Curators of the University of Missouri - Combined January 1, 2016 through December 31, 2016
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- Baldric Garrison
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1 Cost Management Report Delta Dental Network Coverage Network Utilization Discount Delta Dental PPO Network 28.3% 29.4% Delta Dental Premier Network 67.0% 12.0% Total 95.3% Savings Categories $ % of Net Submitted Dollars % of Paid Dollars Total Submitted Claims $26,518,502 RFI/Duplicate/Eligibility $1,264, % Net Submitted Claims $25,254,140 Claims Management Savings Non-Covered Services $746, % 5.3% Professional Review $207, % 1.5% Non-Billable Services* $96, % 0.7% Optional Services $22, % 0.2% Coordination of Benefits $144, % 1.0% Subtotal $2,482, % 17.7% Delta Dental Difference Savings Delta Dental PPO Network $2,095, % 15.0% Delta Dental Premier Network $2,003, % 14.3% Out-of-Network $47, % 0.3% Subtotal $4,146, % 29.6% Program Design/Member Responsibility Savings Deductible Applied $1,330, % 9.5% Patient Coinsurance $3,136, % 22.4% Over Maximums $1,423, % 10.2% Subtotal $5,890, % 42.1% Total Savings $12,519,173 Total Paid Claims $13,999,289 *When treatment is received from a Delta Dental participating dentist these charges are not billed to the patient. These do not represent network discount percentages. 1 01/08/2017
2 Delta Dental Network Coverage Network Utilization Number of Services Net Submitted Claims Discount Paid Claims Delta Dental PPO Network 54,882 $7,129, % $3,223,092 Delta Dental Premier Network 129,823 $16,671, % $9,939,049 Out-of-Network 9,084 $1,453, % $837,148 Total 193,789 $25,254, % $13,999, /08/2017
3 Paid Claims by Member Type & Service Member Type Paid Claims % of Paid Claims Employee $7,581, % Spouse $3,068, % Children $3,349, % Total $13,999, % Dental Service Paid Claims % of Paid Claims Preventive Services $8,407, % Basic Services $3,252, % Major Services $2,339, % Orthodontic Services $0 0.0% Total $13,999, % 3 01/08/2017
4 Comparison to Delta Dental Book of Business (BOB) % of Services % of Benefit Dental Service Group Delta Dental BOB Group Delta Dental BOB Preventive Services 83.2% 77.9% 60.1% 51.8% Basic Services 13.9% 16.9% 23.2% 28.6% Major Services 2.9% 2.5% 16.7% 14.3% Orthodontic Services 0.0% 2.7% 0.0% 5.3% Network Utilization By Net Submitted Claims Group Delta Dental BOB Difference Delta Dental PPO Network 28.2% 53.9% -25.6% Delta Dental Premier Network 66.0% 39.5% 26.5% Out-of-Network 5.8% 6.6% -0.9% Savings Categories % of Total Submitted Dollars Delta Dental % of Total Submitted Dollars Difference Total Submitted Claims $26,518,502 $1,024,125,93 Claims Management Savings Request for Information 2.5% 5.4% -2.8% Duplicate Claims 2.2% 3.2% -1.0% Eligibility Verification 0.0% 0.0% 0.0% Non-Covered Services 2.8% 5.0% -2.2% Professional Review 0.8% 0.5% 0.3% Non-Billable Services 0.4% 0.4% -0.1% Optional Services 0.1% 0.8% -0.7% Coordination of Benefits 0.5% 1.0% -0.5% Subtotal 9.4% 16.2% -6.9% Delta Dental Difference Savings Delta Dental PPO Network 7.9% 15.2% -7.3% Delta Dental Premier Network 7.6% 5.3% 2.3% Out-of-Network 0.2% 1.0% -0.8% Subtotal 15.6% 21.5% -5.8% Program Design/Member Responsibility Savings Deductible Applied 5.0% 2.1% 2.9% Patient Coinsurance 11.8% 12.7% -0.9% Over Maximums 5.4% 5.0% 0.4% Subtotal 22.2% 21.6% 2.4% Total Savings 47.2% 54.7% -7.5% Total Paid Claims 52.8% 42.5% 10.3% 4 01/08/2017
