These plans would take into account an individual’s risk for dental disease and customize plans based on the needs of the patient. For healthier, low-risk patients, one cleaning per year may be sufficient. Patients with moderate risk would continue with benefits like they have today. For those patients with a high risk for dental disease, three or more annual cleanings may be allowed under their plan. This is referred to as evidence-based dentistry, and we are beginning to incorporate this science to better meet the needs of our customers and help them receive benefits based on those needs.