07/28/2014

Covered California continues work to implement dental benefit

By Nicette Short, CDA director of Public Policy

While the Exchange has not yet released the number of pediatric dental benefit policies sold in its first open enrollment period, the agency continues to move forward with its plans for 2015.

Covered California has not yet released final data on how many pediatric dental policies were ultimately sold prior to the March 31 end of the open enrollment period, but we do know the numbers are far less than originally expected. As of the end of February, only 20,317 policies from the available standalone dental plans had been sold. The coverage could be from any of the five dental companies selling plans in the Exchange in 2014 – Anthem, Delta Dental, Liberty, Blue Shield or Premier Access.

While these Exchange plans function like other commercial insurance products, these are new policies likely sold to new patients who may not have a great deal of experience with dental coverage and may not have focused on the dental benefits included in the policy when they purchased it. It will be important for dental offices to communicate directly and clearly with the patient as well as the patient’s plan before treatment begins. For more information on the pediatric dental coverage offered by the plans through Covered California, the pediatric dental booklet can be accessed here.

Moving into 2015, medical plans as well as dental plans have submitted bids to the Exchange to participate and sell policies next year. Those bids are sealed, so we have little detailed information on them – including any dental plans that have asked to join the Exchange – but we know that the Exchange staff is actively negotiating with plans on the premium rates being offered by those hoping to sell products in the Exchange.

Furthermore, of particular interest to CDA, the Exchange Board has decided to let both standalone dental plans and medical plans offer pediatric dental benefits. While CDA has not opposed medical plans offering the pediatric dental benefit, we have maintained the need for families to have the option to buy products from standalone dental plans. Standalone dental plans will remain an option for families in 2015.  CDA was also successful in its advocacy to make sure the two state departments responsible for regulating the dental plans (Department of Managed Health Care and the Department of Insurance) maintained separate control over the dental benefits offered, even when offered by medical plans. The goal is to have those regulators hold medical plans and dental plans accountable for meeting the needs of the dental patients who purchase those dental benefits. The way the Exchange and regulators are structuring the contracts with plans, those regulatory controls should be in place for consumers in 2015.

In addition, the Exchange Board has decided that it will be offering adult dental benefits in 2015. Those policies will be sold by standalone dental plans and will be paired with the pediatric dental benefit as part of a family plan. CDA worked with the Exchange and other stakeholders to make the dental benefit clearer and easier to understand for patients. All standalone dental plans will be required to provide to policyholders a consumer-friendly Statement of Benefits and Coverage (SBC), which clearly outlines the details of the plan: what is covered, what are the limitations and exclusions, what the out of pocket costs are and how to find a network provider. A standard SBC was required for all medical plans in 2014, but dental plans were originally exempt. In 2015, that consumer protection will finally apply to dental plans offering coverage in the Exchange.

With such complex policy, we continue to expect changes as the implementation rolls out. CDA is an ongoing resource to members who have questions about the health care reform law, its implementation here in California and how it may impact dentists and dentistry. For more information, please contact CDA’s Director of Public Policy Nicette Short at nicette.short@cda.org.





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