Curators of the University of Missouri - Combined January 01, 2013 through December 31, 2013 Cost Management Report
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1 Cost Management Report Program Design Specifics Standard Claims Management SAVINGS CATEGORIES SAVINGS RESULTS % OF NET SUBMITTED DOLLARS % OF PAID DOLLARS Deductible Applied $1,296, % 9.78% Patient Coinsurance $3,381, % 25.51% Over Maximums $1,058, % 7.98% Subtotal $5,736, % 43.27% Eligibility Verification $0 0.00% 0.00% Non-Covered Services $557, % 4.21% Subtotal $557, % 4.21% The Delta Difference Cost Containment Management Features PPO Network Savings* $1,770, % 13.36% Premier Network Savings* $1,047, % 7.90% Non-Network Savings $76, % 0.58% Professional Review $115, % 0.87% Non-Billable Services* $53, % 0.40% Optional Services $22, % 0.17% Coordination of Benefits $196, % 1.48% Subtotal $3,282, % 24.76% TOTAL SAVINGS $9,576, % TOTAL CHARGES SUBMITTED $23,905,149 Request for Information** $556,014 Duplicate Claims** $515,766 NET SUBMITTED CHARGES $22,833,369 Net Submitted Charges by Network PPO Network $6,201,890 Premier Network $15,252,312 Non-Network $1,379,167 TOTAL DELTA BENEFITS PAID $13,256, % *When treatment is received from a Delta Dental participating dentist these charges are not billed to the patient. **Charges for claims that have been returned for additional information or duplicate claims are subtracted from the total charges submitted. Delta Dental PPO Network Savings, Delta Dental Premier Network Savings and Non-Network Savings are calculated as a percentage of Net Submitted Charges by Network.
2 Dentist Selection Patterns Delta Network Coverage Number of Services Submitted Amount Paid Claims Premier Network 134,559 $15,252,312 $9,685,332 PPO Network 50,348 $6,201,890 $2,808,658 Non-Network 9,455 $1,379,167 $762,658 Total 194,362 $22,833,369 $13,256,649
3 Benefit Comparison MEMBERSHIP TYPE AMOUNT PAID Employee $7,462,113 Spouse $2,805,315 Children $2,989,221 Total $13,256,649 PROCEDURE TYPE AMOUNT PAID Preventive Services $7,740,046 Basic Services $3,217,360 Major Services $2,298,636 Orthodontic Services $607 Total $13,256,649
4 Comparison to Norms % of Services % of Benefit Type of Dental Service Group Delta Dental Plan Wide Group Delta Dental Plan Wide Diagnostic & Preventive 81.37% 75.75% 58.39% 50.90% Basic Services 14.99% 17.60% 24.27% 29.47% Major Services 3.47% 2.96% 17.34% 14.68% Orthodontic Services 0.16% 3.69% 0.00% 4.95% SAVINGS CATEGORIES % OF NET SUBMITTED DOLLARS DELTA DENTAL % OF NET SUBMITTED DOLLARS Program Design Specifics Standard Claims Management The Delta Difference Cost Containment Management Features Deductible Applied 5.68% 2.56% Patient Coinsurance 14.81% 16.18% Over Maximums 4.64% 4.02% Subtotal 25.12% 22.77% Eligibility Verification 0.00% 0.00% Non-Covered Services 2.44% 4.60% Subtotal 2.44% 4.60% PPO Network Savings* 28.55% 28.03% Premier Network Savings* 6.87% 9.71% Non-Network Savings 5.55% 13.92% Professional Review 0.50% 0.34% Non-Billable Services* 0.23% 0.32% Optional Services 0.10% 1.25% Coordination of Benefits 0.86% 1.77% Subtotal 14.38% 21.51% TOTAL SAVINGS 41.94% 48.88% TOTAL SUBMITTED $23,905,149 $881,355,112 Request for Information** $556,014 $46,079,558 Duplicate Claims** $515,766 $27,161,646 NET SUBMITTED $22,833,369 $808,113,907 BENEFITS PAID $13,256,649 $413,123,011 Net Submitted Charges Group Delta Dental Plan-Wide PPO Network $6,201,890 $341,331,534 Premier Network $15,252,312 $393,878,870 Non-Network $1,379,167 $72,903,504 *When treatment is received from a Delta Dental participating dentist these charges are not billed to the patient. **Charges for claims that have been returned for additional information or duplicate claims are subtracted from the total charges submitted. Delta Dental PPO Network Savings, Delta Dental Premier Network Savings and Non-Network Savings are calculated as a percentage of Net Submitted Charges by Network.
