Dental & Vision Plans Covered California
individuals & Families
Employer Groups
Introduction To Dental Insurance
Dental & Vision covers things like Root Canals, crowns, Dentures, Braces, routine cleaning, “deep cleaning” eye exams & glasses.
Adult Dental & Vision for adults, 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
- Delta Dental and Dental for Everyone
- Covered CA – Ask us [email protected] or log into your account and click on Select Dental Plan in right hand side under Actions
- Dental Dictionaries
- Op Ed Glasses are still too damn expensive LA Times 1.11.2022
Try turning your phone sideways to see the graphs & pdf's?
Dental For #Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
- One of our colleagues on how Dental for Everyone Works.
- Some of our webpages on dental
- VSP Vision
#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.
Picture of Oral Health
- Dental care reduces likelihood of hospitalization for people with diabetes or coronary artery disease Medical Press 5.6.2022
- The 2022 State of America’s Oral Health and Wellness Report Commissioned by Delta Dental Plans Association
- What drives buyers of individual Delta Dental plans?
- 77 Million Adults Do Not Have Dental Insurance
Steve on buying, shopping and best use of premium dollars
Dental Insurance VIDEO
MORE VIDEOS
- What dental Insurance... should I buy???
VIDEO the dentist attempts to give you some guidance about things to consider before buying a dental insurance plan, finance plans available, negotiating with your dentist - Sacramento Truck driver sudden dealth from tooth infection Sacramento Bee 1.31.2017
- Health Savings Accounts?
- Video - how bad sugary drinks are for you
#Covered California Dental Insurance Plans
- Go into your Covered CA account or use our Instant No Obligation Quote Engine
- Dental Options – Add the plan you want to your cart
- Click on Shop for Dental
- One can only apply for Dental with Covered CA at Open or Special Enrollment email dated 6.12.2019 2:47 PM *
- Plans outside of Covered CA – Dental for Everyone
- Delta Dental Individual & Family™ Delta Dental PPO™ Family Dental Plan
- Delta Dental Individual & Family™ DeltaCare® USA Family Dental HMO
- If you have trouble locating the brochures, email us [email protected]
#Covered CA Certified Agent
No extra charge for complementary assistance
- Appoint us as your broker
- 17 Reasons to appoint us as your agent - broker
- Set Consultation Meeting via Phone, Skype or Zoom
- Get Instant Health Quotes, Subsidy Calculation & Enroll
- Videos on how great agents are
#Delta Dental Direct
Delta Dental - Get Quotes & Enroll
Be sure to put in our AGENT # 2094784
Delta Dental – Covered CA Plans
California
- California Brochures
- Delta Dental PPO Premium Plan covers implants at 50%, after a 12-month waiting period.
- Delta Dental Individual & FamilyTM Delta Dental PPOTM Family Dental Plan 669 KB
- Delta Dental PPOTM Children’s Dental PPO for Small Businesses 790 KB
- Delta Dental PPOTM Family Dental PPO for Small Businesses 794 KB
- Delta Dental Individual & FamilyTM DeltaCare® USA Family Dental HMO 872 KB
- DeltaCare® USA Children’s Dental HMO for Small Businesses 837 KB
- Members Resource WebPage
- Broker ONLY
#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 see FAQ below for more detail.
- Resources & Links
- 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 VIDEO Changes with Health Care Reform Pediatric Dental
Pediatric Dental from Summary of Benefits
Oral Health for #Seniors
Justice in Aging - Advocates Guide
- Justice in Aging - Webinar Oral Health Coverage for Low Income Seniors
- Denti-Cal under Medi Cal
- National Institute for Dental Research - Caregiver information
- Health.Gov tips for older adults
- nia.nih.gov/taking-care-your-teeth-and-mouth
Our other pages on Dental Coverage
We don't put a lot of effort into selling dental coverage. Generally it's a wash on paying premiums vs getting back claims payments. Unless it's employer group. Then the premiums are tax deductible under IRS Section 106.
Here's more information on how we feel about dental. Here's our page on implants, where we get lots of inquires, but few sales. Most people only seem to want dental coverage, after they've been told they need a lot of dental work. Not profitable for Insurance Companies. See our other pages for details & explanations. See our page on Medical Loss Ratio. Insurance Companies need to take in $1 to pay 80c in claims.
