• Require dental insurance companies to report provider network information to the state for all dental plans they sell. Nearly half of Californians with commercial dental coverage are in plans governed by federal ERISA law, which are not included in the current network adequacy assessments conducted by the Dept. of Managed Health Care and Dept. of Insurance. As a result, the state has a very incomplete picture when assessing network adequacy.
• Require all dental plans to comply with a patient’s “assignment of benefits” (AOB) requests, so that patients can receive care from an out-of-network dentist and have the dental plan send payment directly to dental offices that choose this option. Many patients seeing an out-of-network dentist have had to pay 100% of the treatment costs upfront and wait to be reimbursed, putting an unnecessary cost burden on patients and further restricting use of their already limited dental benefits.

Patients should not be penalized for seeing an out-of-network dentist when their dental plan is not ensuring an adequate provider network. AB 1629 helps fix a significant barrier to dental care and improves the value of dental coverage.

Coalition in Support of AB 1629

• AFSCME California
• California Academy of General Dentistry
• California Association of Oral and Maxillofacial Surgeons
• California Association of Orthodontists
• California Dental Association
• California Dental Hygienists’ Association
• California Hospital Association
• California Medical Association
• Dental Hygiene Board of California

Ultimately, this trend is taking health care dollars away from patient care and reducing the value of dental coverage. SB 386 will address this starting April 1, 2026 by:

• Requiring that the default payment method must be one that does not include a fee. If a dentist would like to use VCCs as their primary payment method, they may do so, but only by affirmative consent – and they may opt out of VCCs again at any time.
• Requiring plans to notify dentists of alternative payment methods, how to select a payment method, and any fees associated with each payment method.

The bill will not apply if a contract between a plan and dentist specifically addresses payment methods.

Alternatively, in a federally regulated “self-funded” dental plan, an employer pays fees to an insurance carrier for certain administrative services, but the employer bears the cost of any employees’ health care claims. Despite the numerous California laws and regulations setting standards for insurance, dental plans that are federally regulated simply do not have to comply with California requirements.

The differences between state regulated plans and federally regulated plans can be extensive for both patients and dentists. As a result, understanding what a plan will cover and what a patient must pay out-of-pocket can be difficult and frustrating. Patients don’t know where or how to resolve conflicts with their plan and dentists lack clarity on the type of plan they are dealing with until after the billing process has been completed (when the plan has denied coverage or cited a billing exemption for services already rendered).

With over 40% of Californians enrolled in dental plans that are regulated under federal law, it is vital for patients and providers to be aware of which regulations and laws apply. While states do not have the authority to regulate these federal ERISA plans, additional transparency for patients and providers can be put into place at the state level.

AB 952 requires dental plans, at the time of determination of coverage for patient eligibility, to disclose to the provider whether the patient’s dental coverage is federally regulated and subject to federal compliance. It also requires the term “state regulated” to be displayed prominently on the front of the patient’s insurance information. The bill went into effect January 1, 2025.

California Association of Orthodontists

California Dental Association

California Dental Hygienists Association

California Society of Pediatric Dentistry

California Society of Periodontists

California State Association of Endodontists

Children Now

Union of American Physicians and Dentists

Dental plans could also deny coverage for pre-existing dental conditions like a missing tooth or genetic conditions like a cleft palate.

Furthermore, dental insurance had been exempted from the state’s mandated review process for insurance premium rates, which applies to medical and other types of insurance. AB 1048 requires greater oversight of dental insurance, authorizing the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) to review premium rates and help protect consumers from unreasonable or unjustified increases. The bill went into effect January 1, 2025.

AFSCME California

California Academy of General Dentistry

California Association of Orthodontists

California Dental Association

California Dental Hygienists Association

California Nurses Association

California Pan-Ethnic Health Network

California Primary Care Association/CaliforniaHealth+ Advocates

California School Employees Association

California Society of Pediatric Dentistry

California Society of Periodontists

California State Association of Endodontists

Children Now

Health Access California

Justice in Aging

Latino Coalition for a Healthy California

Leukemia and Lymphoma Society

Maternal and Child Health Access

National Health Law Program

SEIU California

Union of American Physicians and Dentists

Western Center on Law & Poverty

Young Invincibles