Six Pediatric Dental Firms Chosen for California Health Exchange

The Sacramento Bee by Jim Sanders –

June 25, 2013:
Six insurance firms will offer pediatric dental coverage on California’s new health-care exchange beginning in October.

Anthem Blue Cross, Blue Shield of California, Delta Dental, Health Net, Liberty Dental and Premier Access Dental were the firms selected Tuesday by Covered California, the state exchange.

Unlike comprehensive health insurance, Californians are not required under federal law to purchase pediatric dental care, which is available to serve children and teenagers up to age 19.

But Covered California Director Peter V. Lee said that providing affordable dental policies is a key part of the exchange’s mission to boost health statewide, particularly for young and vulnerable residents.

“Dental care is a vital component of overall health, and especially critical for our state’s children,” he said. “Access to dental services as a youngster means better health, both for children and as they get older.”

Only one of the six insurers, Health Net, will offer its pediatric dental care only in conjunction with its comprehensive health insurance plans. Policies from other providers can be purchased as stand-alone products.

Prices will vary within 19 California regions, but most of the insurers will compete in each region. Stand-alone premiums range from $9 to $39 per month, depending upon the provider, region, and type of plan chosen.

In Sacramento, Placer, El Dorado and Yolo counties, the lowest-priced plan will be $10 for a Blue Shield Health Maintenance Organization (HMO) plan. The highest premium will be $33 for an Anthem Preferred Provider Organization (PPO) policy.

HMO plans cover services provided by participating dentists in a network and generally require referrals to a specialist. PPO plans offer choice among participating dentists in a network and cover some out-of-network services.

In some regions of California, a third type of plan will be offered, Dental Exclusive Provider Organization (DEPO), which resembles a PPO but does not cover services by dentists outside its network.

Policies with the lowest premiums tend to require the highest out-of-pocket costs – and vice versa.

The plans encompass dental services ranging from office visits to X-rays, exams, cleanings, crowns, casts, prosthodontics, endodontics, periodontics and oral surgery. Deductibles and maximum out-of-pocket costs vary.

Policies will be offered at two tiers; one will cover roughly 85 percent of total average costs for benefits offered by the plan, the other will cover roughly 70 percent of such cumulative costs.

A breakdown of plans by region and cost is available at Covered California’s website, www.hbex.ca.gov.

Source: John & Rusty Report via Choice Admin