03 Feb Covered California Dental Enrollee numbers hit 60,000
The open enrollment period for health and dental coverage offered through Covered California, California’s benefit marketplace created by the federal Affordable Care Act continues through Jan. 31. Since open enrollment began on Nov.1, more than 60,000 enrollees have selected dental coverage through Covered California’s Family Dental Plans or California Covered for Small Business. Adult dental coverage has been the most requested benefit by Covered California enrollees since the marketplace launched three years ago. For the first time, Covered California has made it available for the 2016 benefit year.
Dental practices report they are receiving patient inquiries regarding Covered California dental plan participation. Covered California dental coverage is only available to people who have purchased health coverage through Covered California.
Consumers who would like their coverage in place by Jan. 1, 2016, will need to complete their enrollment by Dec. 15. Consumers can reach Covered California at 800.300.1506 or visit coveredca.com for more information regarding enrollment options, health and dental plan availability in their area as well as utilize a shop-and-compare tool to evaluate plans and premiums.
Additionally, there are few key points dentists should know regarding the dental coverage offered through Covered California. Unlike the health plans, dental plans participating in Covered California have not established separate dental provider networks for the Covered California products they offer — dental health maintenance organization (DHMO) or dental preferred provider organization (DPPO) plans. However, dentists are encouraged to verify the reimbursement schedule for treating Covered California enrollees when verifying patient eligibility and benefits.
The following plans are offering dental coverage either through embedded dental plans for children or through the family dental plan. However, all plans are not available in all areas of the state. Dentists participating as contracted providers with these plans will be treating Covered California enrollees as in-network providers:
- Access Dental Plan DHMO
- Anthem Blue Cross DHMO or DPPO
- California Dental Network DHMO
- Delta Dental of California DPPO or DHMO
- Dental Benefit Providers DPPO or DHMO
- Dental Health Services DHMO
- Liberty Dental Plan DHMO
- Premier Access DPPO
Details Dentists Need to Know
- Preventive and diagnostic services are covered at no cost for both adults and children under the family dental plan and these services are not subject to the medical deductible for embedded children’s coverage.
- Basic and major treatment services are covered for both adults and children at shared cost.
- Comparable to other commercial coverage, some adult plans have limitations on what the plan will pay for in a year.
- Waiting periods and annual limits exist under the family dental plan. Out-of-network benefits are exceptionally limited.
- Family dental plans include an out-of-pocket maximum of $350 per child per year and $700 per family if more than one child is enrolled.
- When children have dual coverage through an embedded dental plan and a family dental plan, the embedded dental plan is primary when coordinating benefits.
Dentists may contact CDA’s public policy department at 800.232.7645 for assistance.
Covered California, California’s health insurance marketplace for the federal Affordable Care Act, is now offering family dental plans to purchase for the 2016 benefit year. The standalone family dental plans are available in addition to the children’s dental coverage included as an essential health benefit for consumers younger than 19 years old.
As more people are covered there will be more claims filed and that is where eAssist can help. We have the experts and the time to pursue verification of benefits, filing and appealing claims.