Beginning on or after January 1, 2025, under California Assembly Bill 1048 (AB 1048), dental carriers that are regulated by California’s Department of Managed Health Care and the Department of Insurance (the department) shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision in a large group plan or preexisting condition provision for any plan. By eliminating such provisions, the law would allow enrollees to access dental care sooner than they otherwise would have or receive coverage for services that were previously excluded.
In addition, beginning on or after January 1, 2025, and then at least annually thereafter, dental carriers will be required to file certain rate information with the department. Plans must file the required information at least 120 days before any change in the methodology, factors, or assumptions that would affect rates. The department may require that reporting be submitted through the National Association of Insurance Commissioners’ System for Electronic Rate and Form Filing (SERFF). If a plan fails to provide all the required information, the department may determine that a plan’s rate change is unreasonable or not justified. If a plan’s rate change for a group plan contract is determined to be unreasonable or not justified, the plan must provide notice of that determination to a group applicant or subscriber.
While similar reforms were enacted by the federal Affordable Care Act for medical insurance, dental plans have continued to deny claims related to preexisting conditions and impose waiting periods for necessary dental treatment. Dental insurance premium rates were also previously exempt from California’s mandated review process. Thus, AB 1048 addresses the fact that important protections and oversight for medical insurance were missing for dental plans. Additional proposals for future dental plan reform are anticipated.
Employer Impact
This law generally applies to California dental carriers, though employers will want to ensure coverage and reporting requirements will be followed by their carrier for any fully insured group dental plans.
Additional Resources
- California Assembly Bill 1048: Dental Benefits and Rate Review
- California AB 1048 Abbreviated Analysis, April 21, 2023
Connect with a Sequoia consultant to learn how Sequoia’s compliance services are integrated in our benefits services and tailored solutions. And if you’re already a Sequoia client, stay on top of your employer obligations with your Compliance Checklist that highlights important compliance dates, action items, and resources.
The information and materials on this blog are provided for informational purposes only and are not intended to constitute legal or tax advice. Information provided in this blog may not reflect the most current legal developments and may vary by jurisdiction. The content on this blog is for general informational purposes only and does not apply to any particular facts or circumstances. The use of this blog does not in any way establish an attorney-client relationship, nor should any such relationship be implied, and the contents do not constitute legal or tax advice. If you require legal or tax advice, please consult with a licensed attorney or tax professional in your jurisdiction. The contributing authors expressly disclaim all liability to any persons or entities with respect to any action or inaction based on the contents of this blog. © 2024 Sequoia Consulting Group. All Rights Reserved.
