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CDA backs patient protection bill

Measure proposes minimum loss ratio protection

April 07, 2014

By Kelly Soderlund, ADA News staff

Sacramento, Calif.—The California Dental Association wants patients to get what they pay for.

The state dental association is sponsoring a patient protection bill that would require a minimum percentage of consumer premiums be spent on patients' dental care instead of benefit company overhead and administration costs.

If passed, the bill would provide dental patients with the same minimum loss ratio protections that they have with their medical plans. It would require dental plans to spend a minimum percentage of premium revenues, either 80 or 85 percent, directly on patient care.

"We believe there's a lack of clarity among patients and the plan purchasers about what patients are getting for their money," said Dr. James Stephens, CDA president.

Under California state law and the federal Affordable Care Act, all medical plans must adhere to a minimum loss ratio. But the same standard doesn't exist for dental plans, leaving patients without the same assurances that their premium dollars will be used mostly toward their dental care.

"Patients and employers need to know that they're getting value out of their premium dollars dedicated to dental care," Dr. Stephens said. "This bill provides greater transparency for consumers when purchasing dental plans."

Under the bill, dental plans that fail to meet the minimum loss ratio standards would be required to provide rebates or lower premiums to dental plan purchasers as medical plans currently do.

"Our dental patients are our health care patients and they should be protected the same way as they are on the medical side," Dr. Stephens said.

CDA commissioned a report, "Dental Loss Ratio: Factors to Consider in Establishing a Minimum Loss Ratio for Dental Insurance in California," which indicates dental plans have varying loss ratios—some as high as 80.8 percent and as low as 38.1 percent. The report also states that during the first year of the mandated minimum loss ratio for medical plans, consumers were provided $1.2 billion in rebates and premium savings.

"We know on the medical side that the minimum loss ratio produced substantial consumer benefits as well as administrative efficiencies for insurance companies," said Dr. Stephens. "We're confident these same protections can be provided to all patients with dental coverage. In fact, the state's Healthy Families Program required benefit companies to adhere to minimum loss ratios for the dental coverage they offered."