In recent months, the CDA has been working hard to address some practices by dental plans that do not serve the best interest of patients. Several dental or dental-related regulations have been up for review through state Division of Insurance (DOI) processes. Since September, the CDA has given input on seven sets of DOI regulations. In its comments, the CDA has encouraged DOI to:
- Establish a separate pediatric dental deductible within embedded dental plans, especially plans offered through the state healthcare exchange;
- Require plans to clearly disclose dental plan design, including pediatric dental deductibles and cost sharing, at the time of consumer purchase;
- Eliminate cost sharing and deductibles for preventive dental services for pediatric patients in all state regulated plans;
- Ensure plans provide reasonable geographic access to dentists and specialists;
- Ensure all tiers of network plans (from premier to PPO or DPO) have adequate numbers of providers and geographic coverage;
- Continue requiring plans, including stand-alone dental plans, to notify consumers when a plan drops a benefit or makes other substantial plan modifications;
- Require plans to clearly disclose to consumers any rate impacts related to changes in their policies; and
- Collect from plans and publish for public review usable information on what portion of insurance premiums is allocated to delivery of healthcare services (as opposed to administration).
Thus far, the CDA has been successful in improving plan disclosure in the Summary of Benefits and Coverage document provided to patients after plan purchase, but we continue to push the importance of making this information available at the time of plan purchase. We will continue to update members as additional discussions and rule changes occur.