State Update

California Adopts Rule to Embed Pediatric Dental Benefits in Health Plans in 2015

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In a meeting held January 23, the California Health Benefit Exchange Board voted unanimously to offer embedded pediatric dental benefits beginning in 2015.

Covered California staff told the board members that during the first three months of open enrollment, slightly more than 500,000 people enrolled in Covered California. Of those people, about 85% were subsidy-eligible. According to January 2014 enrollment data, 1.2 million Californians received coverage through Medi-Cal as a result of the Affordable Care Act. However, although approximately 30,000 children had enrolled in Covered California as of the January data, only 27% took dental coverage.

Covered California staff made the following recommendations to the board:

  • For the individual market, offer an embedded pediatric dental benefit side by side with a standalone benefit in plan year 2015, understanding that the Exchange must certify an otherwise qualified health plan without a pediatric dental benefit (“9.5”) if proposed by an issuer when a standalone pediatric dental plan is available through the Exchange. 
  • For the Small Business Health Options Program (SHOP) market, allow embedded, 9.5 and standalone pediatric dental options in plan year 2015; and 
  • For both the individual and SHOP markets, allow the Exchange to offer a supplemental adult dental benefit no later than plan year 2016. (Note: Covered California staff indicated that they would like to implement this particular recommendation in 2015.)

During the meeting, public comment was provided. An insurance agent stated, “The computer system is willfully inadequate. Once you choose a health plan, there is nothing to direct you to a dental plan for children.” A health care attorney told the board, “Consumers are already struggling trying to figure out deductibles, so embedding pediatric dental plans will make it easier to explain to consumers what they are getting when they purchase their plans.”

Please be aware that open enrollment for 2014 ended on March 31 for most Americans, although in some cases individuals may request an extension of time to enroll. To learn more about the extension, click here. The 2015 open enrollment period will run from November 15, 2014, through February 15, 2015. To purchase marketplace insurance outside open enrollment, an individual must qualify for a special enrollment period, such as marriage, divorce, birth or adoption of a child or loss of a job.