2004
Ontario Dental Association (ODA) Fee Guide
Selectpath
is now using the 2004 Ontario Dental Association (ODA) Fee
Guide to assess dental claims for plan members in Ontario.
This change applies to group plans that automatically adopt
the most current fee guide each year. The 2004 ODA dental
fee guide represents an increase of 4.09% over 2003 dental
claims.
A New
System
In June
2000, the Ontario Dental Association announced that significant
changes to the fee guide would be phased in over three to
five years, beginning in January 2002. the ODA expected that
the cumulative increase would be about 15%. The most noteworthy
of these changes include:
-
change in the methodology used to develop suggested fees.
This method includes both the cost of providing care and
consumer demand.
-
Elimination of the recall package codes. This means that
the fees for each procedure are set individually.
-
A change in the annual revisions to the fee guide. These
revisions now adjust fees for each individual service, instead
of adjusting bundles of services.
Impact
The table
below shows the weighted average percentage increase by category
over the last three years. Although some dental categories
have increased slightly more than 15%, overall the weighted
average is 10.85%, which is in line with expectations of the
ODA.
Selectpath
has worked closely with the Canadian Life and Health Insurance
Association (CLHIA) to monitor these changes and track their
impact on dental plans. We continue to actively participate
in monitoring the ODA changes so our clinets’ needs
are represented.
Procedure
Codes |
Dental
Category |
2002 |
2003 |
2004 |
Cumulative
Effect |
00000
– 09999 |
Diagnostic |
-1.01% |
4.92% |
5.98% |
10.07% |
10000
– 19999 |
Preventative |
15.69% |
1.12% |
0.41% |
17.47% |
20000
– 23999 |
Minor
Restorative |
2.78% |
4.99% |
8.00% |
16.54% |
24000
– 29999 |
Major
Restorative |
2.27% |
-1.90% |
0.30% |
0.63% |
30000
– 39999 |
Endodontics |
1.42% |
4.09% |
2.30% |
8.00% |
40000
– 49999 |
Periodontics |
-4.65% |
4.68% |
3.87% |
3.68% |
50000
– 59999 |
Prosthodontics
(Removable) |
2.50% |
3.06% |
4.08% |
9.95% |
60000
– 69999 |
Prosthodontics
(Fixed) |
0.37% |
3.89% |
7.57% |
12.17% |
70000
– 79999 |
Oral
Surgery |
3.02% |
5.05% |
7.20% |
16.01% |
90000
– 99999 |
Adjunctive
Services |
2.50% |
3.06% |
3.74% |
9.59% |
Overall
Weighted Average Increase |
- |
2.40% |
4.00% |
4.09% |
10.85% |
For
More Information
If you
have any questions, please contact your group insurance representative.
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