<p>This insurance-focused web site seems to confirm that Anthem “is the only carrier [in California] which charges adults additional monthly premium for pediatric dental.”</p>
<p>[CC</a> Pediatric Dental? - Covered California Q&A](<a href=“http://www.cahba.com/advice/2013/12/requirement_for_pediatric_dent.html]CC”>http://www.cahba.com/advice/2013/12/requirement_for_pediatric_dent.html)</p>
<p>This is older, but I wonder if it offers an additional point of info: <a href=“http://www.ameritasgroup.com/OCM/GetFile?doc=373433[/url]”>http://www.ameritasgroup.com/OCM/GetFile?doc=373433</a></p>
<p>“Medical coverage offered within an exchange must include a pediatric vision and dental benefit. If the same exchange offers a stand-alone dental plan providing the required pediatric dental benefit, the medical plan has the option to exclude that benefit.”</p>
<p>(So, does anthem not offer a stand-alone, thus it gets bundled?) Also this: <a href=“http://www.news.anthem.com/bcp/assets/article/Specialty%20Individual%20Guide%202014%20-%20CA.pdf[/url]”>http://www.news.anthem.com/bcp/assets/article/Specialty%20Individual%20Guide%202014%20-%20CA.pdf</a></p>
<p>So I get a letter today from Blue Shield saying that my application for the HSA Bronze plan, effective April 1, 2014, has been approved. Only problem is that I never initiated or completed an application for this bronze plan. Although I supposedly have a three month extension for my current plan, I have not received a bill and my online account doesn’t indicate that my insurance has been extended. So, for all I know, I may not be currently insured. Guess I will have to call BS tomorrow and probably wait an hour or two on hold to find out what’s going on. Ughh</p>
<p>Here’s an article with some background:
[Will</a> Covered California shut out dental plans? | LifeHealthPro](<a href=“http://www.lifehealthpro.com/2013/10/29/will-covered-california-shut-out-dental-plans]Will”>http://www.lifehealthpro.com/2013/10/29/will-covered-california-shut-out-dental-plans)</p>
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<p>Basically, as best as I can figure, Covered Cal decided to set up separate stand-alone dental plans (SADP) on the exchange rather than requiring them to be included within the main health plans, possibly because of consideration of (or lobbying from) some dental-only companies like Delta.</p>
<p>But there appears to be conflict between what Covered Cal has decided for the exchange and the rules put out by state regulators for insurance sold off-exchange – hence the situation where the purchase of a SADP is “voluntary” on the exchange, but mandatory off-exchange. Basically the State Insurance Commissioner has a different view of things than the Covered Cal board (on many issues): [Jones</a> Wants Exchange Plans To Include Pediatric Dental Coverage - California Healthline](<a href=“http://www.californiahealthline.org/articles/2013/7/1/jones-wants-exchange-plans-to-include-pediatric-dental-coverage]Jones”>Jones Wants Exchange Plans To Include Pediatric Dental Coverage - California Healthline)</p>
<p>Anyway, the situation is still in flux and likely to change for 2015 – here’s a recent report from a consulting firm hired by Covered CA (in case anyone really wants to bury themselves in the details): <a href=“http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/Pediatric%20Dental%20Report.pdf[/url]”>http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2021,%202013/Pediatric%20Dental%20Report.pdf</a></p>
<p>Basically, I think the State insurance regulators have told providers that, because pediatric dental is an EHB, they have to include in all plans sold off-exchange. But the insurance companies seem to have come to different conclusions as to how they will do it. Both Blue Shield & Anthem have their own dental networks – it looks like BS decided that they would include it for everyone, but waive the premium for adults; whereas Anthem is “including” it but also charting an extra premium, under the rationale that everyone ought to pay. I put “including” in quotes because Anthem obviously is also marketing the “included” feature as a separate add on product you have to pay for-- the net difference is that it means that a plan purchased off-exchange from Anthem will always cost something more than the listed, on-exchange price. </p>
<p>In the end it might not really matter – because it’s very possible that in any given market or metal level an equivalent Blue Shield plan with the dental premium waived might have a higher base premium than the Anthem plan with the extra charge. But that’s what it is right now. DStark will have to pay for pediatric dental care he doesn’t need, and Anthem is choosing to make a big point of telling him about it.</p>
