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Covered California for Small Business – New Blue Shield Plans
New Cigna + Oscar (C+O) small group sales and renewals will not be offered in 2025. At C+O’s request, all plans and rates have been removed from the quote engine. However, you can still quote or renew your C+O groups through December 15, 2024 by contacting us at quotes@claremontcompanies.com or 800.696.4543. Please note: the last day of coverage will be December 14, 2025.
Delta Dental PPO™ plan members have access to two Delta Dental networks – Delta Dental PPO and Delta Dental Premier®. Together, they make up the largest network of dentists in the nation, according to Zelis Network360®. In fact, four out of five dentists in the United States are Delta Dental network dentists. The main difference between the two networks is the amount members can save.
Member Savings
There are three options: PPO, Premier, and non-Delta Dental dentists. Members save the most when visiting a Delta Dental PPO dentist, a little less at a Premier dentist, and the least at a non-Delta Dental dentist.
Delta Dental PPO Network
With this large, high-quality and reliable network of dentists, members don’t need to carry paper ID cards or submit claims, since Delta Dental works directly with dentists to manage identification and claims.
By visiting a dentist in the PPO network, members pay less out-of-pocket and make their plan maximum go farther. PPO dentists have agreed to reduced fees, which means added savings and no unexpected out-of-pocket costs.
But members don’t have to sacrifice plan savings if their dentist isn’t in the PPO network.
Delta Dental Premier Network By visiting a dentist in the Premier network, members can expect the same advantages of a high-quality network and easy access, but with more limited out-of-pocket savings.
Delta Dental Premier dentists have also agreed to discounted fees, as part of their contract with Delta Dental. Premier fees are typically higher than Delta Dental PPO fees. Like with PPO dentists, members won’t pay more than their expected share — so there are no surprise bills.
Non-Delta Dental dentists can set any price they wish.
Plan Configuration Can Encourage PPO Utilization
To encourage in-network visits long term, it’s best to build incentives into plan designs that encourage visiting in-network dentists. Groups may have the following options:
Reward employees who stay in network with a higher maximum and lower (or no) deductible for in-network visits.
Cover services at a higher benefit level for in-network care. For example, a plan with a benefit network differential might cover diagnostic and preventive services at 100% at PPO dentists, 90% at Premier dentists and 80% at non-Delta Dental dentists. This makes it clear to members that PPO dentists offer the greatest savings.
Lower out-of-network reimbursement to encourage PPO and Premier network usage and potentially lower the plan’s cost.
Reimbursements
The amount the plan bases its payment on is the reimbursement, also known as the maximum plan allowance. This is separate from the percentage at which certain services are covered.
Under a Delta Dental PPO plan, PPO dentists are reimbursed at PPO fees and Premier dentists are reimbursed at either Premier or PPO fees. How Premier dentists are reimbursed under a PPO plan is up to the plan’s benefits administrator, but there are advantages to each of the two options:
When choosing to reimburse Premier dentists at Premier fees, members enjoy the lowest out-of-pocket costs, but the plan pays more and may cost more overall.
When choosing to reimburse Premier dentists at PPO fees, members face higher out-of-pocket expenses at Premier dentists, but the plan may cost less overall. This option also creates a greater incentive for members to visit a PPO dentist.
In-Network Dentists
With the Find a Dentist tool, members can check a dentist’s network by entering their own location and choosing their preferred network from the ‘Select a Network’ drop-down menu. Each dentist’s directory listing indicates which networks the dentist participates in.
With Delta Dental’s dual network, your clients and their employees can make informed choices about their care and costs, without sacrificing quality.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
For groups with two to 99 employees, the Delta Dental Small Business Program (SBP) offers a wide variety of plans and options, all with comprehensive coverage and easy access to quality care and savings from their large networks. These plans are designed to be flexible so that your small business clients can choose the options that make the most sense for their business and budget. Here is what’s new for 2023!
New Core 201 Plan
The leaner Core 201 plan replaces the Core 200 plan and features 100/80/0 coverage with a $750 annual maximum.
Core/Buy-Up plans will use the new Core 201 offering as the Core plan that will include an additional maximum that is not available on the stand-alone plan.
Core/Buy-Up plan maximums for 2023:
$750 Core/$1,500 Buy-Up
$1,000 Core/$2,000 Buy-Up
Higher Annual Maximum and More Orthodontic Coverage
Advantage 200 and 400 plans are getting a higher annual maximum of $3,000 and adding orthodontic options for adults and children. These plans offer orthodontics for adults and children with a $1,000 or $1,500 lifetime maximum.
