Dental plan reform continues to lead CDA’s advocacy agenda with another successful CDA-sponsored bill that will benefit California dentists and their patients.
Signed into law this month by Gov. Gavin Newsom, Senate Bill 386 will put an end to dental plans’ predatory use of virtual credit cards when it takes effect April 1, 2026. This latest bill adds to the 10 successful pieces of legislation sponsored by CDA as part of a multi-year, multi-pronged dental plan reform strategy that also includes legal action and the Fix Our Dental Insurance campaign.
“We should be proud of these victories, but we aren’t done. Far from it” said CDA President Max Martinez, DDS. “Meaningful dental plan reform takes time, but whether it’s through the legislative or other routes, we’ll keep challenging plans’ poor business behaviors and pushing for solutions that are good for our members and our patients.”
Here is what the 11 successful CDA-sponsored dental plan reform bills to date are accomplishing for California dentists and their patients.
Dentists protected from predatory VCC practices
CDA’s most recent successful dental plan reform bill, SB 386, will finally give California dentists clear choices and real protection when dealing with virtual credit cards for contractual payments owed to them. Beginning April 1, 2026, the new law — the result of a two-year effort — will:
- Prohibit dental plans from using a virtual credit card or any payment method that includes a fee as the default method when reimbursing dentists for contracted services.
- Require plans to notify dentists of alternative payment methods, how to select a payment method and any fees associated with each payment method.
- Require plans to provide a clear and permanent way for dentists to opt in and out of VCC payments.
Learn more about how SB 386 will ensure California dentists receive the full amount they are owed for their contracted services instead of losing a portion due to excessive VCC fees. The law should also improve front-office efficiency.
Consumer protections and rate review
Signed into law in fall of 2023, AB 1048 solves some of the key disparities between dental benefit plans and medical insurance with respect to consumer protections and regulatory oversight. Beginning January 2025, this law:
- Prohibits plans from denying claims related to a patient’s preexisting dental conditions.
- Prohibits plans in the large group market from imposing waiting periods before patients can access their full benefits.
- Requires state regulatory review of the premiums charged by dental plans to help protect consumers from unreasonable or unjustified rates.
Learn more about the bill in the CDA article.
Plans must disclose whether state or federally regulated
Effective January 2024, AB 952 requires dental plans to clearly disclose at the time of coverage determination whether a patient’s plan is state or federally regulated.
This disclosure matters because an estimated 40% of Californians are enrolled in self-insured plans that are exempt from California’s laws and instead are regulated under the federal Employee Retirement Income Security Act (ERISA). Confusion about a patient’s coverage therefore often results and persists until the billing process is completed and the dental plan has denied coverage or cited a billing exemption for services already rendered.
CDA-sponsored AB 952 requires dental plans to disclose through their online patient portal or upon a dental office’s request whether the patient’s plan is state regulated. As part of this disclosure, the plan must also include the phrase “state regulated” if appropriate on the patient’s electronic or physical insurance identification card. The improved disclosure will additionally be helpful when a conflict occurs with a plan by making it easier to identify which regulatory entity to contact.
Learn how AB 952 and AB 1048 became law through CDA’s innovative advocacy campaign.
Required reimbursements for dentists’ increased PPE costs
This CDA-sponsored legislation that took effect in January 2022 requires insurance plans, including dental benefit plans, to reimburse health care providers for increased costs of PPE during future public health emergencies.
CDA spearheaded the bill when the COVID-19 pandemic shone a light on health care service plans’ ability to make record profits while paying fewer claims due to fewer patients receiving care.
During future public health emergencies, the law requires health care service plans to reimburse California-licensed dentists, physicians and other specified health care providers for critical PPE and other business expenses needed to prevent the spread of respiratory-transmitted infectious diseases.
Past CDA Government Affairs Council Chair Stephanie Sandretti, DDS, said after the bill’s signing: “Requiring insurance plans to provide timely financial assistance for PPE and other increased business expenses will help ensure that provider networks remain intact and prevent future disruptions in access to care.”