5 Comparison by Relationship Paid Benefit Amounts Type of DentalService Employee Spouse Children Total Dental Prophylaxis $1,876,223 $703,581 $778,963 $3,358,767 Fluoride Treatments $20 $0 $247,831 $247,851 General Services $58,819 $25,633 $82,736 $167,189 Oral Evaluations $1,153,865 $432,360 $608,068 $2,194,293 Radiographs $909,217 $340,881 $396,650 $1,646,747 Sealants $0 $0 $119,079 $119,079 Space Maintainers $0 $0 $6,120 $6,120 Preventive Services $3,998,144 $1,502,455 $2,239,447 $7,740, % 19.41% 28.93% Amalgam & Composite Fillings $751,335 $292,434 $307,134 $1,350,904 Endodontics $472,486 $164,819 $58,535 $695,840 Extractions - Simple $75,089 $29,213 $41,568 $145,869 Extractions - Surgical $138,695 $55,789 $247,610 $442,095 Other Basic Services $130,848 $52,440 $22,327 $205,614 Periodontics - Non-Surgical $178,726 $67,438 $8,556 $254,721 Periodontics - Surgical $85,559 $29,780 $6,979 $122,319 Basic Services $1,832,737 $691,914 $692,709 $3,217, % 21.51% 21.53% Crowns $1,008,849 $379,923 $32,390 $1,421,163 Dentures - Complete $36,228 $16,931 $0 $53,159 Dentures - Partial $53,991 $18,522 $0 $72,513 Fixed Bridges $168,549 $54,806 $2,450 $225,805 Implants $272,868 $108,766 $16,095 $397,728 Inlays/Onlays $12,902 $6,226 $772 $19,900 Oral Surgery $41,074 $14,811 $4,457 $60,342 Other Prosthodontics $24,583 $9,107 $100 $33,789 Veneers $12,023 $1,854 $359 $14,236 Major Services $1,631,067 $610,946 $56,623 $2,298, % 26.58% 2.46% Orthodontics $165 $0 $442 $607 Orthodontic Services $165 $0 $442 $ % 0.00% 72.82% Grand Total $7,462,113 $2,805,315 $2,989,221 $13,256,649
6 Relationship - All Relationships Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 51, % $3,358, % Fluoride Treatments 9, % $247, % General Services 3, % $167, % Oral Evaluations 52, % $2,194, % Other Diagnostic % $0 0.00% Other Preventive % $0 0.00% Radiographs 39, % $1,646, % Sealants 2, % $119, % Space Maintainers % $6, % Preventive Services 158, % $7,740, % Amalgam & Composite Fillings 16, % $1,350, % Endodontics 1, % $695, % Extractions - Simple 2, % $145, % Extractions - Surgical 2, % $442, % Other Basic Services 3, % $205, % Periodontics - Non-Surgical 2, % $254, % Periodontics - Surgical % $122, % Basic Services 29, % $3,217, % Crowns 3, % $1,421, % Dentures - Complete % $53, % Dentures - Partial % $72, % Fixed Bridges % $225, % Implants % $397, % Inlays/Onlays % $19, % Oral Surgery % $60, % Other Prosthodontics % $33, % Veneers % $14, % Major Services 6, % $2,298, % Orthodontics % $ % Orthodontic Services % $ % Grand Total 194,362 $13,256,649
7 Relationship - Employee Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 27, % $1,876, % Fluoride Treatments % $ % General Services 1, % $58, % Oral Evaluations 27, % $1,153, % Other Diagnostic % $0 0.00% Other Preventive % $0 0.00% Radiographs 21, % $909, % Sealants % $0 0.00% Space Maintainers % $0 0.00% Preventive Services 79, % $3,998, % Amalgam & Composite Fillings 9, % $751, % Endodontics 1, % $472, % Extractions - Simple 1, % $75, % Extractions - Surgical 1, % $138, % Other Basic Services 2, % $130, % Periodontics - Non-Surgical 1, % $178, % Periodontics - Surgical % $85, % Basic Services 16, % $1,832, % Crowns 2, % $1,008, % Dentures - Complete % $36, % Dentures - Partial % $53, % Fixed Bridges % $168, % Implants % $272, % Inlays/Onlays % $12, % Oral Surgery % $41, % Other Prosthodontics % $24, % Veneers % $12, % Major Services 4, % $1,631, % Orthodontics % $ % Orthodontic Services % $ % Grand Total 101,039 $7,462,113
