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New California law requires transparency in dental benefits

October 04, 2018

By Jennifer Garvin

Sacramento — A new California law will require dental insurers to create a standardized benefits form to help patients better understand their benefits.

SB 1008, The Dental Plan Transparency Act, was signed into law Sept. 29 by California Gov. Jerry Brown and calls for dental plans to establish the same transparency standards as medical plans. The bill, which goes into effect in 2021, was introduced by State Sen. Nancy Skinner and cosponsored by the California Dental Association.

"Healthy teeth are a key part of overall health," said Sen. Skinner, who represents the state's 9th district, in a statement. "My bill fills a gap in consumer protection by holding dental insurance policies to a similar standard of disclosure as health insurance policies."

"Signing this bill into law is an unqualified victory for dental plan patients in California. Patients deserve to have clear, understandable information about their dental plans," said Dr. Natasha Lee, CDA president, in a press release thanking Gov. Brown and Sen. Skinner. "As providers, we all too often see patients in our offices struggle to understand what procedures are and are not covered. We aim to stop that and ensure patients get the care they need."

The new standardized benefits form will include the following:

  • Annual plan deductible.
  • Annual benefit limit.
  • Coverage for the following categories: preventive and diagnostic services, basic services, major services and orthodontia services.
  • Dental plan reimbursement levels and estimated enrollee cost share for services
  • Waiting periods.
  • Examples to illustrate coverage and estimated enrollee costs of commonly used benefits.

The law also requires the California Department of Managed Health Care and the Department of Insurance to work with stakeholders to develop the form. Currently carriers are required to file a Medical Loss Ratio report with the state indicating the percentage of premium revenue spent on dental care. Under the new law, transparency is enhanced as the MLR information submitted by the carriers now must be posted on select state websites within 45 days after receiving all reports.

Read the entire bill here.

The ADA continues to advocate for dentists by helping states pass legislation that is favorable to dentists and patients. For more information, visit