ERISA Plans

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Dental plans generally fall into two categories: self-funded and fully insured. This difference determines who oversees them.

  • Self-funded plans are typically regulated by federal law (ERISA).
  • Fully insured plans are regulated by state laws.

Understanding the distinction of plans helps explain why not all dental plans follow the same rules, even within the same state.

 

Federal Laws vs. State Laws

The Employee Retirement Income Security Act of 1974 (ERISA) regulates self-funded dental plans. Some carriers argue it allows them to ignore state insurance laws meant to protect patients. How does this impact your practice and what should you do about it?

ERISA Plans: Are State Laws Ignored (PDF)

How can ERISA reform better support patients and providers?

Understanding plan differences explains why dental coverage isn’t governed the same way—even within one state. Requiring state insurance laws to apply to both fully insured and self-funded plans would close the ERISA loophole some carriers use to bypass those rules that protect patients and providers.

Improving Dental Administration Act (PDF)

Why does ERISA need to be reformed?
  • ERISA regulates plan administrators and establishes minimum standards for the pensions plan and private industry. The ADA is not advocating to change this.
  • ERISA governs how employers provide benefit plans to employees to protect the interests of workers. The ADA wants to protect these workers too by ensuring that patient protection provisions within dental insurance laws passed in each state are enforced on carriers, whether they are acting as plan administrators or as insurance companies.
  • Since the enactment of ERISA five decades ago, there has been a major shift in insurance plan categories in the U.S. We’ve seen a dramatic increase in “self-funded” plans over “fully insured” plans. The effect of this shift is that carriers administering self-funded plans use their interpretation of ERISA to preempt compliance with state laws, ultimately harming the doctor patient relationship. That’s why it is critical for the ADA to act on this issue.
  • To date, we are aware of more than 360 insurance reform laws specific to dental care that have been enacted by states to protect patients and providers from abusive practices by insurers and third-party administrators. Insurers should not be permitted to choose which laws to follow and which to ignore when states have worked hard to pass them.
  • The ADA wants to ensure that the ERISA preemption is used correctly. The reform we are seeking would not impact retirement plan assets (like 401k or 403b) or pensions.
Advocacy

March 12, 2026 — Organized Dentistry Coalition (ODC) Thanks Representative Van Drew and Representative Conaway for the Introduction of the Improving Dental Administration Act (IDA). (PDF)

January 22, 2026 — ADA Comments on House Energy and Commerce Hearing, Promoting Standardized Dental Affordability and Performance Reporting, ERISA Transparency, Ending Non-Consensual Network Expansion, Claims Reforms, Freedom of Choice, Predictable Cost Barriers, and Administration Modernization. (PDF)

September 11, 2024 - Letter to the House Judiciary Committee on the ADA’s perspective on antitrust and ERISA. (PDF)

September 10, 2024 - Letter to the Committee on Education & the Workforce on the ADA's perspective of ERISA and Federal preemption. (PDF)

Amicus Brief to the U.S. Supreme Court (PDF)

State laws designed to protect patients and providers should not be preempted by ERISA. (PDF)

Thank You Letter to Senator Joe Manchin (PDF)

News

Insurance Reform Bill Upholds State Regulations

Legislation introduced to apply state dental insurance laws to self-funded plans

States should take back ability to regulate health care.

ADA files Amicus brief with Supreme Court. Federal ERISA law should not supersede states’ authority.