<p>FWIW, the BCBS (Michigan) agent I spoke to long ago had advised me that since employee x’s family would be on the exchange, the multistate plan that included pediatric dental was what x would need to buy. I had taken it from that convo that our silver HSA off-exchange did not include pediatric dental and that it didn’t need to but now I am wondering. Our switchover won’t be until the end of the month because we were hoping to avoid the exchange crunch for employee x, so I guess I won’t know until the dust clears :)</p>
<p>[APNewsBreak:</a> Adding a baby to health plan not easy - Houston Chronicle](<a href=“http://www.chron.com/news/politics/article/APNewsBreak-Adding-a-baby-to-health-plan-not-easy-5110397.php]APNewsBreak:”>http://www.chron.com/news/politics/article/APNewsBreak-Adding-a-baby-to-health-plan-not-easy-5110397.php)</p>
<p>Calmom, thanks for the posts on the dental issue. I guess I dont need to call. :).</p>
<p>Goldenpooch, </p>
<p>Perhaps your evil twin signed you up for health plan on the exchange. </p>
<p>That is so strange.</p>
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<p>It’s odd. DStark has to pay for a lot of benefits he absolutely, positively won’t need: cystic fibrosis treatment, sickle cell treatment, Huntington’s disease treatment, maternity benefits, pediatric dental. All but pediatric dental are built in to his premium.</p>
<p>It doesn’t surprise me that dstark has to pay for pediatric dental care; what surprised me is that he was required to <em>select</em> a plan. One would think that if you check the box (or whatever) that indicates you won’t be using it, then the coverage would default to adding the lowest cost pediatric dental premium, rather than make you go through the motions of looking at the options.</p>
<p>I suppose that a few ineligible subscribers might be contemplating adopting a child old enough to need a dentist in the current year, and that might be a reason to allow subscribers to evaluate which plan to select.</p>
<p>I did not select a dental plan. If I gave that impression, sorry. </p>
<p>I do not have dental insurance.</p>
<p>I was sent a bill to cover the dental mandate for young people. When I bought my plan, I thought my plan was all inclusive of mandates.</p>
<p>We paid the mandated dental plan bill today.</p>
<p>I just found a letter from Anthem dated Dec 9. </p>
<p>Anthem told me they were going to charge me an additional $5.87 per person for the dental mandate.</p>
<p>Oh well… :).</p>
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<p>Anthem has basically figured out a way to charge people buying off-exchange a larger premium for the same policy that they could have purchased on-exchange by tacking on the extra dental charge. Otherwise, they are required to set the same rates for the policies. But the dental-insurance quirk created something of loophole that lets them tack on the extra charge. </p>
<p>In other words, if an older couple selects, say, the Anthem Gold on-exchange – and the premium for that is $1200/month – that is what they pay. If they go to the Anthem web site and pick the exact same Gold plan they pay $1212, for the pediatric dental add-on (at $6 per person). That’s probably not enough money for the couple to lose sleep over, but when cumulated over many policies, it should keep Wellpoint shareholders happy.</p>
<p>Anthem also offers policies off-exchange that are not identical to the on-exchange policies, and of course I don’t know which DStark chose. If he happened to choose a policy that could have been bought on-exchange, he’s now paying monthly for that privilege. (Even if he does not qualify for subsidies, he could have opted to buy on-exchange at full cost, without the extra dental add on). On the other hand, it’s possible that he chose an off-exchange plan with a somewhat lower premium for an actuarially equivalent policy because of a different way the benefits are structured (higher deductible or higher copays, for example)-- so he might still be coming out ahead despite Anthem’s approach. </p>
<p>But the point is – in California this is an Anthem-only practice. The other insurers don’t seem to be doing it – so while Anthem is not likely to change, it is a factor to keep in mind when choosing among insurers. </p>
<p>And based on my links above, things may be changing in 2015 anyway.</p>
<p>I had a choice between two identical plans. One on exchange and one off exchange.</p>
<p>I decided to sign up off exchange because I thought it would be easier than signing up on exchange.</p>
<p>It wasnt easy signing up off exchange but I will never know if signing up on exchange would have been easier.</p>
<p>Anthem’s premiums are still cheaper, including the dental plan premium, in my area than Blue Shield or Kaiser.</p>
<p>DStark, it may still be possible for you to sign up for the same policy on-exchange to start later – given that open enrollment continues until 3/31. So, for example, you could sign up now for a policy to start Feb. 1 and as soon as you confirm & pay that policy, cancel the one purchased directly from Anthem – and avoid that extra dental charge. However, if your plan has a deductible, then expenses incurred in January wouldn’t apply to the new plan. I’m not sure that it’s worth it to you – however, while the Covered Cal web site has a few issues, I think overall that is actually pretty easy to work with. </p>
