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19 <br />Attachment 4 <br />Page <br />DENTAL INSURANCE OVERVIEW <br />Over the past few years, the County has been systematically improving claim reimbursements <br />to employees, rather than making a dramatic shift in costs. In 2009, Orange County increased <br />reimbursements for Diagnostic and Preventive Services. In 2010, reimbursements for Basic <br />Restorative Services (e.g., fillings) were increased. <br />The reimbursements -for major restorative services (e.g., crowns), Endodontics (e.g., root <br />canals), Periodontics (e.g., gum disease), and extractions still lag behind most other <br />organizations. Because of the difference between County reimbursements and actual charges, <br />employees pay a increasingly higher portion of charges as costs for these services increase. <br />Staff reviewed dental claims and determined that reimbursements for Endodontics, <br />Periodontics, and Oral Surgery can be increased to the Delta Dental rates with little impact to <br />the Dental Fund balance. Reimbursements for Major Restorative Services can be increased by <br />15%, with little effect. Employees can minimize their out of pocket dental expenses by using <br />providers within the Delta Dental Premier network. Employees can further reduce costs by <br />using providers in the newly created Delta Dental Preferred Option network. <br />At the end of FY 2009-10, the dental plan's fund balance was in excess of $300,000 after <br />paying claims of nearly $400,000. By making the changes to reimbursements, the County can <br />expect an increase of $38,000-$45,000 in claims in 2011. The administrative fee of $2.25 will <br />increase to $2.55 per member per month (a total increase of $2,200/year) effective January 1, <br />2011. The fund will be able to absorb this budgeted increase of $.23 per employee per month <br />as well as the anticipated increase in claims. <br />Recommended Changes to the Orange County Table of Allowances includes: <br />• Increasing reimbursement for Endodontics, Periodontics, and Oral <br />Surgery to Delta Dental rates <br />• Increasing reimbursements for Major Restorative Services by 15% <br />