California Department of Insurance Proposes Regulation to Increase Transparency of Dental Benefits Coverage

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By: Jennifer Wilczynski

On January 19, 2021, the California Department of Insurance (DOI) filed a request for adoption of emergency regulations regarding the Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) with the Office of Administrative Law (OAL). Prior to filing with OAL, DOI released a Notice of Proposed Emergency Action on January 8, 2021. The purpose of the matrix is to provide a visual comparison of different dental coverage options.

According to Insurance Code section 10603.04(f), the adoption of a regulation is an emergency if the legislature determines that it is necessary for the preservation of public health and safety. The notice proposes to adopt emergency regulations that will establish requirements for the SDBC. Insurers will have to comply with the new form, content, and delivery requirements. Additionally, insurers will have to complete the SDBC for each dental policy that they offer. These regulations effectively ensure that consumers will have all necessary documents that describe coverage of dental benefits in a uniform manner, thus providing consumers with a better understanding of different coverage options.

The emergency regulation applies to insurers that issue, sell, renew, or offer a health insurance policy that also provides dental coverage. For individual coverage, the insurer must provide a SDBC for prospective individual enrollment or for individual applications for dental coverage within seven business days following receipt of the application for coverage. For group contracts, the insurer must provide a SDBC for each policy that provides coverage for dental benefits it offers in the group market. For insured individuals or prospective insured individuals qualifying for coverage under a special enrollment period, the insurer must provide a SDBC to the individual at the same time it provides other disclosure information. When requested by an insured, regardless of individual or group coverage, the insurer must provide the applicable SDBC within seven business days of the request.

The regulations seek to benefit California consumers by disseminating information about dental health benefit coverage in a clear and transparent format. The Matrices will provide detailed information on dental benefits in a visual format that will make it easier for consumers to compare different health plans. The regulations will not result in costs incurred by or have a fiscal impact on any local, state, or federally funded agency.

Copies of the SDBC can also be found on the Department of Insurance website, www.insurance.ca.gov, search “SB1008 Dental Matrix.” The Department will hold a public hearing and 45-day comment period at a later date after it has published notice to make these regulations permanent. At this writing, the rulemaking is currently under review by OAL.

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