<p>I found that just about everything-Anthem was difficult-- they never did update their on-site provider network info for California, and phone calls to Anthem were just a time-consuming maze that led to nowhere – that’s why I decided to opt for Blue Shield in November when I was still unsure about networks, even though the BS premium is +$50/month. I just ended up getting too frustrated. Not that BS was a whole lot better – but they did get their network posted online and overall it has been very easy to deal with them by phone. I may be put on hold, but generally the person who answers the line is able to address or deal with whatever question or issue I have. In hindsight it was the best choice for me anyway – I couldn’t get a straight answer from anyone at Anthem about my area network, and in the end it turns out that the Anthem network in my region is terrible.</p>
<p>Obviously you’ll want to keep the pediatric dental issue in mind for 2015 – and make it a point to keep informed of any changes to Covered Cal.</p>
<p>Just curious, DStark: did you opt for a Bronze level plan? It seems that in Region 2, Anthem has the lowest cost Bronze, Blue Shield has an EPO that is the lowest cost at higher metal levels, and Anthem is one of the most expensive at the Platinum level. I’m not sure whether this pattern holds for all possible age/group combinations (though mathematically it should) – I do know that I see similar variance in other regions, though I could not discern a consistent pattern.</p>
<p>Calmom, I like your post #8675. </p>
<p>“DStark, it may still be possible for you to sign up for the same policy on-exchange to start later – given that open enrollment continues until 3/31”</p>
<p>I have thought about this. I probably should do this but I am not going to do it. If I pursue this I am getting less utility. The upside is not worth it to me. I am tired of calling Anthem. 
I am already paying for 1 kid temporarily in 2 states. I M already overpaying. Another $23.48 a month isnt going to matter. You know how it is. Young men!</p>
<p>It is all going to work out.</p>
<p>I agree that Anthem is very difficult to deal with and for many people Blue Shield may be better. Blue Shield may be better for me and I just dont know it. :)</p>
<p>I have a bronze plan. The silver plan does not make sense for my family. Personally, my health care costs were close to zero in 2013. </p>
<p>But I am a big believer in health insurance. :)</p>
<p>Well I think Blue Shield only has an EPO in your region, and I am wary of the EPO model - so I think that Anthem is the best for you locally. I think I personally would prefer HMO to EPO simply because at least with the HMO I know what I am getting - - an EPO would be very frustrating especially as the networks are still shaping up.</p>
<p>I think it depends on the EPO? If somebody buys an EPO plan from Blus Shield in Ca, is that person covered by every provider that takes a Blue Shield exchange plan in Ca?</p>
<p>Or does that somebody just receive regional coverage with an EPO?</p>
<p>My opinion is I would prefer Kaiser over BS in my area because Kaiser does have some history of insuring people out of network. I think there would be less arguing with Kaiser. I could be persuaded.</p>
<p>I’m not sure – my impression is that EPO may have less flexibility to seek coverage from an out-of-region facility. Obviously that is a question that I would want answered before signing onto an EPO.</p>
<p>This page suggests that the Blue Shield EPO network is different than PPO network, though perhaps nto tied to a specific region: <a href=“https://www.blueshieldca.com/producer/ifp/products/networks.sp[/url]”>https://www.blueshieldca.com/producer/ifp/products/networks.sp</a></p>
<p>I personally want some flexibility to see a doctor when traveling out of state, so an EPO could be restrictive. Thought that is also something to ask about – it’s hard to find the answers because it seems that pre-2014 EPO’s gave access to the full BS network, including Blue Card – but post-2014 things may be different.</p>
<p>But bottom line, I think that if you tend to have zero annual health care costs, then going with whatever is cheapest is probably the best. Just probably would have been nicer for you if Anthem had been a little more transparent in disclosing costs – I have a feeling that if you realized that there was, in essence, a $24/month surcharge for buying direct from Anthem as opposed to the exchange, you might have found it worth your while to set up a Covered California account.</p>
<p>Yea… I might have set up an exchange account with more knowledge.</p>
<p>Calmom, looking at your link, I am not sure a Blue Shield plan has coverage in M
most areas of Nor Cal.</p>
<p>“Exclusive PPO Network – for Blue Shield of California PPO plans
Exclusive EPO Network – for Blue Shield of California EPO plans”</p>
<p>Then there is the map of coverage.</p>