August 2025
Diana Craig, Associate Director, Benefits Compliance
Summary
Recent years have seen increased regulation of California insured dental plans. Most recently, during the 2023/2024 legislative cycle, California Governor Gavin Newsom signed AB 1048, which prohibits large group insured dental plans (100+ employees) from including a dental waiting period provision. More specifically, it precludes imposing separate benefit-specific waiting periods after an individual has satisfied a general waiting period and is covered by a plan. It does not regulate a plan’s general eligibility waiting period.
AB 1048 also prohibits insured dental plans from imposing pre-existing condition exclusions, respecting both large and small group markets. As a reminder, a pre-existing condition exclusion is a provision that excludes coverage for up to a year for a condition for which medical advice, care, or treatment was received within a certain period prior to the individual’s enrollment date. The Affordable Care Act (“ACA”) eliminated pre-existing condition exclusions for major medical plans beginning in 2014. The law applies to policies issued, amended, or renewed on or after January 1, 2025. It does not apply to self-funded plans.
During the 2023/2024 legislative cycle, Governor Newsom also signed AB 952. This law requires all insured dental plans to disclose whether an enrollee’s dental coverage is “State Regulated” via a provider portal (upon request), and must be detailed on the enrollee’s electronic or physical identification card. The law applies to policies issued, amended, or renewed on or after January 1, 2025. It was intended to eliminate confusion regarding covered services and to provide clarity around billing procedures (which can differ between fully-insured and self-funded dental plans). While insured dental plans are regulated through the Department of Insurance or the Department of Managed Health Care and subject to California Insurance Code (“CIC”) benefit mandates, self-funded dental plans are subject to limited federal regulation under the law of ERISA.
As a final reminder, for several years, California has required insurance issuers offering dental plans in California to disseminate a Summary of Dental Benefits and Coverage Disclosure Matrix (“SDBC”). The required content and format are similar to the ACA’s Summary of Benefits and Coverage requirements, which apply to major medical plans. Employer plan sponsors are then required to make the SDBC available to eligible employees as part of the open enrollment process, as well as to new hires and to special enrollees. The SDBC may be provided:
- In paper form (free of charge), delivered to the individual’s mailing address;
- Electronically by email, along with a notice that a paper copy is available free of charge; or
- Electronically, by directing the individual to the insurer’s website for a copy of the SDBC, with notice that a paper copy is available free of charge.
The requirement does not apply to self-funded plans. The law, SB 1008, was passed in 2018, followed by the publication of implementing regulations. The SDBC requirement went into effect for plan years beginning in 2022.
Employer Action Items
- Stay informed. Follow the latest state-level legislative developments related to dental plan governance and administration.
- Review and revise participant disclosures. Update employee communications so that employees understand changes in dental plan policies and contracts.
- Communicate with issuers and administrators. Communicate with dental insurance companies regarding how they will communicate these changes and whether they will be updating Dental Plan ID Cards and online patient portals accordingly.
- Ensure SDBC dissemination. Verify that dental carriers are developing SDBCs and confirm this content is being provided to eligible employees.
Additional Information and Resources
- Bill Text – SB-1008 Health insurance: dental services: reporting and disclosures
- CDA-sponsored bill signed into law, improves dental plan disclosures for dentists, patients – CDA
For more information
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