8 Relationship - Spouse Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 10, % $703, % Fluoride Treatments % $0 0.00% General Services % $25, % Oral Evaluations 10, % $432, % Other Diagnostic % $0 0.00% Other Preventive % $0 0.00% Radiographs 8, % $340, % Sealants % $0 0.00% Preventive Services 30, % $1,502, % Amalgam & Composite Fillings 3, % $292, % Endodontics % $164, % Extractions - Simple % $29, % Extractions - Surgical % $55, % Other Basic Services % $52, % Periodontics - Non-Surgical % $67, % Periodontics - Surgical % $29, % Basic Services 6, % $691, % Crowns 1, % $379, % Dentures - Complete % $16, % Dentures - Partial % $18, % Fixed Bridges % $54, % Implants % $108, % Inlays/Onlays % $6, % Oral Surgery % $14, % Other Prosthodontics % $9, % Veneers % $1, % Major Services 1, % $610, % Orthodontics % $0 0.00% Orthodontic Services % $0 0.00% Grand Total 39,133 $2,805,315
9 Relationship - Children Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 12, % $778, % Fluoride Treatments 8, % $247, % General Services % $82, % Oral Evaluations 13, % $608, % Other Diagnostic % $0 0.00% Other Preventive % $0 0.00% Radiographs 9, % $396, % Sealants 2, % $119, % Space Maintainers % $6, % Preventive Services 47, % $2,239, % Amalgam & Composite Fillings 3, % $307, % Endodontics % $58, % Extractions - Simple % $41, % Extractions - Surgical 1, % $247, % Other Basic Services % $22, % Periodontics - Non-Surgical % $8, % Periodontics - Surgical % $6, % Basic Services 6, % $692, % Crowns % $32, % Fixed Bridges % $2, % Implants % $16, % Inlays/Onlays % $ % Oral Surgery % $4, % Other Prosthodontics % $ % Veneers % $ % Major Services % $56, % Orthodontics % $ % Orthodontic Services % $ % Grand Total 54,190 $2,989,221
10 Relationship Age Range Diagnostic & Preventive Number of Services By Age Basic Services Major Services Ortho Services Total Services % of Total Employee 24 & Under , % 25 to 34 11,453 2, , % 35 to 44 12,133 2, , % 45 to 54 14,952 2, , % 55 to 64 18,685 3,391 1, , % 65 & Over 21,628 4,287 1, , % Totals: 79,662 16,507 4, ,039 Spouse 24 & Under % 25 to 34 3, , % 35 to 44 4,928 1, , % 45 to 54 5,587 1, , % 55 to 64 8,147 1, , % 65 & Over 8,541 1, , % Totals: 30,784 6,458 1, ,133 Children 0 to 5 5, , % 6 to 12 19,441 1, , % 13 to 18 13,974 1, , % 19 to 23 6,971 1, , % 24 & Over 2, , % Totals: 47,714 6, ,190 GRAND TOTAL 158,160 29,138 6, ,362 Aggregate Totals All Children 47,714 6, , % 24 & Under , % 25 to 34 14,958 3, , % 35 to 44 17,061 3, , % 45 to 54 20,539 4,025 1, , % 55 to 64 26,832 4,952 1, , % 65 & Over 30,169 5,920 2, , % Totals: 158,160 29,138 6, ,362