Medicare Plans
- Blue Cross Dental & Vision
- Blue Shield Dental & Vision
- Original Medicare Dental under Medicare is very limited
Individual & Family Plans
- Blue Cross Dental
- Blue Shield Dental & Vision
- Health Net Dental & Vision
- Dental & Vision for Adults and Mandatory Pediatic as an essential benefit
Dental For Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
One of our colleagues on how Dental for Everyone Works..
Employer Group Plans
Dental - Glossary – #Dictionary
- Golden West
- Sealants Fact Sheet
- Dental Site – Dr. Dorfman DDS Excellent Site for Dental Information
- Deep Cleaning explanation & coverage
- Dental Implants
- Sacramento Truck driver sudden dealth from tooth infection Sacramento Bee 1.31.2017
Technical & Research Resources
- webb dental.com/
- TMJ society.org/
- tmj.org/
- AB 2994, TMJ mandated if medically-necessary
Dental FAQ’s
Coordination of benefits – two or more policies in force?
Is it worth it and safe to have dental coverage, during the pandemic as people are postponing routine cleaning, etc, during the pandemic?
Blue Cross has already announced lower rates and that they are paying extra to the dentists for COVID 19 extra costs to prevent transmission.
If no one goes to the dentist, under the Medical Loss Ratio rule, Insurance Companies will have to give rebates, so that they pay out 85 cents on every dollar they take in .
Anthem issues premium credits to employer groups
We continue to look for ways to provide support and financial relief to our employers and members during the COVID-19 emergency.
Shelter-in-place orders across the country have caused significant disruption to traditional patterns of care. As a response to these challenges, we are supporting our customers by issuing premium credits to our Fully Insured employer groups based on their April 2020 invoices.
The credits will appear on employers’ August 2020 invoices (issued in July 2020):
• 15% of the April premium for Anthem Small Group medical plans
• 50% of the April premium for Anthem Dental plans – Source – Broker Email 6.5.2020PPE reimbursement protects members and supports dentistsCOVID-19 requires that dentists take extra precautions to protect both themselves and their patients. These added steps can add to the cost of a dental visit.
To protect the health of our members while minimizing unexpected fees, we are paying dentists an extra reimbursement from June 15 through August 31, 2020.
Anthem will pay $10 per dental patient, per visit, on dental PPO network claims for personal protective equipment (PPE).
Supporting the dentists in our networks can help preserve employee access to providers in their plans. Broker email dates 6.22.2020
is it safe to go to the dentist?
COVID-19 spreads primarily through respiratory droplets that often make their way into your mouth, nose, or even eyes, you may be putting yourself in danger while sitting in the dentist chair (remember: dental hygienists and dentists are all up in your mouth during cleanings and procedures—and you wearing a mask is basically impossible).
questions to ask medical and dental staff when scheduling an appointment:
Do the staff and patients wear masks at all times?
Do the staff have enough masks and protective equipment?
Will there be a limit on how many people can be in a waiting room?
Are the staff being tested for COVID-19?
How often are staff cleaning the waiting rooms and offices?
If you don’t drive, can you take public transit while keeping your distance from other people and washing your hands before and afterward?Evidence of Coverage for Delta Dental PPOTimely Access to CarePPO and Premier Providers have agreed waiting times to Enrollees for appointments for care which will
never be greater than the following timeframes:
for emergency care, 24 hours a day, 7 day days a week;
for any urgent care, 72 hours for appointments consistent with the Enrollee’s individual needs;
for any non-urgent care, 36 business days; and
for any preventative services, 40 business days.
During non-business hours, the Enrollee will have access to his or her Provider’s answering machine,
answering service, cell phone or pager for guidance on what to do and whom to contact if he or she is
experiencing an Emergency Dental Condition.
If the Enrollee calls our Customer Service Center, a representative will answer their call within 10 minutes
during normal business hours.
Should the Enrollee need interpretation services when scheduling an appointment with any of our PPO or
Premier Providers, he or she may call our Customer Service Center at 800-471-0287 for assistance.
