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					National Dental
CareFirst




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                  CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
 Agenda
National Dental
   •Project Goals & Background
   •Who is DNoA?
   •Competitive Landscape
   •Communications
   •Provider Network
   •Key Selling Points
   •Underwriting and Pricing
   •Administration
   •Questions?
Project Goals
Four main goals to this initiative:
   1. Provide seamless national dental network
   2. Meet the needs of national accounts and groups
      with employees or retirees outside of the CF service
      area
   3. Be more competitive in the dental marketplace
   4. Sell profitable dental business




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Background & Situation
 • No seamless national dental network for Risk and ASO
   groups (under 200) with our Traditional and Preferred
   Dental plans
 • Groups with CareFirst Regional dental coverage pay
   higher out-of-pocket fees to dentists outside of our
   service area
 • Many dental bids/opportunities lost because of this gap
   in the dental portfolio



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Solution
  •CareFirst partnership with Dental Network of America (DNoA); all
   dental groups and members gain access to 100,000+ dentists
  •Effective January 1, 2009 for all Risk and ASO dental groups with
   CareFirst’s Traditional and Preferred (DPPO) products will have
   access to the Dental Network of America (DNoA).




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Who is DNoA?
 • Dental Network of America (DNoA) --wholly owned
   subsidiary of Health Care Service Corporation (HCSC),
   operating through its BCBS plans in IL, TX, NM, and OK
 • Administers large proprietary networks in IL, TX, NM,
   and OK and leases DenteMax and Carrington networks
   in other states
 • Over 2.7 million members
 • Largest national accounts are Autozone, Nalco, and
   McDonald’s Licensees


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Scope & Effective Date
In Scope
   All new and renewing groups with CareFirst’s Traditional
   and DPPO plans will automatically have access to the
   national network
Out of Scope
   Individual, FEP, DHMO, Existing Dental on NASCO
Effective Date
   Turnkey January 1, 2009


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Target Market
All employer groups who want a fully-insured or self-
funded DPPO or Traditional dental plan offering access
to a national network:

   • National Accounts
   • Local employers with associates in multiple
     states (retirees, students, commuters, etc)
   • Small and medium employers looking for
     emergency out-of-service area dental coverage
     for associates

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Key Competitors
                                  CareFirst Dental’s Estimated Market Share
 Delta Dental                               vs. Key Competitors
 UCCI (United Concordia)
 MetLife
                                                   Other
 Cigna                                      (Plans with <5%
                                                               CareFirst Dental
                                              Market Share)
 United                                          22.6%
                                                                   23.5%


 Aetna                     DentaQuest
                              5.2%                                United Concordia

 DentaQuest                                                           10.5%

                            United/MAMSI
                                 8.5%                              Delta Dental
                                                                     10.4%


                                         Aetna Dental
                                            9.5%        MetLife Dental
                                                            9.8%




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 Regional Networks and Discounts
CareFirst’s Regional Networks vs. Key Competitors   CareFirst’s Average Network Discounts vs. Key Competitors



         Company               # Participating                Company              Average % Discount
                                  Dentists
                                                      MD CareFirst Preferred
 UCCI – Advantage Plus              4188              (Today)
                                                                                          42.52%

 CareFirst – Traditional            4103              Aetna                               41.08%
 Delta PPO                          3904              Guardian                            38.73%
 CareFirst – Preferred              3415              Met Life                            38.37%
 Guardian                           3336              UHC                                 37.15%

 Met Life                           3326              MD CareFirst Traditional
                                                                                          36.14%
                                                      (Today)
 CIGNA                              3230
                                                      UCCI                                30.81%
 Aetna                              3077
                                                      Delta PPO                           26.07%
 UHC                                2192              CIGNA                               23.28%


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National Networks
    CareFirst’s New National Networks vs. Key Competitors


           Company                 # Participating Locations
Delta Premier                               125,000             Average discount
UCCI – Advantage Plus                        117,000             level for DNoA’s
MetLife                                      110,000           national network is
Delta PPO                                   108,000                30% off UCR.
CareFirst – Traditional                     105,600
                                                                 This discount level
CareFirst – Preferred                       104,900            compares favorably to
CIGNA                                       102,000             the discounts offered
Aetna                                       101,000               by other national
                                                                   dental carriers.
Guardian                                     91,000


UHC                                          78,000
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Key Messages & Benefits
• Access to a DNoA’s national network of dentists outside of the
  CareFirst service area
• Access to the CareFirst Regional provider networks in Maryland, DC,
  Northern VA, and in some bordering counties
• DNoA network dentists will file claims and mail them to the address on
  the back of your Identification Card.
• Access to pre-negotiated fees on dental care when visiting a
  participating provider
• Access to a CareFirst BlueCross BlueShield dental product
• CareFirst and DNoA are continually expanding our networks to assure
  the most convenient access for our members


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Communications
 Providers
      Notification –DNoA, Carrington, and DenteMax dentists notified that network has
       been leased to CareFirst in late October
 Groups
      Pre-Sale Materials – National Dental Flyer & New Benefit Summaries
      Materials for Existing Groups – Account Letter and FAQs
      Mass Mailings – Announcement for Existing Dental Groups on Facets (Early
       December) & Special Mailing to Existing Medical Groups w/o CF Dental
       Coverage (TBD)
 Members
      Vitality Article – Article in a January issue of Vitality with information on how to
       access the new national dental network
      New ID Cards and Updates to Find a Doctor Tool



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Marketing Materials
Sample materials that can be used for account presentations:




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Provider Network
Comprised of either the CareFirst Regional Preferred (PPO) or Regional
Traditional network in combination with the DNoA national provider
network.



