Dental care is essential to a person’s overall health and well-being.

Californians deserve quality, meaningful dental insurance to ensure their dental needs are met. But today, dental coverage isn’t real insurance, and lacks many of the protections and oversight that come with medical insurance.
Fix Our Dental Insurance | Dental Insurance Companies: Header
Face no minimum requirements for benefits they must cover.
Commonly have annual coverage maximums that are limited to $1,500 – $2,000.
Deny claims related to patients’ pre-existing conditions, like a missing tooth or cleft palate.
Can make patients wait up to a year after buying coverage before they can fully use their benefits.
Are not held accountable to the same regulatory oversight as medical insurance in California.
Face no limits on the amount of patient premiums they can spend on overhead costs and executive compensation.
Furthermore, over 40% of Californians have dental coverage that is exempt from state-level protections and is instead regulated under less stringent federal law.

TAKE ACTION

Join us in the fight for strong requirements to hold dental insurance companies accountable.

Take Action Now!

Governor Gavin Newsom signed two bills in 2023 strengthening dental insurance requirements. Learn more about this great progress and stay tuned for what’s to come!

Passed!

AB 1048

Patient Protections & Rate Review

This legislation by Assembly Member Buffy Wicks (D-Oakland) will establish stronger patient protections and transparency in dental insurance plans by:
  • Prohibiting dental plans from denying claims related to a patient’s pre-existing dental conditions.
  • Prohibiting imposing arbitrary waiting periods in the large group market.
  • Requiring dental insurance premium rates to be reviewed by state regulators to improve value for patients and employers.
Dental plans have been allowed to impose waiting periods, often ranging from three months to one year, before patients can access certain benefits (even though they are paying premiums). These arbitrary waiting periods limit the ability for a patient to access needed care, usually major services like a root canal or a crown. Dental plans can also deny coverage for pre-existing dental conditions like a missing tooth or genetic conditions like a cleft palate.

Furthermore, dental insurance was exempted from the state’s mandated review process for insurance premium rates, which applies to medical and other types of insurance. Meanwhile, recent reports of health care spending show that out-of-pocket expenses for dental services grew by 16% in 2021, and a California Health Care Foundation survey found that 38% of Californians have a family member who skipped dental care last year due to cost. And yet, the typical annual coverage maximum for a dental plan has been $1,500-$2,000 since the 1970s (a $2,000 annual maximum in 1970 would be equivalent to $15,745 in 2023 dollars). AB 1048 will require 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 will take effect January 1, 2025.

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I just purchased a [dental plan] at $64.92 per month. I’m told that I must wait six months before they will cover a root canal procedure, which will run me out-of-pocket around $2,000, because for big procedures [the plan] requires me to wait. But I need it now, and I don’t plan on losing my tooth or having my infection get worse."
Connie
patient in Elk Grove, CA

Passed!

AB 952

ERISA Notification

This legislation by Assembly Member Jim Wood, DDS (D-Santa Rosa) will increase transparency of dental insurance by requiring appropriate notification to patients and dentists of whether a dental plan is state or federally regulated.
Dental insurance is generally regulated by state law, apart from “self-insured” employer plans which are regulated at the federal level through the Employee Retirement Income Security Act of 1974 (ERISA).

In a state regulated dental plan, an employer pays a premium to an insurance carrier, and the carrier pays the cost of health care claims for anyone in the plan (employees and their dependents). 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 would require 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 would also require that the term “state regulated” be displayed prominently on the front of the patient’s insurance information. This simple transparency measure will benefit patients and dentists without unduly burdening dental plans. The bill will take effect January 1, 2025.

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Coalition In Support

AB 1048:

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

AB 952:

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

info@fixourdentalinsurance.com

Paid for by the California Dental Association