Reduced Participation Requirements
The employer-paid participation requirement for adult orthodontics has dropped from 25 to five employees. With this reduction, more small groups will now be eligible for this optional adult benefit.
New Dual Choice 4 Plan
Dual Choice 4 features the new Core 201 plan as the low plan and Advantage 200 as the high plan with limited maximum options:
$750 low/$1,500 high.
$1,000 low/$2,000 high.
Voluntary is limited to $750 low/$1,500 high.
More Options for D&P Maximum Waiver and Orthodontia
These options have been added to the following plans:
The Buy-Up plan for Core/Buy-Up.
Both plans for Dual Choice 3 or high plan only.
The high plan for Dual Choice 4.
SmileWay® Wellness Benefits
Delta members with any of these conditions are entitled to additional routine and periodontal cleanings. The member must advise their dentist at the time of visit and they can submit a specific note with the electronic billing for payment consideration.
DeltaVision
No plan changes for 2023. The 2022 rates will hold for 2023.
Rates and Quoting
2023 plans and rates are available for quoting through PRISM, our free and easy online quoting system.
New business rates are guaranteed for a one-year contract period – effective dates from January 1, 2023 to December 1, 2023.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Currently, your clients may be experiencing tighter than expected budgets due to economic uncertainty, inflation, and rising interest rates. Fortunately, DeltaCare® USA plans offer full-featured benefits and affordable, predictable prices – perfect for groups looking to save money without sacrificing coverage.
DeltaCare USA Benefits
In addition to lower costs, DeltaCare USA (HMO-type) plans provide a broad range of coverage including:
Additional cleanings at low set copayments.
Orthodontic coverage for kids and adults.
Most plans also feature:
– At-home teeth whitening.
– Porcelain crowns.
DeltaCare USA plans also offer an added bonus for employees who have begun, but not completed, an orthodontic procedure. In-progress provisions allow new members to continue treatment with their current orthodontist ― even if that orthodontist isn’t in the DeltaCare USA network.
DeltaCare USA plans also include:
Tooth-colored fillings for any tooth.
No lab fees or other hidden fees.
No hidden charges for restorative materials like resins, metals or porcelain.
As a fixed copayment plan, DeltaCare USA offers employees convenience and simplicity with:
No waiting periods.
No deductibles or maximums.
No claim forms to fill out.
Low or no copayments for diagnostic and preventive care to encourage healthy habits.
Predictable copayments that are easy to budget for upcoming costs.
How DeltaCare USA works
Plan members select a primary care dentist from the DeltaCare USA network and pay set copayments for covered services directly to that dentist. This dentist provides most of the treatment and coordinates any necessary specialist referrals. Best of all, there’s no paperwork to fill out. Visit Delta Dental to learn more.
Why employers should offer dental coverage when budgets are tight:
Dental benefits can help your clients save money over the long run.
Providing dental coverage can improve employees’ overall wellness. Poor oral health has been linked to severe health conditions such as diabetes, heart disease, and certain cancers.
Employees without coverage may avoid going to the dentist or delay care because of the cost, which can result in more severe dental issues, costly care, and more time off work. In contrast, employees with dental coverage are more likely to visit the dentist and maintain a higher level of health and wellness.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
To earn additional compensation for selling and retaining eligible groups of 2-99 lives, enroll in Delta Dental’s Broker Rewards Program for small groups at ddsbrewards.com. This rewards program is for brokers who sell Delta Dental’s small group plans, including plans from their new Small Business Program portfolio – effective dates from January 1, 2022 to December 1, 2022.
How It Works
Retention Sales Bonus
Retain at least 92% of your book of business through 2022 and earn a bonus on your existing business and qualify for new sales rewards. The more you retain, the more you earn.
3% bonus when you retain 92%-96.9% of your existing business.
4% bonus when you retain 97%-100% of your existing business.
New Sales Bonus
Once you’ve met your retention goal, there are three levels of sales rewards. New sales bonuses are based on the number of new groups or total new premium received for effective dates in 2022. As you sell more and retain your existing business with Delta Dental, your rewards grow. And this rewards program is in addition to your existing standard small business commission.
Level 1: 3% bonus – 5-14 new groups or $150,000-$499,999 new premium.
Level 2: 4% bonus – 15-24 new groups or $500,000-$999,999 new premium.
