LA HAP Bulletin for 11/5/18

Summary of LA HAP Dental Policies Effective in 2019

Major changes are coming for LA HAP clients in 2019 as HIP begins a partnership with the Guardian dental insurance network. Beginning on January 1st, 2019, HIP will no longer cover any premiums or cost-shares associated with standalone, individual market dental plans. Instead, clients enrolled in standalone dental plans are invited to opt into the LA HAP/Guardian Plan.

Useful documents related to the LA HAP/Guardian Dental Plan can be found here.

 

Highlights of Guardian plan:

  • $0 deductible
  • 100% coinsurance paid by HIP, billed by provider to Guardian without the client incurring office copays
  • No waiting period
  • Annual Maximum of $5,000 per client per year

The LA HAP/Guardian Dental Plan covers most Preventive, Basic, and Major services such as:

Preventive: cleaning, fluoride treatments, oral exams, sealants, x-rays

Basic: anesthesia, fillings, perio surgery, repair and maintenance of crowns, bridges and dentures, root canals, scaling and root planning, simple extractions, single crowns, surgical extractions

Major: bridges and dentures, dental implants, inlays, onlays, veneers

LA HAP clients who join this plan must stay within the Guardian network in order to avoid out-of-pocket costs.

Full plan details are available to enrolled members in the Certificate of Coverage.

 

Considerations for LA HAP clients:

  • Clients with NO dental insurance are strongly encouraged to enroll in the LA HAP/Guardian Plan.
  • Clients who are currently enrolled in a standalone, individual market dental plan will lose HIP assistance with their plan on December 31st. As such, they are strongly encouraged to enroll in the LA HAP/Guardian Plan.
    • For clients whose standalone dental plan has an attached vision benefit, their vision benefit cannot stand by itself and so it will be canceled. For those clients who still require HIP assistance with a vision plan, they are encouraged to enroll in a standalone vision plan and send an Insurance Add/Change Form to LA HAP. Vision carriers typically allow for year-round enrollment.
  • Clients with a dental plan sponsored by their group policy can choose between keeping their group dental plan or enrolling in the LA HAP/Guardian Plan, but cannot choose both. If they opt for the LA HAP/Guardian Plan, they should take steps to cancel their other coverage.
  • Clients with Medicare can choose between enrolling in a Medicare Dental Supplement or the LA HAP/Guardian Plan, but cannot choose both. If they opt for the LA HAP/Guardian Plan, they should take steps to cancel their other coverage.

Enrollment into the LA HAP/Guardian Plan is and will be ongoing. Clients can decide to opt into this plan at any point during their LA HAP eligibility period and are NOT limited to the Marketplace Open Enrollment period.

 

Enrollment:

All LA HAP clients will receive a Dental Enrollment Form in the mail in the next couple weeks which explains these changes and invites them to enroll. LA HAP has created two such forms for this initial enrollment period—one for clients currently enrolled in a standalone dental plan, and one for all other clients.

Clients may fill out the form and send to LA HAP or can call LA HAP to enroll with a Client Services Specialist over the phone.

Alternatively, case managers can download the form from our website at the link above, fill them out with your clients, and send back to LA HAP. Please check your clients’ current dental enrollment status to ensure that you are sending the correct version of the form. Once the form has been processed, you will see this change reflected in Ramsell.

Please feel free to reach out to Alicia with any questions about this Bulletin.