Sad news about a business colleague

Over the weekend, I was sad to learn about the passing of my business colleague, Gary Long, former president of Public Service of New Hampshire.  We spent many hours working together on the Council of Junior Achievement and the Granite United Way.  We also served together on the Board of Directors for the New Hampshire Business Committee for the Arts.  Gary’s leadership and passion for giving back to the community was more than admirable.

Gary was many things to many people including a wonderful husband to his wife, Mary, father to Martha, Thomas and Timothy, grandfather to Lily and James, a son, a brother, and the list continues.  He will forever be remembered as a leader and force at PSNH and the many organizations and people who had the pleasure of knowing or working alongside him.

My wife, Lisa, our family, and the entire Northeast Delta Dental community send our thoughts and prayers to Gary’s loved ones during this difficult time.  Please accept our deepest sympathies.

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How would you assess the first year of the Affordable Care Act’s Performance?

With several technological issues of the Health Insurance Marketplace (exchange) rollout, frustration mounted as visitors to the website for Maine and New Hampshire and the Vermont Health Connect website for Vermont were hampered from enrolling in health coverage. Eventually, most of the technological glitches were addressed and nearly eight million Americans enrolled in coverage through the exchanges. In all three states, Northeast Delta Dental offered Stand Alone Dental Benefit (SADB) Plans. More than 4,500 people enrolled in these plans and now have access to dental coverage through Northeast Delta Dental for 2014.

Let’s review our journey to date and then explore likely outcomes related to the procurement of medical and dental coverage. Open enrollment for 2014 was scheduled to begin October 15, 2013. Vermont, running its own exchange, was on schedule. The federal exchanges in Maine and New Hampshire were delayed by a month. However, when the exchanges were made available to individuals (SHOP exchanges were scheduled to be functional in the fall of 2015), there were many challenges. Vermont Health Connect had several technical glitches, and the federal exchanges for Maine and New Hampshire were not able to handle the volume of users and crashed. Even individuals that were able to enroll online were not confident that they successfully obtained health coverage.

Once the exchanges became functional, more than 40,000 individuals in Maine and New Hampshire and more than 38,000 in Vermont enrolled. Of these a vast majority received some form of subsidy through the exchanges.

Among those satisfied with their non-Affordable Care Act (ACA) compliant medical plans, there was a scramble to renew their existing plans known as ‘grandmothered plans’ in order to avoid a change in health coverage. The government recognized the need for action and sanctioned the ‘grandmother plans’ through a ‘transitional relief’ program for certain medical plans. This enabled the plans to remain ‘as is,’ many until 2016. This did not affect SADB Plans at all.

Now, confidence is high that an individual can utilize the exchanges to obtain coverage. Although some technological issues persist, such as mid-term changes in family enrollment, the new ‘normal’ is that enrollment can be confirmed in a timely manner, and the necessary information and payment will be properly transferred from the exchange to the carrier. Northeast Delta Dental has collaborated with the exchange operators to address any “blips” and we do not anticipate significant future challenges.

Anthem was the only medical carrier participating on the exchange in New Hampshire in 2014. At least four new carriers, Harvard Pilgrim, Maine Community Health Options (Maine based co-op), Assurant Health, and Minuteman Health (Massachusetts based co-op) have applied to the New Hampshire Insurance Department (NHID) for consideration to include their plans on the exchange for the 2015 enrollment period. They are waiting for approval from the NHID and Health and Human Services. Northeast Delta Dental offered the only SADB Plan for the 2014 rollout; however, other dental insurance carriers have applied and are waiting for 2015 approval.

Small Business Health Options Program (SHOP) exchange implementation is expected to be functional this fall for 2015 plans for employers with fewer than 50 full-time equivalent employees in Maine and New Hampshire. However, employees will not be able to take advantage of full ‘employee choice’ (a choice of multiple plans at the same metal level) until at least the 2016 plans. For 2015, small group employers in Vermont will continue to directly enroll with carriers for ACA “exchange certified” small group plans offered through Vermont Health Connect.

The government is now working on an automatic renewal and reenrollment plan for 2015. The proposed rule was posted on July 1, and public comments were accepted until July 28. After reviewing feedback, the government will publish a final rule and guidance. In the interim, testing of the auto-renewal technology requirements continues.

A recent ruling by a Washington, DC court cast doubt on whether or not federal exchanges can offer subsidies for health coverage. The administration is going to appeal that decision. Meanwhile, the decision has been stayed, which means at the moment the subsidies for many people in New Hampshire and Maine will stay in place.
Vermont is a state run exchange and would not be affected by the ruling because subsidies for state run exchanges are specifically mandated by the ACA.

In summary, as long as Congress and the administration resist compromise and fail to identify solutions to the unintended consequences of the ACA, barriers to a smooth, successful implementation will continue to exist, inhibiting the ACA from fully achieving its original goals of:

    • Improving the affordability of health insurance
    • Significantly decreasing the number or people who don’t have health insurance
    • Reducing the cost of health care in the United States

Northeast Delta Dental will continue to update you on the many challenges and associated solutions of the ACA.