Level 3: 5% bonus – 25+ new groups or $1,000,000+ new premium.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
With the annual inflation rate at 8.6% for the 12 months ending May 2022, businesses of every size are feeling squeezed. Thankfully, Delta Dental’s Small Business Program (SBP) plans make it easy for your clients to help protect employees’ smiles and save money.
The Delta Dental Small Business Program
For groups with two to 99 employees, the SBP offers a wide variety of plans and options, all with comprehensive coverage and easy access to quality care at competitive rates. These plans are designed to be flexible so that your clients can choose the options that make the most sense for their business and budget.
Coverage Options
SBP dental plans feature a three-tier structure (Deluxe, Advantage, and Core) to meet your clients’ needs regardless of budget. Delta Dental PPO™ and DeltaCare® USA plans are available at each tier. And employers can stretch their dollars even further while increasing employee satisfaction with Dual Choice and Core/Buy-Up plans.
If your clients are looking for more, they can pair their Delta Dental plan with a DeltaVision plan (only plans administered by Allied Administrators are eligible for DeltaVision pairings). There are also options with Delta Dental PPO plans for voluntary benefits, where employees pay anywhere from 50% to all of the premiums.
Delta Dental PPO
With Delta Dental’s PPO plans, enrollees get the most choice. They can visit any dentist, but they’ll save the most with a PPO network dentist. Your groups can choose from a range of plan designs with different coinsurance levels and available options to fit their needs. PPO plans offer industry-leading network savings for enrollees backed by the nation’s largest dentist network.
DeltaCare USA
The copay HMO-type plans offer comprehensive coverage including orthodontics, teeth whitening, and more, but with a lower monthly price. These plans have set all-inclusive co-payments, no waiting period, no annual deductibles and no maximums for covered benefits. Enrollees have no surprise out-of-pocket costs or unexpected fees when they visit their selected primary care network dentist.
Dual Choice and Core/Buy-Up Plans
Delta Dental offers several choices to help both employers and employees manage their costs and control their expenses while increasing employee satisfaction. Each plan allows your clients to offer their employees a choice of two plan designs. Your clients can choose the plan design that best suits their needs and decide their level of contribution. Their employees can choose the plan that best meets their family’s dental needs. Groups can offer side-by-side:
Dual choice:Build your own plan. Choose any one PPO plan and any one DeltaCare USA plan.
Dual choice 2:Matching premiums. Offer two same-priced plans with differing coverage, so employees can decide what works best for them; a PPO plan with higher coverage or a PPO Plus Premier plan with greater dentist choice.
Dual choice 3:Differing premiums. Offer both a high and a low PPO plan with different prices and coverage amounts, so employees can decide what works best for them: more coverage at a higher price or less coverage for a lower price.
Core/Buy-Up. Your clients have a way to control costs with a set contribution, while still giving their employees the option to purchase more coverage.
Why employers should offer dental coverage when budgets are tight:
Dental benefits can help your clients save money over the long run.
Providing dental coverage can improve employees’ overall wellness. Poor oral health has been linked to severe health conditions such as diabetes, heart disease, and certain cancers.
Employees without coverage may avoid going to the dentist or delay care because of the cost, which can result in more severe dental issues, costly care, and more time off work. In contrast, employees with dental coverage are more likely to visit the dentist and maintain a higher level of health and wellness.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
A commonly requested dental benefit by employees with children, sealant coverage is crucial to starting young people early on the right path for a lifetime of oral health. Parents naturally seek out the best for their kids, so a simple benefit like sealants that can help protect children’s teeth adds value to an insurance plan. Below is an explanation of sealants and the types of coverage Delta Dental offers groups and individuals.
What are sealants?
Dental sealants are a thin protective coating (clear, white or slightly tinted) made from plastic or other dental materials. The dentist, dental hygienist or other qualified dental professional brushes them in liquid form onto molars and premolars covering the enamel and sealing the small spaces between teeth. Special care is taken to cover the deep grooves and pits on the chewing surfaces that trap food particles that brushing and flossing can’t remove. After the sealant has been applied (painted on), it is then hardened for a few moments with a curing light. It’s a fast, painless procedure that requires no numbing or drilling.
What are the benefits of sealants?
Sealants form a protective barrier or shield against bacterial plaque that causes decay – like a raincoat for your teeth. Once applied, sealants protect against 80% of cavities for two years and continue to protect against 50% of cavities for up to four years, therefore preventing the risk of tooth loss and possible bite issues for other teeth brought on by cavities.
