Delta Dental selected by Covered California to offer children's dental coverage

June 26, 2013

Affordable dental options extend access to large dentist networks

San Francisco/Sacramento — Delta Dental of California announced today its selection by Covered California™ as one of six companies that will make affordable dental coverage available to California children up to 19 years old in the state's health exchange.

Among the statewide options Delta Dental will offer are PPO and dental HMO (DHMO) plans, some offered as a stand-alone policy and others in combination with several of the health insurers selected two weeks ago by Covered California.

"We're pleased by this unique opportunity to do precisely what our nonprofit corporate mission dictates, which is to make affordable dental services available to more Californians," said Gary D. Radine, Delta Dental's president and chief executive officer. "We are grateful to be one of the state's partners working to innovate a new kind of dental program never before offered, to fulfill the oral health needs of children."

Covered California announced that a total of nine stand-alone dental plans will be offered by six issuers. The new coverage will look somewhat like typical small group dental insurance sold today, with a few notable exceptions:

  • No annual benefit maximums: Although most DHMOs do not have annual maximums, virtually all PPO dental plans have maximums in the $1,000 to $2,000 range. Under federal regulation, however, all essential pediatric dental plans are prohibited from such restrictions.
  • Out-of-pocket maximums: A completely new feature for dental plans sold through the exchange is an annual out-of-pocket limit of $1,000. Where a typical dental PPO plan would stop offering coverage once the benefit maximum was reached, these plans in contrast will pay 100% coverage after an enrollee meets the out-of-pocket maximum, thereby protecting enrollees from catastrophic dental costs.
  • Medically necessary orthodontia: Typical dental insurance today provides 50% coverage for orthodontics up to a lifetime maximum of $1,500. While cosmetic orthodontia is not included as an essential pediatric dental benefit, the Covered California standard dental plan provides coverage for medically necessary orthodontics, which refers to orthodontic treatment needed to ensure normal chewing and speaking, as well as to treat cleft palate and severe malocclusion (the misalignment of teeth between upper and lower teeth). Combined with the new out-of-pocket maximum, this new benefit means children whose typical insurance might only cover $1,500 of a $6,000 to $10,000 medically necessary orthodontia bill will never face out-of-pocket charges of more than $1,000 per year, with the rest fully covered.
  • Separate lower deductibles and out-of-pocket maximums: With cost sharing that is entirely separate from the cost sharing in a medical policy, the standard Covered California dental plan guarantees robust children's coverage that always pays a substantial portion of covered dental services once a modest deductible of $50 to $60 is satisfied. Outside the exchange, these lower cost sharing limits will be advantageous compared with some individual and small group pediatric dental products where the pediatric dental services will be subject to a combined $2,000 individual medical-dental deductible and up to $6,400 in out-of-pocket expenses.

"Covered California did California consumers a real favor by carefully considering federal guidance on separate cost sharing for essential pediatric dental benefits," said Radine. "This is a very innovative approach that allows Delta Dental and the other selected issuers to work within the framework of the Affordable Care Act to ensure that real benefits get delivered addressing the real oral health needs of children."

Delta Dental additionally plans to offer small group products outside Covered California in 2014 that complement the newly required pediatric dental coverage soon to be sold with small group health policies. These products will ensure adults and adult-aged dependents between the ages of 19 age 26 can also enjoy robust dental coverage.

Delta Dental of California, along with Delta Dental of Pennsylvania, Delta Dental Insurance Company and Delta Dental of New York, are part of a group of companies under common management that provide dental benefits to 26 million people. All are part of the Delta Dental Plans Association, whose member companies collectively cover more than 59.5 million people nationwide.

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