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Oregon Dental Insurers Object to Fees on Health Insurance Exchange

Jul 29, 2013

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Oregon dental insurers agreed to an administrative fee on the sales of standalone dental plans through the state's health insurance exchange in 2014 because they thought that it would be temporary.  But a recent proposal by the state wants to make the fee permanent, and at least two dental insurance groups say making the fee permanent at the proposed rate could impact dental plan affordability.

The state plans to charge a fee of 93 cents per month, per member to fund its exchange after federal grant funding expires, even though the exchange has not opened yet. The fee is based on the idea that the average dental premium makes up 10 percent of the average medical premium. Opponents who want the fee lowered argue that dental premiums make up only 5 percent of the average medical premium.

If insurers don’t pay the fees, the state could close their plans to new enrollments or de-certify their dental plans within the exchange. Revenue from the annual fee to the state is an estimated $674,000.

Cover Oregon, the state’s health insurance exchange created as part of the Affordable Care Act, is opening October 1. Oregon will offer only standalone dental plans that cover pediatric dental essential health benefit at 85% or 70% actuarial value.

Two groups wanting lower fees for insurers participating in the exchange are Willamette Dental and the National Association of Dental Plans. They testified that charging the 93 cent monthly fee per member could impact the affordability of dental plans.

A spokeswoman for Cover Oregon said the rate was based on industry standard information and committee staff making the recommendation said their rationale was “sound.”

Enrollment in standalone dental plans is projected at 72,400, or one-third of the estimated total enrollment in Cover Oregon.


Copyright 2013 Bloom Insurance Agency, LLC©

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