Cost Management Report Program Design Specifics Standard Claims Management SAVINGS CATEGORIES SAVINGS RESULTS % OF NET SUBMITTED DOLLARS % OF PAID DOLLARS Deductible Applied $1,296,627 5.68% 9.78% Patient Coinsurance $3,381,408 14.81% 25.51% Over Maximums $1,058,440 4.64% 7.98% Subtotal $5,736,475 25.12% 43.27% Eligibility Verification $0 0.00% 0.00% Non-Covered Services $557,744 2.44% 4.21% Subtotal $557,744 2.44% 4.21% The Delta Difference Cost Containment Management Features PPO Network Savings* $1,770,607 28.55% 13.36% Premier Network Savings* $1,047,554 6.87% 7.90% Non-Network Savings $76,605 5.55% 0.58% Professional Review $115,296 0.50% 0.87% Non-Billable Services* $53,202 0.23% 0.40% Optional Services $22,816 0.10% 0.17% Coordination of Benefits $196,422 0.86% 1.48% Subtotal $3,282,501 14.38% 24.76% TOTAL SAVINGS $9,576,721 41.94% 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 $13,256,649 58.06% *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.
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
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
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.
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 $7,740,046 51.66% 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 $3,217,360 56.96% 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 $2,298,636 70.96% 26.58% 2.46% Orthodontics $165 $0 $442 $607 Orthodontic Services $165 $0 $442 $607 27.18% 0.00% 72.82% Grand Total $7,462,113 $2,805,315 $2,989,221 $13,256,649
Relationship - All Relationships Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 51,388 26.44% $3,358,767 25.34% Fluoride Treatments 9,309 4.79% $247,851 1.87% General Services 3,002 1.54% $167,189 1.26% Oral Evaluations 52,439 26.98% $2,194,293 16.55% Other Diagnostic 16 0.01% $0 0.00% Other Preventive 39 0.02% $0 0.00% Radiographs 39,008 20.07% $1,646,747 12.42% Sealants 2,930 1.51% $119,079 0.90% Space Maintainers 29 0.01% $6,120 0.05% Preventive Services 158,160 81.37% $7,740,046 58.39% Amalgam & Composite Fillings 16,392 8.43% $1,350,904 10.19% Endodontics 1,633 0.84% $695,840 5.25% Extractions - Simple 2,551 1.31% $145,869 1.10% Extractions - Surgical 2,675 1.38% $442,095 3.33% Other Basic Services 3,096 1.59% $205,614 1.55% Periodontics - Non-Surgical 2,402 1.24% $254,721 1.92% Periodontics - Surgical 389 0.20% $122,319 0.92% Basic Services 29,138 14.99% $3,217,360 24.27% Crowns 3,848 1.98% $1,421,163 10.72% Dentures - Complete 142 0.07% $53,159 0.40% Dentures - Partial 172 0.09% $72,513 0.55% Fixed Bridges 865 0.45% $225,805 1.70% Implants 877 0.45% $397,728 3.00% Inlays/Onlays 50 0.03% $19,900 0.15% Oral Surgery 362 0.19% $60,342 0.46% Other Prosthodontics 369 0.19% $33,789 0.25% Veneers 66 0.03% $14,236 0.11% Major Services 6,751 3.47% $2,298,636 17.34% Orthodontics 313 0.16% $607 0.00% Orthodontic Services 313 0.16% $607 0.00% Grand Total 194,362 $13,256,649
Relationship - Employee Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 27,853 27.57% $1,876,223 25.14% Fluoride Treatments 900 0.89% $20 0.00% General Services 1,474 1.46% $58,819 0.79% Oral Evaluations 27,974 27.69% $1,153,865 15.46% Other Diagnostic 7 0.01% $0 0.00% Other Preventive 20 0.02% $0 0.00% Radiographs 21,386 21.17% $909,217 12.18% Sealants 47 0.05% $0 0.00% Space Maintainers 1 0.00% $0 0.00% Preventive Services 79,662 78.84% $3,998,144 53.58% Amalgam & Composite Fillings 9,087 8.99% $751,335 10.07% Endodontics 1,036 1.03% $472,486 6.33% Extractions - Simple 1,327 1.31% $75,089 1.01% Extractions - Surgical 1,071 1.06% $138,695 1.86% Other Basic Services 2,040 2.02% $130,848 1.75% Periodontics - Non-Surgical 1,679 1.66% $178,726 2.40% Periodontics - Surgical 267 0.26% $85,559 1.15% Basic Services 16,507 16.34% $1,832,737 24.56% Crowns 2,712 2.68% $1,008,849 13.52% Dentures - Complete 100 0.10% $36,228 0.49% Dentures - Partial 128 0.13% $53,991 0.72% Fixed Bridges 633 0.63% $168,549 2.26% Implants 596 0.59% $272,868 3.66% Inlays/Onlays 33 0.03% $12,902 0.17% Oral Surgery 239 0.24% $41,074 0.55% Other Prosthodontics 242 0.24% $24,583 0.33% Veneers 49 0.05% $12,023 0.16% Major Services 4,732 4.68% $1,631,067 21.86% Orthodontics 138 0.14% $165 0.00% Orthodontic Services 138 0.14% $165 0.00% Grand Total 101,039 $7,462,113
Relationship - Spouse Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 10,698 27.34% $703,581 25.08% Fluoride Treatments 350 0.89% $0 0.00% General Services 606 1.55% $25,633 0.91% Oral Evaluations 10,769 27.52% $432,360 15.41% Other Diagnostic 5 0.01% $0 0.00% Other Preventive 12 0.03% $0 0.00% Radiographs 8,333 21.29% $340,881 12.15% Sealants 11 0.03% $0 0.00% Preventive Services 30,784 78.67% $1,502,455 53.56% Amalgam & Composite Fillings 3,649 9.32% $292,434 10.42% Endodontics 363 0.93% $164,819 5.88% Extractions - Simple 517 1.32% $29,213 1.04% Extractions - Surgical 412 1.05% $55,789 1.99% Other Basic Services 781 2.00% $52,440 1.87% Periodontics - Non-Surgical 638 1.63% $67,438 2.40% Periodontics - Surgical 98 0.25% $29,780 1.06% Basic Services 6,458 16.50% $691,914 24.66% Crowns 1,044 2.67% $379,923 13.54% Dentures - Complete 42 0.11% $16,931 0.60% Dentures - Partial 44 0.11% $18,522 0.66% Fixed Bridges 226 0.58% $54,806 1.95% Implants 247 0.63% $108,766 3.88% Inlays/Onlays 15 0.04% $6,226 0.22% Oral Surgery 98 0.25% $14,811 0.53% Other Prosthodontics 125 0.32% $9,107 0.32% Veneers 12 0.03% $1,854 0.07% Major Services 1,853 4.74% $610,946 21.78% Orthodontics 38 0.10% $0 0.00% Orthodontic Services 38 0.10% $0 0.00% Grand Total 39,133 $2,805,315
Relationship - Children Type of DentalService Number of Services % Benefit Amount(s) % Dental Prophylaxis 12,837 23.69% $778,963 26.06% Fluoride Treatments 8,059 14.87% $247,831 8.29% General Services 922 1.70% $82,736 2.77% Oral Evaluations 13,696 25.27% $608,068 20.34% Other Diagnostic 4 0.01% $0 0.00% Other Preventive 7 0.01% $0 0.00% Radiographs 9,289 17.14% $396,650 13.27% Sealants 2,872 5.30% $119,079 3.98% Space Maintainers 28 0.05% $6,120 0.20% Preventive Services 47,714 88.05% $2,239,447 74.92% Amalgam & Composite Fillings 3,656 6.75% $307,134 10.27% Endodontics 234 0.43% $58,535 1.96% Extractions - Simple 707 1.30% $41,568 1.39% Extractions - Surgical 1,192 2.20% $247,610 8.28% Other Basic Services 275 0.51% $22,327 0.75% Periodontics - Non-Surgical 85 0.16% $8,556 0.29% Periodontics - Surgical 24 0.04% $6,979 0.23% Basic Services 6,173 11.39% $692,709 23.17% Crowns 92 0.17% $32,390 1.08% Fixed Bridges 6 0.01% $2,450 0.08% Implants 34 0.06% $16,095 0.54% Inlays/Onlays 2 0.00% $772 0.03% Oral Surgery 25 0.05% $4,457 0.15% Other Prosthodontics 2 0.00% $100 0.00% Veneers 5 0.01% $359 0.01% Major Services 166 0.31% $56,623 1.89% Orthodontics 137 0.25% $442 0.01% Orthodontic Services 137 0.25% $442 0.01% Grand Total 54,190 $2,989,221
Relationship Age Range Diagnostic & Preventive Number of Services By Age Basic Services Major Services Ortho Services Total Services % of Total Employee 24 & Under 811 356 20 4 1,191 1.2% 25 to 34 11,453 2,968 310 30 14,761 14.6% 35 to 44 12,133 2,651 453 29 15,266 15.1% 45 to 54 14,952 2,854 772 28 18,606 18.4% 55 to 64 18,685 3,391 1,288 26 23,390 23.1% 65 & Over 21,628 4,287 1,889 21 27,825 27.5% Totals: 79,662 16,507 4,732 138 101,039 Spouse 24 & Under 76 15 0 0 91 0.2% 25 to 34 3,505 998 67 6 4,576 11.7% 35 to 44 4,928 1,080 214 7 6,229 15.9% 45 to 54 5,587 1,171 