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?

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#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.

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Why you need Group Dental Coverage


Steve on buying, shopping and best use of premium dollars
Dental Insurance VIDEO

steve's video on dental coverage


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Delta Dental - Get Quotes & Enroll Affiliate Link

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Welcome to Delta Dental VIDEO

Delta Dental – Covered CA Plans 


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

Dental for everyone free quote

VSP Vision Enroll ONLINE

#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.

Pediatric Dental from Summary of Benefits  

Pediatric Dental from Summary of Benefits

California Broker - Dental Survey   2021 



Cal Broker Magazine Dental Survey

Forbes - Best Dental Insurance for Implants 2024  

Dental - Glossary – #Dictionary

Dental FAQ’s


  • Question What is Coordination of benefits – two or more policies in force?
  • Answer  Basic and general rules on Coordination of Benefits
  • .
  • Question Is it worth it and safe to have dental coverage, during the pandemic as people are postponing routine cleaning, etc, during the pandemic?
  • Answer 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
  • Question is it safe to go to the dentist?
  • Answer 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).
    • Viral transmission can happen if someone isn’t showing symptoms yet, so even if a dental office is making staff who are showing symptoms stay home, that won’t be helpful if a staffer is asymptomatic. That said, “as long as the dentist and assistants wear masks and get tested,” a dental procedure can be perfectly safe if you’re experiencing any type of dental emergency—swelling, uncontrolled bleeding, pain, trauma from an accident, or if you have a dental concern related to an underlying condition (chemotherapy, uncontrolled diabetes, etc.)—it’s important to see your dentist as soon as possible since, again, many offices are still open for emergency procedures and visits.
    • In the meantime, and again, as long as you’re not currently facing a dental emergency, remember to keep your teeth and mouth healthy by brushing your teeth and flossing twice a day (yes, even in quarantine).  Learn more 6.3.2020 Is it safe?
  • questions to ask medical and dental staff when scheduling an appointment:
  • Answer
    • 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:
      • ƒ for emergency care, 24 hours a day, 7 day days a week;
      • ƒ for any urgent care, 72 hours for appointments consistent with the Enrollee’s individual needs;
      • ƒ for any non-urgent care, 36 business days; and
      • ƒ 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.

Technical & Research Resources

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

Individual & Family Plans

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

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

  1. 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?

  2. 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.

  3. 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.  

    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.

    • 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

      cleaning vs deep cleaning

      You Tube VIDEO on deep cleaning

      Better VIDEO on deep cleaning

      If you’re a dentist check out Spear

      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

      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.

      People with manual dexterity issues or arthritis might do better with an electric toothbrush.

      People who don’t like wrapping floss around their fingers can use floss picks or power cleaners like Waterpiks.

      People who have larger spaces between their teeth can try small brushes for cleaning that area.
      Visiting your dentist periodically is also key. Regular cleanings can catch gum disease early and keep the plaque and tartar from spreading below the gumline.

  4. 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.

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