In another legislative victory for California dentists and their patients, Gov. Gavin Newsom last night signed the latest CDA-sponsored bill strengthening dental plan coverage requirements and transparency.
AB 1048 by Assemblymember Buffy Wicks (D-Oakland) passed the Legislature without any “no” votes despite opposition from the dental plan industry. The bill enacts the following provisions, which will take effect Jan. 1, 2025:
- Prohibits dental benefit plans from denying claims related to a patient’s preexisting dental conditions.
- Prohibits dental benefit plans in the large group market from imposing arbitrary waiting periods before patients can access their full benefits.
- Requires state regulatory agencies to review the premiums charged by dental plans to help protect consumers from unreasonable or unjustified rates.
“This is an important step as we pursue our goal of making dental plan coverage more meaningful,” said CDA President John Blake, DDS. “It’s very encouraging to see a bill with these substantive reforms be signed into law over the objections of the dental plan industry. We’ve had a very successful year for our dental plan reform agenda, giving us good momentum as we develop our next steps. There’s plenty more to come.”
New law will give the state greater insight into how plans are setting rates
The new law addresses the fact that dental plans lack the same protections and oversight that come with medical insurance.
While the federal Affordable Care Act enacted similar reforms for medical insurance, dental plans have continued to impose waiting periods for needed dental treatment and deny claims related to preexisting dental conditions. Common examples are a “missing tooth” clause for a tooth lost prior to starting dental coverage or dental treatment related to a genetic condition like cleft palate.
Waiting periods can range from three months to a year and limit patients’ ability to access major services like a root canal or a crown, even when it is clinically necessary. (AB 1048 originally applied to waiting periods in all dental plans; the Legislature narrowed the ban to just large group plans due to cost concerns about the individual and small group markets.)
Furthermore, dental plans had previously been exempted from the state’s mandated review process for insurance premium rates. This review process applies to many other types of insurance including medical and automobile insurance. Requiring dental plans to undergo a review of their premium rates by the respective state regulator — either the Department of Insurance or the Department of Managed Health Care — will give the state greater insight into how plans are setting rates and will hold them more accountable.
In July, Gov. Newsom signed the first CDA-sponsored dental plan reform bill this year, AB 952, which will improve the disclosures of whether a patient’s plan is state or federally regulated. Improved disclosures are particularly important given that an estimated 40% of Californians are enrolled in federally regulated plans that are not subject to state laws.
AB 952 will also go into effect on Jan. 1, 2025.
Comprehensive advocacy campaign included coalition building, targeted advertising
CDA engaged in a comprehensive campaign to promote and advocate for these bills, which included:
- Managing a digital advertising campaign, Fix Our Dental Insurance, targeting the state Legislature.
- Building a coalition composed of over 20 dental, labor, consumer, community health and ethnic organizations — the largest coalition CDA has assembled in support of a dental plan reform bill. (See all participating organizations at the bottom of the campaign homepage.)
- Advocacy by member-dentists at the state Capitol in Sacramento with 47 dentists and dental students participating in advocacy days and meeting with 40 legislative offices. In addition, more than 250 members contacted their legislators encouraging them to support the bills.
CDA received a strong, positive response from state legislators throughout the process. Dentists can go to CDA’s YouTube channel to watch a video clip from one of the State Senate’s hearings on the bill. Numerous legislators spoke effectively on the overall problems with dental plans and their lack of value, the importance of oral health, what they’re hearing from constituents about these issues and what they have directly experienced themselves.
“We saw some powerful examples of dental champions at work in the state Legislature this year as these bills were considered,” added Dr. Blake.
Successes of 2023 build on past legislative victories for dental plan reform
Dental plan reform continues to be the top priority of CDA’s advocacy agenda, and these bills follow several successful pieces of legislation sponsored by CDA in recent years. These bills include reforms to:
- Enact a standardized reporting system requiring dental plans to disclose their medical loss ratio data, indicating how they spend their premium revenue.
- Require dental plans to use a uniform matrix to disclose their benefits, similar to the one used by medical plans, providing a summary of plan details like covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions.
- Increase “network leasing” transparency when dental plans lease access to a network of contracted dentists from another plan.
- Prohibit dental plans from capping fees charged for noncovered procedures.
CDA will keep members updated on the implementation of AB 1048 and AB 952 along with future dental plan reform proposals that benefit dentists and patients.