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Northeast Delta Dental Mount Washington Road Race Re-Cap

It is hard to imagine in this beautiful summer weather, but just three weeks ago I was one of more than 1,000 runners who tackled the 7.6 mile Mt. Washington Auto Road for the 54th annual Northeast Delta Dental Mount Washington Road Race. With the harsh winds and chill of mid-30 temperatures at the nearly 6,300 foot summit, I am thankful to be back and running in sub 90 degree weather.

This year’s winners of the male and female titles were Joseph Gray and Shannon Payne, both of Colorado Springs, Colorado. Dave Dunham of Billerica, Massachusetts and Craig Fram of Plaistow, New Hampshire were inducted to the Hall of Fame for performing exceptionally well in previous Mount Washington Road Races. Dunham first ran (and won) in 1988 and won again in 1989 and 1994. His course record is one hour and 50 seconds. Fram won the race in 1997, holds many age group records, and has finished in the top ten seven times. Congratulations on your accomplishments, Dave and Craig.

As the most trusted name in group and individual dental insurance in Maine, New Hampshire, and Vermont, we are pleased that half of all proceeds from the Northeast Delta Dental Mount Washington Road Race are contributed to Coos County Family Health Services for their oral health programs. Based in nearby Berlin, New Hampshire, this community-based organization provides innovative, personalized, comprehensive health care and social services to everyone, regardless of economic status.

Thank you to the runners, hundreds of volunteers, and the Mt. Washington Auto Road staff who work tirelessly to make the Northeast Delta Dental Mount Washington Road Race a success every year. I look forward to 2015.

Watch the race re-cap video by Salmini Films here:

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Considerations for Selecting a Stand-Alone Dental Plan

Effective January 1, 2014, the Affordable Care Act (ACA) requires children to have dental coverage. (Major exceptions to this rule exist, including for those getting their health insurance through their employer.) Since pediatric dental coverage is now an “Essential Health Benefit”, stand-alone dental plans (SADPs) are a popular alternative option for individuals who want to purchase dental insurance apart from their medical insurance. That is actually the “norm” today; the National Association of Dental Plans reports that 98 percent of people in the United States with dental insurance have a SADP apart from their medical coverage.

SADPs are available on the Health Insurance Marketplace (HIM) in Maine and New Hampshire and on Vermont Health Connect (VHC) in Vermont. Thus far, 4,500 consumers in Maine, New Hampshire and Vermont have signed up for SADPs on the HIM and on VHC. SADPs are also available online directly from dental carriers and in the private marketplace. Northeast Delta Dental provides dental insurance coverage through all of these options.

On the HIM or VHC if a medical insurer is offering dental coverage, individuals can select to either purchase a combined medical/dental package from their medical insurer or purchase their medical coverage from the medical insurer and enroll separately in a SADP for their dental coverage.

There are multiple factors to consider before purchasing a combined medical and dental package. First of all, a combined medical and dental package typically applies the medical deductible to both the medical and dental claims, in which case the medical deductible must be satisfied before any dental claims are paid. Additionally, renewal prices for the combined package are based on the medical plan. And, if the plan is purchased on the HIM, the renewal price for the combined package will also include a 3.5 percent fee. Since dental insurance plans have very different loads for industry factors than medical insurance plans do, the medical rating restrictions will also be different with combined plans. Possibly the biggest difference to consider is that the 2014 medical out-of-pocket maximum, which generally is applicable to dental claims in a combined medical and dental package, is more than nine times (9x) the 2014 SADB out-of-pocket maximum, $6,350 vs $700. Once an out-of-pocket maximum is satisfied, all covered services are covered at 100%; until then, the consumer is paying some or all of the costs.

An advantage of a combined plan is a single contract bill for the medical and dental coverage. However, in addition to the points above, with a combined plan there may be fewer choices for dental providers, or there may be a requirement to switch your dentist based on the plan.

Always consult with your health insurance professional to determine which plan is best for your employees and/or family.

To enroll in a Northeast Delta Dental plan, please visit, call your insurance agent, or contact us directly at 1-800-537-1715. And as always, you can find us at

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Anthem BCBS to allow more non-ACA plans to renew

Anthem BCBS in New Hampshire has decided to allow plans coming up for renewal beginning on October 1, 2014 through the fourth quarter of this year to be renewed, even though the plans do not meet all of the Affordable Care Act’s requirements, in response to President Obama’s announcement of that option.  People are referring to this group of plans as “grandmothered plans”.

Before there were grandmothered plans, there were grandfathered plans. Let’s review what a grandfathered plan is. A grandfathered plan is a health plan that existed on March 23, 2010 when the ACA was signed into law. Grandfathered plans were exempted from some of the rules and protections of the ACA to make the transition to the healthcare reforms easier for individuals and businesses. Grandfathered plans still have to follow some ACA requirements, though, such as allowing dependent children to remain on their parents’ plans until the age of 26 and guaranteeing no lifetime dollar limits on benefits. However, many insurers decided to cancel existing plans instead of continuing to offer them.