Sealants can help protect teeth from decay for up to 10 years. However, they need to be checked for chipping or wearing at regular dental check-ups and reapplied as needed.
Who can get sealants?
Anyone with healthy teeth can get sealants – including adults without decay or fillings in their molars. But children should receive them as soon as their molars and premolars come in around the age of six, and then again as additional, permanent molars come in around age 12. Protecting them early will keep them healthy between the cavity-prone years of 6-14. Molars and premolars are particularly susceptible to tooth decay. According to the CDC, children without sealants have almost 3 times as many cavities than children with sealants. Sealing these teeth as soon as they come through can keep them cavity-free from the start, which helps save time and money in the long run.
Why sealant coverage is an important benefit.
Sealants aren’t just an effective weapon against bacteria and acids; they’re also cost-effective in the fight against cavities. Sealants can spare families the hassle, discomfort and expense of cavities, and unlike most cavity treatments, sealant application is a simple, one-time, and painless procedure.
First introduced in the 1960s, the prevalence of sealants has increased overall in children ages six to 11, from 31% during 1999–2004 to 42% during 2011–2016. Knowing about and having access to sealants through dental coverage can provide parents and their kids with a health advantage that pays off for a lifetime.
Delta Dental sealant coverage for groups and individuals.
Considered preventive services, most Delta Dental plans cover dental sealants, so members can often get all their kids’ protective sealants at little or no out-of-pocket cost.
Sealants are a standard benefit in group Delta Dental PPO™ plans. An age limitation typically applies.
All standard DeltaCare® USA plans cover sealants.
For individual plans, both Delta Dental PPO and DeltaCare USA include sealant coverage:
The Basic Plan and Premium Plan cover sealants at 100% after members reach their deductible.
DeltaCare USA individual plans cover sealants with a low copayment.
Plans that include sealants generally limit the benefit to permanent first and second molars subject to age limitations by contract. Under some Delta Dental PPO plans, there is a maximum allowance payable per tooth, and the patient is responsible for the remainder of the allowed fee. Benefits for sealants include repair or replacement within 24 months by the same dentist or dental office.
With the growing demand for sealants and the competitive job market, offering affordable, highly rated sealant coverage can give your clients the competitive edge to attract and retain top talent.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
People lose teeth for many reasons and it’s a common problem. It can happen as a result of an accident, gum disease or other oral health problems. In fact, 69% of adults ages35 to 44 have lost at least one permanent tooth, and by age 74 more than a quarter of adults have lost all their permanent teeth. When a tooth is lost, simple tasks like eating and talking are affected, in addition to the impact on self-image. Until recently, there have not been many good options.
Dental Implants Are a Popular Option For Tooth Replacement
Unlike dentures that can be costly, uncomfortable and inconvenient, and become stained, chipped, or broken when worn for many years, dental implants can be less expensive in the long-run because of their permanent nature. In addition to being more more attractive, once implanted, they are treated like natural teeth – which means only regular maintenance is required.
What is a Dental Implant?
Made from high-grade, durable titanium, a dental implant is a cylinder-shaped post that is surgically inserted into the jawbone. Over a period of usually three to six months, the implant will fuse with the bone structure. After this is done and the gum tissue heals, a titanium abutment can be added to anchor a porcelain restoration to the implant.
Dental Implant Advantages
Natural look and feel that closely resembles real teeth.
Permanent and comfortable.
Avoids bone loss associated with losing a tooth.
No removal for overnight soaking or cleaning.
No adhesives or anchoring to healthy teeth.
95% success rate with minimal risks or complications.
Cost-effective over the patient’s lifetime.
About 3 million people in the U.S. have dental implants, and another 500,000 implants are placed each year, according to the American Academy of Implant Dentistry. With the aging U.S. population (by 2030, people aged 65 and older will outnumber those aged 18 and under) and tooth loss more prevalent in older populations, demand for implants is rising.
With an increasing number of dentists performing dental implant procedures and the growth of group practices and dental service organizations, implant costs are expected to go down while their popularity goes up. As a result, the US market for implants is expected to grow to exceed $1.5 billion in 2027.
Delta Dental Implant Coverage
Initial implant costs can range from $3,000 to $5,000 each. To address the growing demand for dental implants and help mitigate the costs, Dental Dental offers affordable and highly rated implant coverage for both groups and individuals:
Group-sponsored Delta Dental PPO™ plans vary and may include implant coverage.