Waiting Period
Major Services
limited to enrollees who have been enrolled in the Contract for 6 consecutive months
Periodontics (other than maintenance)
Endodontics
Crowns and Casts
Prosthodontics
Oral Surgery
https://www.cda.org/Home/News-and-Information/Newsroom/Article-Details/cda-sponsored-bills-seek-more-protections-increased-oversight-of-dental-insurance
https://patch.com/connecticut/wethersfield/legislators-decide-if-dental-patients-will-be-allowed-speak
https://www.usatoday.com/story/money/2022/08/19/reasons-americans-avoid-dentist-dental-insurance/10348042002/?gnt-cfr=1
https://www.aegisdentalnetwork.com/news/2022/08/11/89-of-u-s-adults-agree-having-dental-insurance-provides-peace-of-mind-according-to-delta-dental-study
https://www.wbrc.com/2022/07/13/add-dental-care-another-area-were-seeing-costs-surge/
https://khn.org/news/article/children-vision-problems-schools-screenings-glasses/
https://insider-update-online.com/2021/03/uninsured-dental-populations/
https://www1.deltadentalins.com/brokers/resources.html
https://insider-update-online.com/2020/08/dental-health-overall-health-link/
give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare
Adding dental, hearing and vision benefits to Medicare.
Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,”
Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.
https://www.fiercehealthcare.com/payer/framework-for-3-5t-senate-package-seeks-to-close-medicaid-gap-add-new-medicare-benefits-and
I have an employer group dental plan with Walmart that only coordinates with other group plans.
I’m interested in a Individual Delta Dental PPO.
What does their co-ordination of benefits say?
We’ve answered your question on our dual coverage page – Co-ordination of benefits.
Dr Brent Matza called in this prescription for me last week because I have a tooth that was growing under another and couldn’t be removed at that time .
I have a terrible infection or abscess in my jaw where tooth is infected under the gums.
I really need to get another presc of amoxicillin to finish clearing up the swelling and infection.
I can’t lay on that side of my cheek, right side jaw bone hurts bad.
I’ll be trying to find a dentist next week.
My prescriptions go in to Walgreens on Ming Ave in bakersfield CA 93309
Thanks for the compliment, asking us complex claims problems….
However, we are not the official claims site for Health Net or any dental insurer.
Please try the number on the back of your ID card.
If you have questions like, what gets covered by Health Insurance or what gets covered by dental, we can probably look that up, if you let us know exactly what policies you have. Here’s an example EOC Evidence of Coverage
If we don’t have access to your EOC Evidence of Coverage, then you’ll need to send them to us.
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”,
Reply
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.
Next Question
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.
Our Reply
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.
Next Question
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.
What dental plan provides the most comprehensive coverage for “deep cleaning?”
Deep dental cleaning is also called periodontal scaling and root planning, or SRP. It’s similar to how a hygienist typically cleans your teeth but focuses on the outer surface of the roots and below your gum line. This special cleaning is needed when tartar buildup has caused infection of the gums. Pockets form, a widening of the gumline that has pulled away from the tooth. Loss of this connective tissue can lead to bone loss and, eventually, tooth loss. Learn More
The Difference: Deep Dental Cleaning vs Regular Cleaning
You Tube VIDEO on deep cleaning
Better VIDEO on deep cleaning
If you’re a dentist check out Spear Education.com
If you have recently sat in your dentist’s chair for a routine exam, or you plan to in the near future, you are already ahead of the 34% of Americans who skip their checkup.
Let’s set the record straight: if your dentist has suggested a deep cleaning, it is important that you get one scheduled right away. my ideal dental.com
Here’s how to avoid the need for a deep dental cleaning
You can prevent gingivitis and periodontal disease and avoid the need for a deep dental cleaning. “Probably 95 to 98% of dental disease, and periodontal disease in particular, is preventable,” Dr. Crum says.
Key to prevention is better home care. You’ve had the recommendations drilled into your head since you were a kid—brush twice a day and floss once a day. If traditional brushing and flossing aren’t cutting it for you, there are different home care tools you can try.
considerable.com
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.