5 Comparison by Member Type Total Paid Claims Type of Dental Service Employee Spouse Children Total Dental Prophylaxis $2,010,011 $769,544 $857,949 $3,637,504 Fluoride Treatments $0 $0 $321,480 $321,480 General Services $80,038 $31,233 $92,041 $203,311 Oral Evaluations $1,199,279 $467,629 $678,668 $2,345,575 Other Diagnostic $0 $0 $0 $0 Other Preventive $0 $0 $2,733 $2,733 Radiographs $960,733 $377,328 $436,684 $1,774,745 Sealants $0 $0 $111,866 $111,866 Space Maintainers $0 $0 $10,216 $10,216 Preventive Services $4,250,062 $1,645,733 $2,511,636 $8,407,431 % of Total 50.6% 19.6% 29.9% Amalgam & Composite Fillings $701,457 $293,594 $362,215 $1,357,265 Endodontics $456,093 $206,009 $52,731 $714,833 Extractions - Simple $76,166 $33,873 $41,373 $151,412 Extractions - Surgical $157,056 $60,164 $277,954 $495,174 Other Basic Services $125,406 $55,197 $26,828 $207,431 Periodontics - Non-Surgical $156,587 $67,308 $8,672 $232,567 Periodontics - Surgical $64,775 $23,714 $5,628 $94,116 Basic Services $1,737,539 $739,859 $775,400 $3,252,799 % of Total 53.4% 22.7% 23.8% Crowns $973,723 $413,075 $34,125 $1,420,923 Dentures - Complete $30,909 $18,709 $0 $49,618 Dentures - Partial $45,587 $18,640 $0 $64,227 Fixed Bridges $143,934 $62,676 $2,893 $209,504 Implants $313,145 $134,945 $14,524 $462,614 Inlays/Onlays $11,430 $3,015 $0 $14,445 Oral Surgery $46,650 $21,058 $10,282 $77,990 Other Prosthodontics $21,030 $6,916 $152 $28,098 Veneers $7,657 $3,986 $0 $11,643 Major Services $1,594,063 $683,020 $61,977 $2,339,060 % of Total 68.1% 29.2% 2.6% Orthodontics $0 $0 $0 $0 Orthodontic Services $0 $0 $0 $0 % of Total 0.0% 0.0% 0.0% Grand Total $7,581,664 $3,068,613 $3,349,013 $13,999,289 % of Grand Total 54.2% 21.9% 23.9% 100.0% 5 01/08/2017
6 Member Type - All Type of Dental Service Number of Services % of Total Paid Claims % of Total Dental Prophylaxis 53, % $3,637, % Fluoride Treatments 8, % $321, % General Services 2, % $203, % Oral Evaluations 55, % $2,345, % Other Diagnostic 3 0.0% $0 0.0% Other Preventive % $2, % Radiographs 39, % $1,774, % Sealants 2, % $111, % Space Maintainers % $10, % Preventive Services 161, % $8,407, % Amalgam & Composite Fillings 15, % $1,357, % Endodontics 1, % $714, % Extractions - Simple 2, % $151, % Extractions - Surgical 2, % $495, % Other Basic Services 2, % $207, % Periodontics - Non-Surgical 1, % $232, % Periodontics - Surgical % $94, % Basic Services 26, % $3,252, % Crowns 3, % $1,420, % Dentures - Complete % $49, % Dentures - Partial % $64, % Fixed Bridges % $209, % Implants % $462, % Inlays/Onlays % $14, % Oral Surgery % $77, % Other Prosthodontics % $28, % Veneers % $11, % Major Services 5, % $2,339, % Orthodontics 4 0.0% $0 0.0% Orthodontic Services 4 0.0% $0 0.0% Grand Total 193,789 $13,999, /08/2017
