Exchange Board meets to discuss dental benefit

California’s Health Benefit Exchange Board, which is tasked with implementing the federal Affordable Care Act in California, held a special meeting on Aug. 8 to focus primarily on issues surrounding the implementation of the pediatric dental Essential Health Benefit.

The Exchange had two major issues for discussion. The first was if they should reverse their decision to only include stand-alone dental benefits for sale in the Exchange and allow health plans to offer health insurance products embedded with the pediatric dental benefit. The board upheld its decision to allow only stand-alone dental plans and ruled that it was too close to the date of open enrollment (Oct. 1, 2013) to allow traditional health plans to submit new bids including the pediatric dental benefit at this time.

The board did commit to offering embedded products for sale in the Exchange in 2015. CDA strongly supported the Exchange’s decision to allow stand-alone dental plans, as CDA continues to believe it provides the most choice for consumers and provides the best opportunity for consumers to maintain their relationship with their current dentist.

In testimony at the Exchange Board meeting, and in private meetings with key board members, CDA conveyed its position that it does not oppose the Exchange’s interest in offering embedded products for 2015, but believes the Exchange needs to implement it in a way that is consistent with CDA’s key principles. These include requiring separate pricing and offering of the pediatric dental benefit to ensure families can make a true apples to apples comparison with the stand-alone products, ensuring there is clear financial transparency to ensure the dental benefit being offered by health plans can be sufficiently overseen by regulators and ensuring that they maintain clear, transparent, robust provider networks to maintain access to care.

The second decision the board was tasked with was whether the pediatric dental benefit should be a required purchase for families buying coverage inside of the Exchange. CDA strongly urged the board to require its purchase and argued the board had the authority to mandate its purchase and the benefit being offered was reasonably priced. Ultimately, the board decided not to make the dental benefit a mandatory purchase. They did express their intent to devise their information technology system and their marketing materials to strongly encourage families to buy the dental benefit.

Most advocates in attendance argued that because embedded products were not going to be available to families, which they believe would be much cheaper, the stand-alone benefit was not an affordable option and the board should not require its purchase. The California Society of Pediatric Dentistry, the Center for Oral Health and First Five Sacramento were the only advocates to join CDA in urging the Board to mandate coverage. 

Paul Reggiardo, DDS, a pediatric dentist with the California Society of Pediatric Dentistry, was able to share that, ”it is well documented, children with dental insurance are more likely to receive both preventive and treatment services and have better oral health,” highlighting the need for the Exchange to ensure children get this coverage.

The Exchange has committed to a robust stakeholder process over the next few months to address outstanding issues around the offering of embedded products. CDA will be actively engaged in those discussions.

For more information, please contact CDA’s Manager of Legislative Affairs, Nicette Short.