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Dental Insurance Update—Your TDA Legislative Team in Action

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This is an important follow-up communication to the dental insurance notice TDA sent to all members on Friday, December 1, 2017.

As noted in the previous communication, TDA is aware of concerns regarding potential changes to some dental insurance plans, specifically PPO plans and EPO plans. For information on these plans, please see the previous communication which can be accessed here: https://www.tda.org/InsuranceNews

In 2011 during the 82nd Legislative Session, the TDA legislative team successfully amended the Texas law creating exclusive provider organization (or EPO) plans to specifically exclude dental care benefits. See Tex. Ins. Code § 1301.0042(b). As a result, state-regulated EPO plans are not authorized to provide dental care benefits in Texas. This exclusion benefits Texas dental patients and Texas dentists. The unique exclusion, however, is a state law that applies to plans regulated by the State of Texas. It may not similarly restrict plans governed by the federal Employee Retirement Income Security Act (ERISA), which can preempt the application of state insurance laws to qualifying employee benefit plans.

TDA and ADA have been working closely on this issue. The ADA has made several inquiries to leading dental insurance plans. To date TDA and ADA have not received evidence that substantial changes with EPO plans will go into effect on January 1, 2018. TDA and ADA are continuing to investigate, and will leave no stone unturned.

As the insurance marketplace grows in complexity, it is important for Texas dentists to have foundational knowledge on the difference between state- and federally-regulated plans and various insurance plan options. TDA will be releasing a primer on dental insurance plans to help our members build that knowledge base. Watch your email inbox for details this month for this new member benefit.

Looking ahead, we strongly encourage you to keep the following in mind: Texas dentists are responsible for (1) determining whether a patient’s particular insurance policy is regulated by state or federal government, and (2) determining what type of insurance product the patient has (e.g., HMO, PPO, EPO, etc.). Dentists contracted in-network with a dental plan(s) are encouraged to directly contact the plan to determine whether there will be any significant changes to contract coverage in 2018.

TDA remains fully engaged on this dental insurance issue and all legislative and regulatory issues affecting oral health. For more information, TDA members may contact TDA’s Department of Legislative and Regulatory Affairs at tda-dlra@tda.org.