Wednesday, December 18, 2013


For those of our patients who are still considering the various Covered California healthcare plans, the deadline is December 23rd to get healthcare coverage starting January 1, 2014.  We know that this has been a confusing process for many of our patients' families, but hope that we can clarify a few things that will make your decision a little easier - at least when it comes to dental coverage.

-    The State of California only mandates that Pediatric Dental Care be OFFERED as coverage.  It does not mandate that each health care plan have the coverage as a part of the bundle, or package.

-    The bundled healthcare plans that do include pediatric dental coverage may not include a PPO dental plan (a plan that enables you to choose your own dentist), but rather an HMO plan (you will have to go to a dentist in their network). We do not accept HMO plans here at One Parker.

-    Supplemental Pediatric Dental Plans are available for purchase through Covered California but beware - they can be expensive and not worth the investment.  Monthly premiums can run as high as $47 per month per person with most plans just covering a percentage of preventative care and have maximums of $1,000 or $1,500.  If your child generally has cavity-free check-ups, and is not in orthodontia in the near future, your monthly premiums could cost more than two annual visits.  Read the individual plan descriptions carefully.

-    Our office is a Delta Dental Premier provider and we also participate with Anthem Blue Cross PPO dental plans - we are considered in-network with these plans.  With all other PPO carriers we are considered out of network - you can still choose us as your dentist, but you will reimbursed directly from your insurance company. 

1 comment:

  1. Pediatric Dental Plans

    Effective January 1, 2014

    Pediatric dental care is an essential health benefit that must be included with every medical plan purchased directly through Blue Shield. To expand your clients' pediatric dental benefit options, Blue Shield provides four pediatric dental plans to choose from (two PPOs and two HMOs) – each of which can be bundled with your clients’ medical plan. All four pediatric dental plans are available for purchase with a medical plan through Covered California or through Blue Shield.

    Pediatric dental plans feature:
    Preventive and diagnostic services for $0 out of pocket
    Orthodontic coverage (medically necessary) with no waiting period
    An out-of-pocket maximum of $1,000 for a child and $2,000 for two or more children in a family application
    A premium rate cap for three or more children in a family plan

    Pediatric dental plan benefits are provided only to those under age 19. Because pediatric dental care is an essential health benefit, applicants (including adults) applying for a medical plan directly through Blue Shield must select a pediatric dental plan to ensure that their plan is compliant with the ACA requirement of having all 10 essential health benefits. Although individuals age 19 and older must select a pediatric dental plan, they will not be eligible for benefits and the pediatric dental rate will not apply.

    Pediatric dental plans can also be paired with an additional family dental plan to provide coverage for the entire family.