11 Relationship Age Range Diagnostic & Preventive Paid Benefits By Age Basic Services Major Services Ortho Services Total Services % of Total Employee 24 & Under $42,524 $45,249 $7,624 $0 $95, % 25 to 34 $584,909 $329,416 $114,664 $80 $1,029, % 35 to 44 $622,880 $301,419 $161,729 $85 $1,086, % 45 to 54 $756,574 $329,006 $277,323 $0 $1,362, % 55 to 64 $942,709 $369,798 $467,339 $0 $1,779, % 65 & Over $1,048,549 $457,850 $602,388 $0 $2,108, % Totals: $3,998,144 $1,832,737 $1,631,067 $165 $7,462,113 Spouse 24 & Under $4,130 $1,731 $0 $0 $5, % 25 to 34 $177,843 $111,130 $23,901 $0 $312, % 35 to 44 $248,319 $123,815 $76,620 $0 $448, % 45 to 54 $270,625 $126,495 $119,488 $0 $516, % 55 to 64 $389,433 $157,128 $175,434 $0 $721, % 65 & Over $412,104 $171,614 $215,503 $0 $799, % Totals: $1,502,455 $691,914 $610,946 $0 $2,805,315 Children 0 to 5 $234,726 $27,774 $130 $0 $262, % 6 to 12 $846,877 $133,178 $1,240 $0 $981, % 13 to 18 $675,993 $240,153 $12,120 $442 $928, % 19 to 23 $369,754 $225,175 $29,276 $0 $624, % 24 & Over $112,097 $66,429 $13,857 $0 $192, % Totals: $2,239,447 $692,709 $56,623 $442 $2,989,221 GRAND TOTAL $7,740,046 $3,217,360 $2,298,636 $607 $13,256,649 Aggregate Totals All Children $2,239,447 $692,709 $56,623 $442 $2,989, % 24 & Under $46,654 $46,980 $7,624 $0 $101, % 25 to 34 $762,752 $440,546 $138,565 $80 $1,341, % 35 to 44 $871,199 $425,234 $238,349 $85 $1,534, % 45 to 54 $1,027,199 $455,501 $396,811 $0 $1,879, % 55 to 64 $1,332,142 $526,926 $642,773 $0 $2,501, % 65 & Over $1,460,654 $629,464 $817,891 $0 $2,908, % Totals: $7,740,046 $3,217,360 $2,298,636 $607 $13,256,649
12 Month Regular Claims Monthly Claims Cost Orthodontic Claims All Claims Combined # of Primary Subscribers Enrolled Average Claims per Primary Subscriber 2013-January $1,163,456 $0 $1,163,456 22,390 $ February $1,181,960 $0 $1,181,960 22,333 $ March $1,046,368 $0 $1,046,368 22,418 $ April $1,061,982 $80 $1,062,062 22,351 $ May $1,421,731 $82 $1,421,813 22,426 $ June $1,029,734 $0 $1,029,734 22,094 $ July $969,770 $105 $969,875 22,348 $ August $1,314,602 $63 $1,314,665 22,347 $ September $915,296 $190 $915,486 22,398 $ October $1,151,662 $0 $1,151,662 22,403 $ November $947,619 $87 $947,706 22,389 $ December $1,051,861 $0 $1,051,861 22,399 $46.96 Total $13,256,042 $607 $13,256, ,296 $49.41
13 Demographic Profile Month Total Employees Employee Only Employee with Dependents Total Spouses Total Children Total Members Members per Employee 2013-Jan 22,390 10,923 11,467 8,917 12,676 43, Feb 22,333 10,918 11,415 8,879 12,617 43, Mar 22,418 10,956 11,462 8,908 12,693 44, Apr 22,351 10,942 11,409 8,873 12,641 43, May 22,426 10,978 11,448 8,896 12,692 44, Jun 22,094 10,772 11,322 8,804 12,506 43, Jul 22,348 10,938 11,410 8,888 12,601 43, Aug 22,347 10,919 11,428 8,895 12,589 43, Sep 22,398 10,971 11,427 8,898 12,577 43, Oct 22,403 10,973 11,430 8,894 12,539 43, Nov 22,389 10,962 11,427 8,890 12,535 43, Dec 22,399 10,961 11,438 8,905 12,563 43, Average per Month 22,358 10,934 11,424 8,887 12,602 43,
Curators of the University of Missouri - Combined January 1, 2016 through December 31, 2016
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