Analysis of California Assembly Bill 1048: Dental Benefits and Rate Review

The California Assembly Committee on Health requested that the California Health Benefits Review Program (CHBRP) 1 conduct an evidence-based assessment of California Assembly Bill (AB) 1048.AB 1048 would prohibit a health insurer that covers dental services or specialized health care service plan or health insurer that covers dental services, from issuing, amending, renewing, or offering a plan contract or policy that imposes a dental waiting period provision or pre-existing condition provision, upon an enrollee or insured.The bill excludes Medi-Cal.The bill would also require the Department of Managed Health Care and the Department of Insurance to establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a specialized health care service plan contract or specialized health insurance policy covering dental services is unreasonable, or not justified, under the applicable requirements of the rate review provisions under existing law. Oral HealthOral health includes many local and systemic issues that can affect the mouth and beyond.Oral health also encompasses the connective tissues, ligaments, and bone in or interfacing with the mouth and teeth as well as the nervous, immune, and vascular systems that affect the mouth.Various oral conditions such as infections, immune disorders, injuries, and cancers can affect functioning in other parts of the human body.Likewise, systemic conditions such as diabetes, high blood pressure, respiratory problems, and stroke can impact oral health. Dental SpendingAlthough national rates of dental insurance remain lower than those of medical insurance, more than 26 million Americans have some form of dental coverage, with half receiving that coverage through their employer.Dental spending represents approximately 4% of total health care spending in California in 2020. Dental Insurance in CaliforniaThe majority of dental benefit plans are "fully insured" and regulated at the state level by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).The Affordable Care Act (ACA), helped California expand Medi-Cal eligibility and offer 1 Refer to CHBRP's full report for citations and references.