7 Member Type - Employee Type of Dental Service Number of Services % of Total Paid Claims % of Total Dental Prophylaxis 28, % $2,010, % Fluoride Treatments 7 0.0% $0 0.0% General Services 1, % $80, % Oral Evaluations 28, % $1,199, % Other Diagnostic 1 0.0% $0 0.0% Other Preventive % $0 0.0% Radiographs 21, % $960, % Sealants 1 0.0% $0 0.0% Space Maintainers 0 0.0% $0 0.0% Preventive Services 79, % $4,250, % 4,250,062 Amalgam & Composite Fillings 8, % $701, % Endodontics % $456, % Extractions - Simple 1, % $76, % Extractions - Surgical 1, % $157, % Other Basic Services 1, % $125, % Periodontics - Non-Surgical 1, % $156, % Periodontics - Surgical % $64, % Basic Services 14, % $1,737, % 1,737,539 Crowns 2, % $973, % Dentures - Complete % $30, % Dentures - Partial % $45, % Fixed Bridges % $143, % Implants % $313, % Inlays/Onlays % $11, % Oral Surgery % $46, % Other Prosthodontics % $21, % Veneers % $7, % Major Services 3, % $1,594, % 1,594,063 Orthodontics 2 0.0% $0 0.0% Orthodontic Services 2 0.0% $0 0.0% 0 Grand Total 97,824 $7,581, /08/2017
8 Member Type - Spouse Type of Dental Service Number of Services % of Total Paid Claims % of Total Dental Prophylaxis 11, % $769, % Fluoride Treatments 4 0.0% $0 0.0% General Services % $31, % Oral Evaluations 11, % $467, % Other Diagnostic 2 0.0% $0 0.0% Other Preventive % $0 0.0% Radiographs 8, % $377, % Sealants 0 0.0% $0 0.0% Space Maintainers 0 0.0% $0 0.0% Preventive Services 31, % $1,645, % 4,250,062 Amalgam & Composite Fillings 3, % $293, % Endodontics % $206, % Extractions - Simple % $33, % Extractions - Surgical % $60, % Other Basic Services % $55, % Periodontics - Non-Surgical % $67, % Periodontics - Surgical % $23, % Basic Services 6, % $739, % 1,737,539 Crowns 1, % $413, % Dentures - Complete % $18, % Dentures - Partial % $18, % Fixed Bridges % $62, % Implants % $134, % Inlays/Onlays 7 0.0% $3, % Oral Surgery % $21, % Other Prosthodontics % $6, % Veneers % $3, % Major Services 1, % $683, % 1,594,063 Orthodontics 0 0.0% $0 0.0% Orthodontic Services 0 0.0% $0 0.0% 0 Grand Total 39,314 $3,068, /08/2017
9 Member Type - Children Type of Dental Service Number of Services % of Total Paid Claims % of Total Dental Prophylaxis 13, % $857, % Fluoride Treatments 8, % $321, % General Services % $92, % Oral Evaluations 14, % $678, % Other Diagnostic 0 0.0% $0 0.0% Other Preventive % $2, % Radiographs 9, % $436, % Sealants 2, % $111, % Space Maintainers % $10, % Preventive Services 50, % $2,511, % 4,250,062 Amalgam & Composite Fillings 3, % $362, % Endodontics % $52, % Extractions - Simple % $41, % Extractions - Surgical 1, % $277, % Other Basic Services % $26, % Periodontics - Non-Surgical % $8, % Periodontics - Surgical % $5, % Basic Services 6, % $775, % 1,737,539 Crowns % $34, % Dentures - Complete 0 0.0% $0 0.0% Dentures - Partial 0 0.0% $0 0.0% Fixed Bridges 9 0.0% $2, % Implants % $14, % Inlays/Onlays 0 0.0% $0 0.0% Oral Surgery % $10, % Other Prosthodontics 2 0.0% $ % Veneers 0 0.0% $0 0.0% Major Services % $61, % 1,594,063 Orthodontics 2 0.0% $0 0.0% Orthodontic Services 2 0.0% $0 0.0% 0 Grand Total 56,651 $3,349, /08/2017
10 Number of Services by Age Band Relationship Age Range Preventive Basic Major Ortho Total % of Total Employee 24 & Under , % 25 to 34 11,008 2, , % 35 to 44 11,841 1, , % 45 to 54 13,621 2, , % 55 to 64 18,038 2, , % 65 & Over 24,362 4,465 1, , % Totals: 79,642 14,401 3, ,824 Spouse 24 & Under % 25 to 34 3, , % 35 to 44 4, , % 45 to 54 5, , % 55 to 64 8,067 1, , % 65 & Over 9,786 1, , % Totals: 31,554 6,142 1, ,314 Children 0 to 5 6, , % 6 to 12 20,000 1, , % 13 to 18 13,936 1, , % 19 to 23 6,914 1, , % 24 & Over 2, , % Totals: 50,117 6, ,651 Grand Total 161,313 26,912 5, ,789 Aggregate Totals Children 50,117 6, , % 24 & Under , % 25 to 34 14,239 3, , % 35 to 44 16,823 2, , % 45 to 54 19,010 3, , % 55 to 64 26,105 4,403 1, , % 65 & Over 34,148 6,271 2, , % Totals: 161,313 26,912 5, , /08/2017