Virtually seamless network of providers; benefits are administered as
follows:
     1. CareFirst Regional Provider = in-network
     2. DNoA Participating Provider = in-network
     3. Non participating CareFirst or non participating DNoA provider
          = out-of network



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Provider Network
                 Non-Participating CareFirst
       Out-of-Network




                                               Out-of-Network
                        CareFirst
                        Providers




                 Non-Participating DNoA
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National Network Map




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Border Counties – DNoA Network
  The DNoA network will increase our number of
  participating providers in the following border
  counties:
     •VA – Spotsylvania and Fredericksburg
           City

     •PA – Bedford, Chester, Delaware, and
           Lancaster

     •DE – Kent, New Castle, and Sussex

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Border Counties – CF Network
A number of bordering counties are using CareFirst’s Regional
network instead of the DNoA network, including:


•VA – Arlington, Fairfax, Prince William, Loudoun, Stafford,
      Falls Church City, Arlington City, Manassas City,
      Alexandria City, and Fairfax City

•PA – York, Adams, Franklin, Fulton and Somerset

•WV –Berkeley, Hampshire, Jefferson, Mineral, Morgan and
     Preston

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Provider Directory
Link (current and prospective members) can be found on Find a Doctor
section of CareFirst website starting 12/1/08


                          CareFirst Website
                CareFirst Regional Preferred (DPPO)
                           provider search
                                                      National Dental Network
                                                      Find a Participating
                                                      Dentist
                        CareFirst Website
                   CareFirst Regional Traditional
                                                        Searchby Saved
                         provider search
                                                       Searches
                                                        Search by Name
                                                        Search by Location
                                                        Search by County

                        CareFirst Website
                     National Provider Search


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Product Options
• Standard Product Offerings remain the same
   o 1-50: 4 Preferred (PPO) and 4 Traditional
   o 51+: 10 standard products -- 5 Preferred (PPO) and 5
     Traditional
• Groups will continue to have the flexibility to change
  annual maximums, deductibles, and coinsurance levels
  and add or exclude orthodontic coverage




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            Provider Directory
• Finding a National Dental Provider;
•   Visit CareFirst.com
•   Click on Members & Visitors and select the Find a doctor tool
•   Click on Dental
•   Select Regional Traditional Dental or Regional Preferred Dental
•   On the next screen, under the Step 2 heading, and above the Zip code
    entry box, you will find the following text:

•   “if your are searching for a provider outside of the Maryland, DC,
    Northern Virginia service area, please use the National Dental
    Directory”

•   Click on the National Dental Directory link to search for out-of-area
    dental providers

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Benefit Overview
DPPO and Traditional plans cover five “classes” of dental care:
Class I      Preventive & Diagnostic
             exams, X-rays, cleanings, fluoride treatments, sealants,
             palliative treatment

Class II     Basic Services
             fillings, non-surgical periodontics, simple extractions

Class III    Major Services, Surgical
             Surgical periodontics, endodontics, complex oral surgery

Class IV     Major Services, Restorative
             Inlays, onlays, crowns, dentures, bridges

Class V      Orthodontia (optional)
Updated benefit summaries will be available on SOS soon.
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Business Rules
• All normal business rules apply, including participation
  requirements!
• IMPORTANT to note that:
   • National Dental is offered with CareFirst’s Traditional and
     Preferred (PPO) dental products.
   • National Dental is available for new and renewing groups of all
     sizes
   • National dental will be available regardless of an account’s
     medical status: medical with CareFirst, no medical, etc.
   • These products will be treated as CareFirst products and will not
     add any cost to implement on CareFirst Connect.


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Pricing Methodology
Pricing methodology varies by segment
1-50 Business (MSGR & Non-MSGR)
• A minor adjustment will be made to our small group book rates
   based on the total number of 1-50 contracts within our entire book
   of business that fall outside of our service area.
51-199 Risk Business
• A slight adjustment will made to our premium rates for 51-199
   groups based on the total number of contracts within our entire
   book of business that fall outside of our service area




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Underwriting and Pricing

 • CareFirst Pricing and Underwriting will continue to
   assist with DPPO and Traditional Dental plans
 • Groups automatically gain access to DNoA providers
   starting 1/1/09 – Won’t be retroactively charged for
   access to national network at renewal
 • For majority of groups, impact should be minimal –
   great value for money




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Commissions

•Broker Commission – No change
•$4.67 per contract/per month




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Customer Service
 • CareFirst’s Dental Business Operations continues to handle all
   customer service inquiries
 • Dental Member Service telephone number (866-891-2802)
   appears on the back of the ID card.

 CareFirst and DNoA providers may also use the number to
   access member eligibility




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Client Administration
•DNoA will provide access to its national dental network. CareFirst
 handles other administrative functions, including:
    - Account Installation
    - Enrollment of Members
    - Claims Adjudication
    - ID Card and EOB Distribution
    - Customer Service for Members and Participating Dentists

The goal of this project is to provide a seamless, national solution for
our members, employer groups, and providers.




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ID Cards
• All Traditional Dental or Preferred Dental (DPPO) groups with effective dates between
  January 15, 2009 – December 15, 2009 will receive new ID cards upon renewal, even if
  they do not make benefit changes.
• CareFirst’s Dental Business Operations (866-891-2802) will answer members and
  providers questions regarding the new network.
• DT (Traditional) or DP (Preferred) product indicator (below Copay section)




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Questions?

				
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