Dental plan portal.

Plain English Breakdown

The official summary does not provide details on how the portal will be funded or maintained, leaving this aspect unclear.

Dental Plan Portal

This law requires dental plans and insurers to create a free online portal that provides dentists with real-time, clear information about patients' benefits and payment amounts.

What This Bill Does

• Requires dental plans and insurers to establish an accessible online system for treating dental providers.
• The portal must provide accurate, real-time benefit eligibility and benefits information in a clear format.
• It should include actual payment or reimbursement amounts for covered services.
• The portal is required to accept attachments in electronic form.

Who It Names or Affects

• Dental plans and insurers
• Treating dental providers (dentists)
• Patients with dental coverage

Terms To Know

Enrollee

A person who is part of a dental plan.

Insured

Someone covered by a dental insurance policy.

Limits and Unknowns

• The bill does not specify how the portal will be funded or maintained.
• It only sets up requirements for the portal; it doesn't create specific penalties for non-compliance beyond existing laws.

Official Summary Text

AB 2029, as amended, Sharp-Collins.
Dentistry.
Dental plan portal.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth requirements for a contract between a plan or insurer and a dentist and requires a plan or insurer to make specified disclosures to an enrollee or insured regarding noncovered dental services.
This bill would require a dental plan or dental insurer to establish a dental portal accessible to a treating dental provider to provide information regarding an enrollee’s contract or insured’s policy, including the
actual payment or reimbursement amounts for covered services. The bill would require the portal to provide accurate, real-time benefit eligibility and benefits information in a clear and understandable format, provide specified information about a corresponding payment, accept attachments in an electronic format, and be made available at no cost to contracted and noncontracted dental providers, among other requirements. Because a willful violation of these provisions relative to health care service plans would be a crime, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Dental Practice Act, establishes the Dental Board of California in the Department of Consumer Affairs to license and regulate the practice of dentistry.
This bill would state the intent of the Legislature to subsequently enact legislation that would establish minimum standards for online dental provider information portals to require them to allow a user to verify eligibility, submit claims, access fee schedules, and obtain other critical information to promote transparency, efficiency, and timely access to information necessary for the delivery of dental care.

Current Bill Text

Download Bill PDF