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One of the 10 “essential health benefits” covered under the Patient Protection and Affordable Care Act is access to pediatric services, including dental and vision care. Insurance policies must cover these benefits in order to be certified and offered in the marketplace, and all Medi-Cal plans must cover these services, as well. The requirement to cover children’s dental care highlights the importance of good dental care and its role in overall health.
Children’s Dental Coverage
Covered California provides dental coverage to children under the age of 19 in the exchange’s individual and small-group employer markets.
All of Covered California’s health insurance plans include children’s dental coverage for the 2015 coverage year, as part of the cost of the health plan. (The standalone pediatric dental plans that were offered in 2014 are no longer available.) The health insurance companies negotiated all products with embedded pediatric dental plans. Health plans will contract directly with dental plans to deliver care. See the table below, showing which dental plan corresponds with each Covered California health insurance plan for 2015.
| Health Plan |
Children’s Dental Coverage Embedded in Health Plan |
| Anthem Blue Cross | Anthem Blue Cross DHMO, DPPO |
| Blue Shield of California | Blue Shield of California DPPO |
| Chinese Community Health Plan | Delta Dental of California DHMO |
| Health Net | Dental Benefit Providers DHMO, DPPO |
| Kaiser Permanente | Delta Dental of California DHMO |
| L.A. Care Health Plan | Liberty Dental Plan DHMO |
| Molina Healthcare | California Dental Network DHMO |
| Sharp Health Plan | Access Dental Plan DHMO |
| Valley Health Plan | Liberty Dental Plan DHMO |
| Western Health Advantage | Access Dental DHMO |
Note: DHMO = dental health maintenance organization. DPPO = dental preferred provider organization.
Child dental preventive and diagnostic services, such as X-rays, exams, cleanings and sealants, are included free of charge in Covered California health plans. Other child dental services, such as fillings, root canals and crowns, are also covered by the health plan.
In addition to embedded children’s dental coverage, Covered California will offer supplemental dental coverage for adults in the 2016 plan year, through optional family dental plans.
Children who qualify for Medi-Cal will receive dental services through Medi-Cal’s dental program. For more information, visit www.CoveredCA.com/medi-cal/benefits.