Keenan Briefings

Briefing

SB 1008: Update to Dental Benefit Disclosures

Q: I just got a form from my dental plan outlining the benefits it provides. Why am I getting this?

Answer: In 2018, California passed SB 1008 (Chapter 933, Statutes of 2018) which added section 1363.04 to the Health and Safety Code and Section 10603.4 to the Insurance Code. Those laws require health plans that issue, sell, renew or offer policies or plans covering dental services in California to use a Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) to disclose the following information:

• The annual overall policy deductible.
• The annual benefit limit.
• Coverage for the following categories:
  • Preventive and diagnostic services.
  • Basic services.
  • Major services.
  • Orthodontia services.
• Dental policy reimbursement levels and estimated insured cost share for service.
• Waiting periods.
• Examples to illustrate coverage and estimated insured costs of commonly used benefits. The examples shall include at least one service from each of the following categories:
  • Preventive and diagnostic services.
  • Basic services.
  • Major services.

In the case of group plans for dental services, carriers are required to make the completed SDBC available to the group upon delivery of the completed contract or policy for dental insurance. Group plans are required to make available the completed SDBC to all persons eligible to be covered under the group policy at the time those persons are offered dental coverage. If group members are offered a choice of dental plans, separate SDBCs must be made available for each dental plan offered. Each group must also make available copies of SDBC, upon request, prior to enrollment and to all policyholders insured under the group plan.

This law does not apply to Medi-Cal dental plans, nor does it apply to self-insured dental plans.

The statute requires these provisions to go into effect for policy years on and after January 1, 2021, or 12 months after the Department of Insurance (DOI) and Department of Managed Health Care (DMHC) issue regulations, whichever comes later. Both departments issued emergency regulations in January of 2021. Both departments also have permanent regulations in process. Under the statute and the emergency regulations, compliance with these new rules will go into effect for plan years beginning on and after January 28, 2022 for those plans regulated by the DOI. For dental HMOs, the new rules went into effect for plan years beginning on or after January 25, 2022.

With regard to a group plan’s obligations, the regulations require the group plan to provide an applicable SDBC to each person eligible to be covered under the plan at the following times:

• At the same time the group provides other disclosure materials (like the Summary of Benefits and Coverage or SBC for health plans).
• As part of any written application materials that are distributed for enrollment at the time the application materials are distributed. (As a practical matter, these first two bullets may occur at the same time, during open enrollment.)
• If changes are made to the SDBC then the group must provide the current SDBC to the applicant within 7 business days after receipt of the application but no later than the first day of coverage.
• For plans where renewal occurs automatically, the group must provide the SCBC no later than 30 days prior to the first day of the policy year.
• Within 7 business days of a request by an insured.

Delivery can be made in paper form, mailed to the individual or electronically—either by email, or by directing the individual to the carrier’s website for a copy of the SDBC.

AP Keenan is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Clients are advised to consult with their own attorney for a determination of their legal rights, responsibilities, and liabilities, including the interpretation of any statute or regulation, or its application to the clients’ business activities.