Covered California embedded children's dental plans released

The 2017 open enrollment period for Covered California, California’s health insurance marketplace for the federal Affordable Care Act, continues through Jan. 31.

Adults and children can enroll in Covered California’s family dental plans as an optional benefit. These plans were offered for the first time in 2016, largely in response to the high volume of requests from Covered California enrollees after the marketplace launched in 2013. There is no tax penalty for consumers who choose not to enroll in the family dental plan. CDA advocated to ensure that patients throughout the state had options in the types of plans offered. Depending on the location of the purchaser, there are two product types available for purchase: a dental preferred provider option and a dental health maintenance organization.

CDA reported in September on the partial list of participating dental plans for 2017. As of that time, the 2017 embedded children’s dental plans had not been determined. (These embedded plans are not standalone family dental plans; rather, they are included automatically in the Covered California health plans.) The complete list of providers, along with the 2017 embedded children’s dental plans, has now been released, as detailed below.

2017 embedded children’s dental coverage

The Covered California health plan selected by the enrollee determines which company provides dental benefits to the enrollee’s child.


The embedded plans provide 100-percent coverage of X-rays, exams, cleanings, sealants and other preventive and diagnostic services, which are not subject to the medical deductible. The cost of fillings, root canals and crowns are shared by the consumer and the dental plan and the total out-of-pocket costs for children’s dental care can accumulate toward the health plan’s out-of-pocket maximum ($10,800 for the standard Silver plan in 2017).

Since CDA last reported, the Dental Health Services DHMO was added as a family dental plan provider for individuals and families and as a provider for small businesses:

2017 dental coverage available for individuals and families

Access Dental Plan DHMO
Anthem Blue Cross DPPO
California Dental Network DHMO
Delta Dental of California DHMO and DPPO
Dental Health Services DHMO
Liberty Dental Plan DHMO
Premier Access DPPO

2017 dental coverage available for small businesses
Access Dental Plan DHMO
California Dental Network DHMO
Delta Dental of California DHMO and DPPO
Dental Health Services DHMO
Liberty Dental Plan DHMO
Premier Access DPPO

The dental plan options for small businesses are available for year-round enrollment. For 2017 coverage, businesses are eligible to purchase small group plans if the business meets the following criteria:

  • Has at least one but no more than 100 full-time equivalent employees and meets certain contribution and participation requirements.
  • At least one employee receives a W-2.
  • The majority of eligible employees live in California.

Dentists operating as sole proprietors, with no W-2-receiving employees, may be eligible to purchase coverage through Covered California’s individual marketplace.

Next steps for dentists

Verify participation status: Although dental plans participating in Covered California have not established separate dental provider networks for the Covered California products they offer to date, dentists may want to verify participation status with the dental plans in their area and confirm the reimbursement fee schedule for treating Covered California enrollees. Dentists should also advise patients when scheduling whether they participate as a contracted provider with the patient’s plan.

Avoid unwelcome surprises: Dental practices should prepare for patients’ appointments by obtaining updated dental information at the time of scheduling and verifying the patient’s eligibility and benefits.

New deductibles and copayments: Many plans’ calendar year deductibles and visit frequency limitations were reset. Additionally, some patient plans may have new copayment amounts. Both of these points reinforce the importance of checking patient eligibility and benefits before the patient arrives for his or her visit.

For more information about embedded and family dental plans and dental coverage for small businesses available through Covered California, visit coveredca.com. Also, CDA member dentists can contact TDIC Sales at 800.733.0633, option 1, for assistance with small business health and dental plan purchasing.

Related Items

Under the provisions of the American Recovery and Reinvestment Act, participating Denti-Cal providers may receive up to $63,750 in incentive payments for implementing an electronic health record system and eventually achieving “meaningful use.” The program will close to new registrants on Dec. 31, and any dentist who has not started in the incentive program will lose the opportunity to claim those dollars.

Recent contractual amendments made by Delta Dental of Michigan, Ohio and Indiana effective Jan. 1, 2017, state that dentists who chose to opt out of Medicare Part D in these three states will no longer be eligible to remain Delta Dental network providers. Delta Dental of California verified that it is not adopting the same policy.

California making strides in dental care measurement
By Ann Milar, CDA Sr. policy analyst
As the dental insurance marketplace continues to increase focus on improved quality of care, accountability and value, California’s Health Benefit Exchange (Covered California) has taken the first steps in further ensuring Californians receive quality dental care. Specifically, it has announced that it will require all dental plans offering coverage through the Exchange to adopt the Dental Quality Alliance’s (DQA) Pediatric Quality Measures Set.