Dental Plans

Background
The Health Care Authority (HCA) of the State of Washington is seeking information to assist in its plan design and purchasing strategy for fully-insured dental plans and modifications to a self-insured dental plan.

This initiative aims to potentially procure dental plans for over 775,000 members associated with the Public Employees Benefits Board (PEBB) and the School Employees Benefits Board (SEBB). HCA's current member population includes approximately 320,000 PEBB actives, 335,000 SEBB actives, 118,000 PEBB retirees, and 3,000 COBRA/self-pay members.

The agency is particularly interested in insights from the dental insurer community regarding benefit structures, implementation, and operational aspects of dental plans.

Work Details
HCA is gathering information from dental insurers that possess or can obtain a Washington State Office of the Insurance Commissioner (OIC) license. Insurers are requested to provide insights on various topics including:

1. Benefit Structure: Definitions of in-network/out-of-network benefits, flexibility in applying plan maximums, incentive structures for preventive services usage, copay models without annual coverage maximums, and experience with administering benefit designs akin to standard medical insurance.
2. Clinical: Approaches to prevention and intervention in dentistry, support for enrollees with disabilities or congenital conditions, policies on early intervention treatments like silver diamine fluoride, and use of AI in clinical applications.
3. Quality Assurance: Description of quality assurance programs and experience with utilization reviews to ensure program integrity.
4. Data Management: Capabilities to disaggregate data for health disparities analysis and utilization of Dental Quality Alliance metrics.
5. Administration: Knowledge in claims processing for dental programs including electronic data transmission capabilities and handling appeals.
6. Provider Network: Description of provider networks including tiering systems, adequacy standards, telehealth services offered, and support for rural providers.
7. Financial: Outline of cost control measures and trends in utilization and unit costs by dental class.

Period of Performance
The RFI was released on January 6, 2025, with responses due by January 30, 2025. The timeline includes various stages such as vendor questions due by January 13, HCA answers posted by January 22, and potential ad-hoc conference calls scheduled between February 12-21.

Place of Performance
The contract performance will primarily occur within the State of Washington.