Specifications include, but are not limited to: DPPO Assignment of Benefits Today, the State’s DPPO includes an Assignment of Benefits (AOB) provision by which non- participating dentists are allowed to receive AOB for covered services provided to a State plan participant as long as a signed attestation from the plan participant is submitted with any claims for covered services. The attestation form is the plan participant’s confirmation that they agree to forego certain rights and protections available to them when obtaining covered services from a participating dentist under the terms of the State’s group dental plan, such as the right not to be balance billed, the right to see a dentist fully credentialed by the dental insurance carrier, the right to receive covered services fully subject to the dental carrier’s quality oversight program, the right to appeal the quality of dental work provided under the dental carrier’s in-network grievance program, and the right to receive the dental carrier’s fullest protection against fraud and abuse. A copy of this attestation form can be viewed on the Statewide Benefits Office website via the following link: https://dhr.delaware.gov/benefits/dental/documents/delta-attestation-form.pdf. The State is aware that maintaining this AOB provision may encourage participating providers to drop from the dental carrier’s network and would like to explore potential future implications of retaining this provision on its contract with a dental carrier and on plan premiums. Opportunities for Enhancements Bidders are also encouraged to consider the concerns voiced by current plan participants regarding the dental plan designs, which are described within this section further below. The State is interested in exploring bidders’ capabilities to provide virtual dentistry services to plan participants, as well as any capabilities for bidders to provide dental discount plans in addition to the DPPO and DHMO offerings. The State is also interested in understanding the degree to which bidders are able to demonstrate experience with integrating dental benefits with medical coverage. Examples of this sort of integration include the existence of policies and procedures related to monitoring dental providers’ prescribing of opioid medications and offering enhanced dental benefits for plan participants with a diagnosis of certain health conditions such as cardiovascular disease, diabetes and pregnancy. Alternative DPPO Plan Designs The State is interested in exploring alternatives to offering only one plan design option for the Dental PPO to eligible employees/retirees. However, one plan option within a dual plan offering must match the State’s current DPPO plan design as closely as possible. The State is also interested in exploring another scenario in which it continues to offer only one Dental PPO plan, but various provisions of that plan are enhanced, such as an increased annual maximum or a higher level of reimbursement for implant coverage beyond what is currently offered. Bidders will be asked to quote on these DPPO plan enhancements, which are further described in the Questionnaire section of this RFP. Once it has been determined that a bidder has met the Minimum Requirements and has been selected as a finalist, alternative DPPO plan designs and/or enhanced DPPO provisions will be evaluated. The SEBC may choose not to award an alternate plan design for the DPPO plan.
