Filed Under:Health Insurance, Individual Health

California exchange frees plans from dental mandate

First-grader Hunter Gibson gets a dental checkup. (AP photo/Charlie Riedel)
First-grader Hunter Gibson gets a dental checkup. (AP photo/Charlie Riedel)

The California Health Benefit Exchange -- the agency trying to get the Covered California health insurance exchange system open by Oct. 1, 2013 -- has persuaded California Department of Insurance regulators to ease up on an exchange plan benefits mandate proposal.

The exchange got insurance regulators to change draft emergency essential health benefit (EHB) regulations, to eliminate a provision requiring the "qualified health plans" (QHPs) sold through the exchanges to offer pediatric dental benefits.

The California Office of Administrative Law approved a revised version of the regulations earlier this month.

In the revised version, regulators let QHPs leave out pediatric dental benefits as long as insurers are selling stand-alone dental plans through the exchange. 

Peter Lee, the exchange program executive director, wrote about the problem in a letter posted the board posted in a packet for a regular board meeting that's set to start at 1 p.m. EDT today.

California is setting up its own state-based Patient Protection and Affordable Care Act (PPACA) exchange program.

PPACA requires all QHPs to cover basic EHB package that includes pediatric dental benefits. Officials at the U.S. Department of Health and Human Services (HHS) have ruled that a QHP need not offer pediatric dental benefits if the exchange offers stand-alone dental plans, Lee said in the letter.

Lee told insurance regulators that actually requiring a QHP to provide pediatric dental benefits would conflict with PPACA requirements.

"Our federal colleagues have confirmed that Covered California must permit offering QHPs without pediatric dental in multiple conversations," Lee said. "They were reluctant to provide written guidance on this point because they believed the text of the statute and regulations are so clear."

Because the Covered California QHP solicitation process did not require QHPs to include pediatric dental benefits, none of the QHPs selected for the individual exchange program do so, and implementing the requirement in the original version of the emergency regulations "would cause a delay of Covered California's health plan solicitation process, possibly by several months," Lee said. 

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Nichole Morford

Nichole Morford
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