Since several insurers elected not to offer the grandfathered plan option and many plans were being cancelled, the government recognized the need for another option, leading to President Obama’s decision to allow more plans that do not meet the ACA’s requirements to be renewed.  Many people know this as the “keep your plan” extension, but it’s also referred to as a “transitional plan” and the plans impacted are the grandmothered plans.

President Obama announced on November 14, 2013, that a business or individual could keep their current coverage for one additional year, but states would still have the authority to authorize which plans could be sold.  Later, that was extended to two years. The President said that with the renewals the insurers are required to inform their customers of two things: the ACA protections not included with these renewed plans and the new options offered on the Marketplaces that provide both better coverage and tax credits that may lower costs.

Anthem will be offering the grandmothered plan option for their plans renewing in the fourth quarter of this year. At their discretion, other insurers may also be offering this option. However, you will need to call your insurer to obtain additional information.

Stay tuned for my next blog, which will include updated information regarding Stand Alone Dental Plans (SADPs). We are excited to report there have been over one million individual plans sold nationwide, and about 4,500 sold across Maine, New Hampshire and Vermont.

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JDRF Granite Gala to benefit juvenile diabetes research

On Saturday evening I will serve as the honoree at JDRF’s signature fundraising event, the 13th annual Granite Gala at the Manchester Country Club. JDRF is the leading global organization funding type 1 diabetes (T1D) research and working toward ultimately finding a cure for diabetes.

More than 80 new cases of T1D are diagnosed in the United States every day, which results in nearly 30,000 new cases per year.  At Northeast Delta Dental, we know that oral health is a critical component of overall health. I recently learned that among those who are diabetic, there is an increased prevalence of gum disease, which could lead to other complications if the individual does not visit their dentist regularly or practice good oral hygiene daily.

At the event, inventor Dean Kamen and Founder and President of DEKA Research and Development will be honored with the 2014 Judith & Walter Havenstein Sr. Cure Champion Award for his work to advocate for the importance of science and technology. Among Kamen’s numerous inventions was the first-ever wearable infusion pump which quickly gained attention from many medical specialties including endocrinology.
Many other special guests will be in attendance on Saturday evening including Jessica Dunne, Ph.D., and Regina Shirley. The NH Symphony will entertain guests during dinner.

To learn more about the Northern New England Branch of JDRF or make a donation visit, call (603) 222-2300 or email

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The Affordable Care Act Forum for Small Business at SNHU: Another Success

The Affordable Care Act (ACA) Small Business Forum at Southern New Hampshire University on April 10, was another success.  Many small business owners attended the free forum to learn more about how the ACA could impact them and their small businesses.  Some participants attended to brush up on changes that have occurred since our August 8th forum while others were new attendees. Thank you to all of the presenters and sponsors who were instrumental in making the forum a success!

Presenters included:

  • Seth Goodall, Regional Administrator, U.S. Small Business Association
  • Roger Sevigny, Commissioner, New Hampshire Insurance Department
  • Jennifer Patterson, Esq., Life, Accident & Health Legal Counsel, New Hampshire Insurance Department
  • Tom Boucher, CEO and owner, Great NH Restaurants, Inc.
  • Nicholas Vailas, Senior Vice President for Government and Policy Affairs, Harvard Pilgrim Health Care
  • William Graham, Esq., Compass Founder, Bedford Ambulatory Surgical Center
  • Maria Proulx, Esq., Senior Legal Counsel, Anthem Blue Cross Blue Shield
  • William Enck, CPA, CPC, APA, Senior Manager, BerryDunn
  • Christine Alibrandi, Esq., Director of Health Policy, Northeast Delta Dental
  • Jodie Hittle, Vice President of Sales & Marketing, Northeast Delta Dental

Fifty (50) is an important number when adhering to the ACA.  When your company reaches 50 full-time equivalent (FTE) employees, you will encounter new requirements and benefit from new advantages when complying with the ACA.

At 50 employees, a business is considered an Applicable Large Employer (APL), and therefore must provide health coverage to all employees. If you have 50 to under 100 employees, you are responsible for the Employer Shared Responsibility (ESR), beginning in 2016.  Businesses with 51 and over FTE employees do not need to comply with Essential Health Benefits (EHB).

Businesses with fewer than 50 FTE employees are not required to offer health coverage to their employees. At 50 or fewer FTE employees, you have the option to offer health coverage to your employees through a SHOP Marketplace.

Does it sound complicated? That’s because it is! If you were not able to attend the forum on April 10, see the brochure here to help guide you through the ACA and the associated small business impacts.

At Northeast Delta Dental, we are committed to keeping you informed.
In the coming months, I will continue to update you, covering topics on how the Affordable Care Act affects you and your small business.

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