Dental benefit plan transparency during ‘network leasing’
Insufficient transparency in network leasing by dental benefit plans has long caused confusion for patients and dentists, making it difficult for providers to educate patients about treatment options and the cost of care. But under a successful CDA-sponsored bill, dental benefit plans that lease access to another plan’s network of contracted dentists are required to take specific steps, including:
- Clearly identify a contract clause allowing network leasing.
- Maintain an up-to-date website list of all third parties that have access to a provider network contract.
- Give dentists the ability to opt out of network leasing.
Learn more about AB 954, which took effect for any contracts entered into as of Jan. 1, 2020.
Uniform disclosure of dental benefits required
As of Jan. 1, 2021, standardized disclosures are required for all dental benefit plans using a uniform summary of benefits and coverage template as a result of CDA-sponsored SB 1008 signed into law in 2018. The uniform matrix is similar to the one used by medical plans and provides beneficiaries with a summary of plan details, including covered services, reimbursement levels, estimated enrollee cost share, limitations and exceptions. The law holds plans accountable to comparable standards for medical plans.
“As providers, we all too often see patients in our offices struggle to understand what procedures are and are not covered,” said past CDA President Natasha Lee, DDS, in a news release after the bill’s signing. “We aim to stop that and ensure patients get the care they need with SB 1008.”
Medical loss ratio reporting helps patients understand dental plans’ value
CDA-sponsored legislation signed into law in 2014 requires dental benefit plans to file an annual Medical Loss Ratio report to inform Californians about the value of their dental insurance plans.
A plan’s medical loss ratio indicates how much of its premium dollars are spent on patient care. AB 1962 created a standardized reporting system for dental plans to uniformly disclose how they spend premium revenue. This reporting requirement has provided consumers, CDA and policymakers with 11 years of data and insight into the dental insurance market in California.
This first-in-the-nation dental MLR reporting bill kicked off a national dialogue about dental MLR and the value of dental plans with several other states passing dental MLR legislation to increase reporting, transparency and plan accountability since that time.
Plans must notify contracted dentists of changes to coverage, fees
Dental benefit plans are required under CDA-sponsored AB 2252 signed into law in 2012 to notify contracted dentists (1) when the coverage of a plan the dentist is in network for changes, (2) when the fee schedule changes or there is a change in how treatment is reimbursed and (3) when a claim adjudication system conversion may delay claims processing and payments.
Plans prohibited from capping fees for noncovered procedures
CDA sponsored AB 2275 in 2010 because it understood that dental benefit plans were beginning to dictate fees for procedures that the policy did not cover. AB 2275, which took effect in January 2011, prohibits plans from capping fees charged for procedures that a plan doesn’t cover and never pays for. The outcome of this successful bill is that dentists are allowed to charge patients their usual fee for noncovered services, which are the fees that a dental practice would charge a patient who has no coverage. CDA members can learn more by signing in to read Is it a covered benefit? Understanding the noncovered services law.
Improved coordination of benefits
A bill sponsored by CDA that took effect in 2009 established payment responsibility for dental benefit plans that are secondary for a patient with dual coverage.
AB 895 (1) prohibits “nonduplication of benefit policies,” (2) requires dental benefit plans to declare their coordination of benefits policy prominently in their evidence of coverage documents or in its contracts or policies with both enrollees and insureds and (3) requires the primary dental benefit plan that is coordinating dental benefits with one or more other plans or insurers to pay the maximum amount required by its contract and the secondary dental benefit plan to pay the lesser of either the amount that it would have paid in the absence of any other dental benefit coverage or the insured’s total out-of-pocket cost payable as defined in the bill.
Refund demand requirements
Taking effect in 2009, CDA-sponsored legislation clarified requirements related to plans that seek to recover dental practices’ alleged overpayments. SB 1387 gives the provider 30 working days to respond to a refund demand by either paying the refund or by formally appealing the refund demand.
Visit CDA’s Dental Plan Action Center for all the news and resources related to CDA’s pursuit of dental plan reform along with resources to help members conduct business with dental plans now.