323 6 7,087 18.1% 55 to 64 8,147 1,561 537 9 10,254 26.2% 65 & Over 8,541 1,633 712 10 10,896 27.8% Totals: 30,784 6,458 1,853 38 39,133 Children 0 to 5 5,174 332 1 0 5,507 10.2% 6 to 12 19,441 1,638 7 40 21,126 39.0% 13 to 18 13,974 1,921 40 83 16,018 29.6% 19 to 23 6,971 1,691 81 11 8,754 16.2% 24 & Over 2,154 591 37 3 2,785 5.1% Totals: 47,714 6,173 166 137 54,190 GRAND TOTAL 158,160 29,138 6,751 313 194,362 Aggregate Totals All Children 47,714 6,173 166 137 54,190 27.9% 24 & Under 887 371 20 4 1,282 0.7% 25 to 34 14,958 3,966 377 36 19,337 9.9% 35 to 44 17,061 3,731 667 36 21,495 11.1% 45 to 54 20,539 4,025 1,095 34 25,693 13.2% 55 to 64 26,832 4,952 1,825 35 33,644 17.3% 65 & Over 30,169 5,920 2,601 31 38,721 19.9% Totals: 158,160 29,138 6,751 313 194,362
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 $95,396 1.3% 25 to 34 $584,909 $329,416 $114,664 $80 $1,029,068 13.8% 35 to 44 $622,880 $301,419 $161,729 $85 $1,086,114 14.6% 45 to 54 $756,574 $329,006 $277,323 $0 $1,362,903 18.3% 55 to 64 $942,709 $369,798 $467,339 $0 $1,779,845 23.9% 65 & Over $1,048,549 $457,850 $602,388 $0 $2,108,788 28.3% Totals: $3,998,144 $1,832,737 $1,631,067 $165 $7,462,113 Spouse 24 & Under $4,130 $1,731 $0 $0 $5,861 0.2% 25 to 34 $177,843 $111,130 $23,901 $0 $312,874 11.2% 35 to 44 $248,319 $123,815 $76,620 $0 $448,754 16.0% 45 to 54 $270,625 $126,495 $119,488 $0 $516,609 18.4% 55 to 64 $389,433 $157,128 $175,434 $0 $721,995 25.7% 65 & Over $412,104 $171,614 $215,503 $0 $799,221 28.5% Totals: $1,502,455 $691,914 $610,946 $0 $2,805,315 Children 0 to 5 $234,726 $27,774 $130 $0 $262,631 8.8% 6 to 12 $846,877 $133,178 $1,240 $0 $981,295 32.8% 13 to 18 $675,993 $240,153 $12,120 $442 $928,707 31.1% 19 to 23 $369,754 $225,175 $29,276 $0 $624,204 20.9% 24 & Over $112,097 $66,429 $13,857 $0 $192,383 6.4% 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 $2,989,221 22.5% 24 & Under $46,654 $46,980 $7,624 $0 $101,257 0.8% 25 to 34 $762,752 $440,546 $138,565 $80 $1,341,943 10.1% 35 to 44 $871,199 $425,234 $238,349 $85 $1,534,867 11.6% 45 to 54 $1,027,199 $455,501 $396,811 $0 $1,879,511 14.2% 55 to 64 $1,332,142 $526,926 $642,773 $0 $2,501,841 18.9% 65 & Over $1,460,654 $629,464 $817,891 $0 $2,908,009 21.9% Totals: $7,740,046 $3,217,360 $2,298,636 $607 $13,256,649
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 $51.96 2013-February $1,181,960 $0 $1,181,960 22,333 $52.92 2013-March $1,046,368 $0 $1,046,368 22,418 $46.68 2013-April $1,061,982 $80 $1,062,062 22,351 $47.52 2013-May $1,421,731 $82 $1,421,813 22,426 $63.40 2013-June $1,029,734 $0 $1,029,734 22,094 $46.61 2013-July $969,770 $105 $969,875 22,348 $43.40 2013-August $1,314,602 $63 $1,314,665 22,347 $58.83 2013-September $915,296 $190 $915,486 22,398 $40.87 2013-October $1,151,662 $0 $1,151,662 22,403 $51.41 2013-November $947,619 $87 $947,706 22,389 $42.33 2013-December $1,051,861 $0 $1,051,861 22,399 $46.96 Total $13,256,042 $607 $13,256,649 268,296 $49.41
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 43,983 1.96 2013-Feb 22,333 10,918 11,415 8,879 12,617 43,829 1.96 2013-Mar 22,418 10,956 11,462 8,908 12,693 44,019 1.96 2013-Apr 22,351 10,942 11,409 8,873 12,641 43,865 1.96 2013-May 22,426 10,978 11,448 8,896 12,692 44,014 1.96 2013-Jun 22,094 10,772 11,322 8,804 12,506 43,404 1.96 2013-Jul 22,348 10,938 11,410 8,888 12,601 43,837 1.96 2013-Aug 22,347 10,919 11,428 8,895 12,589 43,831 1.96 2013-Sep 22,398 10,971 11,427 8,898 12,577 43,873 1.96 2013-Oct 22,403 10,973 11,430 8,894 12,539 43,836 1.96 2013-Nov 22,389 10,962 11,427 8,890 12,535 43,814 1.96 2013-Dec 22,399 10,961 11,438 8,905 12,563 43,867 1.96 Average per Month 22,358 10,934 11,424 8,887 12,602 43,848 1.96