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Topics of interest to both consumers and agents related to Covered California and the ACA biased in favor of the successful implementation of the Exchange and deliberately apolitical.


Pediatric Dental Coverage Removed from QHPs

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Covered California has persuaded California Department of Insurance regulators to change essential health benefit (EHB) regulations, to eliminate a provision requiring the “qualified health plans” (QHPs) sold through the exchanges to offer pediatric dental benefits. In the revised version, regulators let QHPs leave out pediatric dental benefits as long as insurers are selling stand-alone dental plans through the exchange.

Peter Lee told insurance regulators that actually requiring a QHP to provide pediatric dental benefits would conflict with ACA requirements to exclude dental from premium assistance. “Our federal colleagues have confirmed that Covered California must permit offering QHPs without pediatric dental in multiple conversations,” Lee said. “They were reluctant to provide written guidance on this point because they believed the text of the statute and regulations are so clear.”

Because the Covered California QHP solicitation process did not require QHPs to include pediatric dental benefits, none of the QHPs selected for the individual exchange program did so, and implementing the requirement in the original version of the emergency regulations “would cause a delay of Covered California’s health plan solicitation process, possibly by several months,” Lee said.

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