11 Paid Claims By Age Band Relationship Age Range Preventive Basic Major Ortho Total % of Total Employee 24 & Under $46,075 $37,509 $7,380 $0 $90, % 25 to 34 $603,511 $322,513 $84,527 $0 $1,010, % 35 to 44 $635,242 $233,811 $161,094 $0 $1,030, % 45 to 54 $734,195 $271,889 $229,073 $0 $1,235, % 55 to 64 $958,229 $353,807 $411,986 $0 $1,724, % 65 & Over $1,272,810 $518,011 $700,004 $0 $2,490, % Totals: $4,250,062 $1,737,53 $1,594,063 $0 $7,581,664 Spouse 24 & Under $5,967 $5,526 $578 $0 $12, % 25 to 34 $177,527 $104,547 $28,385 $0 $310, % 35 to 44 $264,671 $110,116 $61,529 $0 $436, % 45 to 54 $280,973 $123,780 $105,896 $0 $510, % 55 to 64 $414,313 $179,845 $226,073 $0 $820, % 65 & Over $502,282 $216,044 $260,559 $0 $978, % Totals: $1,645,733 $739,859 $683,020 $0 $3,068,613 Children 0 to 5 $329,178 $39,223 $5,110 $0 $373, % 6 to 12 $937,391 $142,666 $939 $0 $1,080, % 13 to 18 $713,349 $244,037 $10,751 $0 $968, % 19 to 23 $394,128 $249,413 $25,135 $0 $668, % 24 & Over $137,591 $100,061 $20,043 $0 $257, % Totals: $2,511,636 $775,400 $61,977 $0 $3,349,013 Grand Total $8,407,431 $3,252,79 9 Aggregate Totals $2,339,060 $0 $13,999,28 9 Children $2,511,636 $775,400 $61,977 $0 $3,349, % 24 & Under $52,042 $43,035 $7,958 $0 $103, % 25 to 34 $781,038 $427,060 $112,911 $0 $1,321, % 35 to 44 $899,913 $343,927 $222,623 $0 $1,466, % 45 to 54 $1,015,168 $395,670 $334,969 $0 $1,745, % 55 to 64 $1,372,541 $533,652 $638,058 $0 $2,544, % 65 & Over $1,775,092 $734,056 $960,563 $0 $3,469, % Totals: $8,407,431 $3,252,79 $2,339,060 $0 $13,999, /08/2017
12 Total Paid Claims Month Regular Claims Orthodontic Claims Paid Claims # of Employees Average Claims Per Employee Jan-2016 $1,133,346 $0 $1,133,346 23,487 $48.25 Feb-2016 $1,135,835 $0 $1,135,835 23,493 $48.35 Mar-2016 $1,336,269 $0 $1,336,269 23,465 $56.95 Apr-2016 $1,160,665 $0 $1,160,665 23,398 $49.61 May-2016 $1,104,061 $0 $1,104,061 23,343 $47.30 Jun-2016 $1,375,558 $0 $1,375,558 23,383 $58.83 Jul-2016 $1,064,311 $0 $1,064,311 23,371 $45.54 Aug-2016 $1,091,613 $0 $1,091,613 23,430 $46.59 Sep-2016 $1,195,203 $0 $1,195,203 23,361 $51.16 Oct-2016 $996,793 $0 $996,793 23,306 $42.77 Nov-2016 $1,063,660 $0 $1,063,660 23,362 $45.53 Dec-2016 $1,341,978 $0 $1,341,978 23,321 $57.54 Total $13,999,289 $0 $13,999, ,720 $ /08/2017
13 Enrollment by Member Type Month Total Employees Employee Only Employee With Dependents Total Spouses Total Children Total Members Members Per Employee Jan ,487 11,412 12,075 9,550 13,183 46, Feb ,493 11,458 12,035 9,491 13,097 46, Mar ,465 11,464 12,001 9,488 13,048 46, Apr ,398 11,427 11,971 9,464 13,018 45, May ,343 11,387 11,956 9,457 12,998 45, Jun ,383 11,423 11,960 9,455 12,976 45, Jul ,371 11,442 11,929 9,427 12,944 45, Aug ,430 11,468 11,962 9,454 12,967 45, Sep ,361 11,444 11,917 9,418 12,869 45, Oct ,306 11,432 11,874 9,398 12,764 45, Nov ,362 11,479 11,883 9,407 12,786 45, Dec ,321 11,468 11,853 9,385 12,747 45, Average per Month 23,393 11,442 11,951 9,450 12,950 45, /08/2017
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