Dental & Vision Plans 

Dental & Vision covers things like Root Canals, Dentures, Braces, routine cleaning, eye exams & glasses.

Adult Dental & Vision, as opposed to coverage for children  is pretty much, but not totally  excluded from Health Plans, as it’s not an essential benefit.  Specimen Policy Page 118      

Please note the maximum payouts/year are generally $1,000 or $1,500 and sometimes 6 months to one year waiting periods to get major services,  There are also rules so that insurance companies can stay financially solvent like the 80% Medical Loss Ratio, rule and underwriting to avoid adverse selection so IMHO he more important issue is:

What plans do you have to take care of your families financial issues and putting food on the table should the breadwinner pass away,  not be able to do all the duties that his work requires or fully able to take care of himself?

Get Quotes & Enroll

Quotit – Online Quotes & Enrollment

Covered CA – Ask us [email protected] or log into your account and click on Select Dental Plan in right hand side under Actions

Dental For Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

One of our colleagues on how Dental for Everyone Works..

Importance of Dental Coverage 
Dental & General Health

Insurance 101?

We suggest that you check out Life Insurance, Disability, Long Term Care and Retirement as these risks may cause much more financial devastating to your budget than dental bills.

I don't quite agree on the individual vs group rates & benefits - also group plans are income tax free - section 106

On the other hand - Sacramento Truck driver sudden dealth from tooth infection Sacramento Bee 1.31.2017

Picture of Oral Health 

Why you need Group Dental Coverage


Why Buy Dental Insurance?  

What dental Insurance... should I buy??? 

When people ask, what dental insurance plan should I buy,

I'm tempted to answer, "None of them".

But that's not a very helpful answer, so in this video I attempt to give you some guidance about things to consider before buying a dental insurance plan. Keep in mind that there also are finance plans available if you decide to go that route.  And, you should not be shy about negotiating with your dentist regarding his or her fee for the services that you need.


Pediatric Dental and Vision

Pediatric Dental and Vision are Mandatory essential benefits under Section “J” 42  USC  18022  SB 951, even if there are no children on the policy.  If there are no children, you are not getting charged.


I am a 60 yr. old mother of adult children, no minors are covered under my individual policy, so how on earth can Pediatric Dental be “mandatory”,

That’s the law. Everyone has to have it. It’s an essential benefit. You are also required to have maternity.  There is no charge for the dental though.  

It is a question of principle, not $6.89 additional monthly fee!

How come this fee is being padded after the contract was signed last year?

There is not a single thing, in my opinion, that has gone right with the roll out of Health Care Reform.

See my SNAFU page I’m doing twice or more work with less than ½ the pay. I especially resent that Covered CA (CC) advertising does not mention that one can buy from an agent. Worse, so many people think they can only buy from CC and only CC provides guaranteed issue. So, I’m certainly not making it up on volume. The policy is effective Jan 1, 2014.

No one mentioned this earlier. It was the law though. For some reason, CC policies do not currently include pediatric dental, nor do I believe it’s available! After months of repeated requests and no resolution to auto payment, now someone decides to add mandatory fee retroactively and initiate auto payment. This is not right!   It is unfair and a dishonest act. If the fee became mandatory after the policy was issued, wait till the renewal date of the policy at the end of 2014 and then add this fee.

Resources & Links

Covered CA Website -Children’s Dental Coverage

Adult – Family Dental Plans – Scroll down to see explanation on when a child should have both the mandatory coverage and additional coverage.

Blue Shield Trio HMO  EOC Evidence of Coverage 2019 Page 50 for Dental & 112 for Vision

HBEX Pediatric Policy Brief  11 pages 7.17.2013  PDF

Blue Shield Graphic on Pediatric Dental & Vision

Covered CA – Ask us [email protected] or log into your account and click on Select Dental Plan in right hand side under Actions

Delta Dental Direct 

Delta Dental – Get Quotes & Enroll

Be sure to put in our AGENT # 2094784


Welcome to Delta Dental VIDEO 

welcome to delta dental video

Technical & Research Resources

UC R Dental Schedule – $25


TMJ – Medical Necessity under Medical NOT Dental Coverage


AB 2994, TMJ mandated if medically-necessary

Glossary – Dictionary

Sealants Fact Sheet

Dental Site – Dr. Dorfman DDS  Excellent Site for Dental Information

1 800 Dentist

Sacramento Truck driver sudden dealth from tooth infection Sacramento Bee 1.31.2017

4 comments on “Dental & Vision for Adults and Mandatory Pediatic as an essential benefit

  1. We have individual family Delta Dental HMO which is due for renewal at just $250/yr total premium

    I need crown work so looking for best plan to move into that will offer the deepest discounts for crown, post, and root canal. My estimate for work is over $5,000

    • Please, when asking us to compare or advise on plans, let us know the exact plan you have, ages and how many people are covered.

      Are you talking about the DeltaCare® USA CAA54 Individual/Family Dental Program Disclosure Contract

      This plan does NOT have waiting periods and no annual maximums!

      Are you happy with the dentists on the provider list?

      How about appointing us as your agent on this plan?

      One problem with dental, is that the premiums and thus the commissions are so low, we don’t really have time to shop and compare for you.

      Thus, we suggest you use the shop & compare tools on our website like:

      Dental for Everyone Which shops maybe 50 plans and allows side by side comparisons.

      Scroll back up and visit our pages and compare benefits for Blue Cross, Blue Shield and Health Net

      It’s also difficult for us as agents, as most people that ask about dental coverage, are in need of MAJOR services and facing huge bills. That’s not really something Insurance Companies are looking to pay immediate claims for.

      Note also, that employer group plans often offer richer benefits, shorter waiting periods and higher maximums as there they are getting people that don’t need MAJOR services right away to make up or help pay for ones with immediate claims.

  2. I would like to get a vision doctor that I can see in the same zip code area 93534

    need a dentist and I need a vision and I need to see a doctor

    Editor’s note – I had to do major cleanup on this post as this person is not very well spoken and very upset about how many phone calls they’ve made and not gotten the answer they are looking for.

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