Groups with DeltaCare® USA coverage can choose the i‑series plans for comprehensive implant coverage.
For individuals, the Delta Dental PPO Premium Plan covers implants at 50%, after a 12-month waiting period.
Benefits Typically Include
Implants, abutments, implant crowns, retainers (either abutment-supported or implant-supported), removal of implant, maintenance procedures, recement and repairs. Parts of an implant may be covered under prosthodontic coverage, such as the crown, bridge or denture supported by the dental implant itself. Some plans may include waiting periods, maximums and deductibles for implants, and not all plans cover pre-existing conditions such as missing teeth.
With the growing demand for implants and the competitive job market, offering dental implant coverage can give your clients the edge to attract and retain top talent.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Available January 2022, DeltaVision is a new partnership between Delta Dental and VSP providing quality eye care with new lower rates and access to VSP’s nationwide network of providers. DeltaVision is underwritten by Delta Dental and administered by Allied Administrators.
Five plan designs: the existing VSP Core, Advantage and Deluxe plans, plus new Easy Options and Value plans with lower premiums.
Extensive VSP network access with over 98,000 network doctors, thousands of retail chains, plus online prescription eyewear through Eyeconic, VSP’s online store.
All plans include exams and lenses every 12 months and generous frame or contact lens allowance options.
DeltaVision Easy Options plan offers additional benefits flexibility, including allowance upgrades at the time of service.
Retinal screenings for members with diabetes plus additional exams and services for diabetic eye disease, glaucoma or age-related macular degeneration.
Vision benefits are increasingly valued by employees. Your employer clients and prospects will want to understand all the vision benefits options available to them. Learn more about DeltaVision.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Delta Dental has announced a 4% rate reduction for all new and existing Small Business Program clients. Best of all, the rate reduction will be effective for two years starting in 2022. Existing Small Business Program groups will receive the rate reduction with their scheduled 2022 renewal or upon their 2022 anniversary date. What’s more, rate reductions have also been made to Delta Dental’s voluntary plans.
The Delta Dental Small Business Program offers a wide variety of affordable plans and options, all with comprehensive coverage, easy access to quality care, top-notch customer service, and savings from the nation’s largest network of dentists.
With benefits your clients can trust, cost savings and predictable rates that a small business budget can count on, your clients will be healthy and happy – making it easier to manage renewals and grow your business.
Recommending plan options with the Delta Dental Small Business Program product portfolio structure is simple. No matter what level of plan your groups choose, all plans offer comprehensive coverage, benefits stability at competitive rates, and the 4% rate reduction for two years.
Include Delta Dental small business plans in your next dental quote and help your groups benefit from the 4% rate reduction.
Designed especially for small business owners, Delta Dental’s new easy-to-sell and easy-to-understand Small Business Program offers a wide variety of plans and options, all with comprehensive coverage, quality care, and savings. For a quick overview, check out this video.
Small Business Program
Three Plan Levels
Deluxe: extensive benefits with the lowest out-of-pocket costs and more options for employees.
Advantage: the most popular plan designs featuring increased choice and flexibility.
Core: quality care at a lower cost.
All PPO plans include:
Low- or no-cost preventive care and comprehensive coverage.
Higher annual maximums up to $3,000.
Expanded access to orthodontics.
White resin fillings on all teeth.
Implant coverage with no separate implant maximum.
No missing tooth exclusions for teeth lost prior to this coverage.
A new lower-cost DeltaCare USA plan (17B) has also been added.
Plus, employers can manage costs by offering a new dual choice plan and Core buy-up option:
Dual Choice 1: Build Your Own Plan: Choose any one PPO plan and any one DeltaCare USA plan.
Dual Choice 2: Matching Premiums: Offer two same-priced plans with differing coverage, so employees can decide what works best for them: a PPO plan with higher coverage (100/100/60) or a PPO Plus Premier plan (100/80/50) with greater dentist choice.
Dual Choice 3: Differing Premiums: Offer both a high (PPO Plus Premier 100/90/60) and a low (PPO Plus Premier 100/80/50) PPO plan with different prices and coverage amounts, so employees can decide what works best for them: more coverage at a higher price or less coverage for a lower price.
Core/Buy-up: Clients can control costs with a set contribution (Core 100/50/50), while giving employees the option to purchase more coverage (Buy-up 100/80/60).
PPO-Eligible Enrollee Contribution and Participation
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more (video tutorial). However, not all carrier forms are available online.
