LDA Health Plan Trust FAQ’s
The LDAHPT is a private, not-for-profit, self-funded, health benefit plan developed by the Louisiana Dental Association (LDA) exclusively to help member dentists and their staffs battle the increasing cost of providing health care benefits for themselves and their families. The LDAHPT utilizes the buying power of its association members as a combined group to provide healthcare benefits at competitive rates for qualifying members through a Multiple Employer Welfare Arrangement (MEWA).
What are the advantages of the LDAHPT?
The LDAHPT is designed to offer significant savings to most member dentists. It is unique and only available to LDA members and their staffs. Because the LDAHPT is a self-insured plan, it has many benefits, including the ability to design plan and deductible options, bring group rates to even solo practitioners, choose networks and features, and keep costs low by avoiding the state insurance premium tax and many of the ACA’s mandated taxes.
So, why is it taking so long for LDAHPT to begin offering coverage?
LDA is literally doing something that has never been done before. While there are clear requirements for starting this type of health benefit plan, there isn’t exactly a roadmap for how you get there. Having to blaze that trail, with quite a few instances of doubling back, has drawn out the process and made predicting an end date highly problematic. Even so, LDAHPT has been issued a Certificate of Authority by the Louisiana Department of Insurance, arguably the most vital component in being able to actually write policies for our health benefit plan.
But the fact that this will be a new plan also makes it harder to project claims experience, which tends to make underwriting more conservative. This has been exacerbated by the corporate buyout of a major industry partner that had history with prior LDA health benefit plans, an event NO ONE could have predicted. So, a significant part of what LDAHPT continues to work on is going the extra mile to assist actuaries in making projections that involve a higher degree of confidence in order to ensure that the underwriting on which those projections is based results in the highly affordable health benefit plan for LDA members we intend to offer.
Who is the LDA partnering with on the LDAHPT?
In addition to industry leaders such as the certified actuary and accredited reinsurer, the LDAHPT partners with:
Healthcare Highways (HCH) - Third Party Administrator
Brown & Brown Association Services Professionals – Marketing Agency
Verity – Network of Providers (with PHCS as a “wrap” network)
Health Cooperative Strategies, LLC (HCS) – Plan Supervisor
What are the liabilities of a self-insured plan?
Because the LDAHPT is a self-insured plan, the benefits are not guaranteed by a licensed insurer and are not covered by the Louisiana Life and Health Guaranty Association. To mitigate this risk, the LDAHPT purchased a stop-loss insurance policy to protect the LDAHPT assets against losses above a certain threshold. But, in the event that the multiple employer self-insured health plan (or the stop-loss insurer) is unable to pay the plan’s obligations, the LDA would have to cover the unpaid obligations. And, in the highly unlikely event the aforementioned entities collectively could not cover the plan’s liability, the employers participating in the plan would be required to contribute the funds necessary to meet any unpaid obligations.
Why offer an employer plan?
Group health plans – like the LDAHPT – qualify as a business expense for the employer. And, employees may pay with pre-tax dollars through a payroll deduction. Best of all, since group plans typically have lower premium rates than individual plans there are likely to be substantial premium savings for many members.
Who is eligible for the LDAHPT?
LDA member dentists that are business owners and their full-time staff members are eligible to apply for benefits.
Does everyone in the office have to participate in the group plan?
All eligible, full-time employees must be offered the opportunity to participate, but they may decline benefits. No employer contribution is required.
What type of health plans are available?
The LDAHPT offers 6 benefit plans with options for traditional co-pay plans or High Deductible Health Plans (HDHP) that qualify for the tax advantages of a Health Savings Account.
Is medical underwriting required?
Medical underwriting will be conducted to determine actual rates.
When can LDA members enroll?
Group enrollment is available throughout the year with effective dates generally being the first of the month following the date of application. Employees that do not choose to participate must wait until open enrollment to apply for benefits to be effective January 1. Alternatively, if you have a qualifying event, such as loss of your current insurance coverage, you may enroll within 60 days of the date of the event. [Note: the initial date on which LDAHPT will begin making coverage effective, while anticipated to be soon, cannot be established definitively just yet.]
What is a qualifying event?
A qualifying event is a life-change that makes you eligible within 60 days of the event to change your health insurance coverage outside the annual enrollment period. Life changes might include a marriage, birth, adoption, death, divorce, loss of coverage due to reduction in work hours, loss of job, relocation, or loss of student insurance or Medicaid.
Will there be a credit for the deductible that has been met?
The LDAHPT plans have calendar year deductibles. Therefore, if enrolling with an effective date other than January 1, the amount of deductible that has been met for the current year will not be credited to the new plan.
Are the LDAHPT health benefit plan rates guaranteed?
No, the rates are not guaranteed. The LDAHPT Board of Trustees (who are all LDA member dentists covered by the plan) works closely with the actuaries to monitor the plan. Though highly unlikely, the LDAHPT may adjust rates as needed during the calendar year.
Which doctors and hospitals are in the LDAHPT network of providers?
The network providers are Verity and PHCS/MultiPlan. Please check their provider directories to obtain lists of current doctors and preferred hospitals.
Verity HealthNet: http://verityhealth.com/searchquery.asp
How is the group policy billed?
The first month’s premium will be paid via check. Subsequent payments must be paid via electronic fund transfer (bank draft) is required.
Do these plans comply with the Affordable Care Act (ACA)?
Yes. The LDAHPT covers the same set of Essential Health Benefits as mandated in the ACA with the exception of pediatric dentistry.
Who is the contact for additional information?