e-mail Print Share

ADA, AAPD urge transparency for dental benefits

October 01, 2015 Baltimore – The ADA and American Academy of Pediatric Dentistry sent a letter to the Center for Consumer Information and Insurance Oversight, urging the Center to require states to make the 2017 essential health benefit benchmark plans more transparent in regards to pediatric dental benefits.

In a joint Sept. 30 letter, ADA President Maxine Feinberg and AAPD President Robert L. Delarosa expressed the need for more details in places where the plans called for "Dental Check-ups for Children" and "Basic Dental, Children."

"With limited information on the specifics of each plan's benefit design, we can only hope that the pediatric oral health services offered by these plans are comparable to those offered in plan years 2014-2016 through either CHIP or FEDVIP supplementation," wrote Drs. Feinberg and Delarosa to CCIIO, part of the Centers for Medicare and Medicaid Services.

The Affordable Care Act requires nongrandfathered health plans in the individual and small group markets to cover essential health benefits, including pediatric oral health services, according to the Center. For plan years 2014-16, most states selected to supplement using a benefit package modeled from either a separate Children's Health Insurance Program or from a benefit package offered through the Federal Employee Dental and Vision Program.

Drs. Feinberg and Delarosa recommended that the Center include the AAPD periodicity schedule in the definition of preventive oral health services provided in a dental plan without cost-sharing implications.

The AAPD Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents recommends:

  • Clinical oral examination and adjunctive diagnostic tools;
  • Oral hygiene and dietary counseling for parents;
  • Removal of supragingival and subgingival stains or deposits as indicated;
  • Systemic fluoride supplements, if indicated;
  • Caries risk assessment;
  • Topical fluoride treatments every six months or as indicated by the individual patient's needs (ages 12 months and above);
  • Scale and clean the teeth every six months or as indicated by the individual patient's needs (ages 2 years and above);
  • Pit and fissure sealants for caries-susceptible primary and permanent molars, premolars, and anterior teeth (ages 2 and above);
  • Substance abuse counseling (e.g. smoking, smokeless tobacco) (ages 12 years and above).

The AAPD guidelines are also available in chart form.

A complete list of essential health benefit benchmark plans for each state can be found here.