Dental and Vision Insurance

About Covered California’s Family Dental Plans
California families will get expanded opportunities for improved dental health through Covered California’s offerings of family dental plans. The plans offer comprehensive coverage for both children and adults. Purchase of the plans is optional and comes at an additional cost. Adults can choose to enroll in family dental plans without enrolling the entire family. In the individual exchange, the participating dental carriers are:

• Access Dental Plan
• Anthem Blue Cross
• Delta Dental of California
• Dental Health Services
• Premier Access

There are two different product types available, depending on where the family lives. The dental preferred provider organization (DPPO) product offers a wide variety of provider choice within a network of participating dentists, as well as coverage for some out-of-network services. The dental health maintenance organization (DHMO) limits coverage to services provided by a dentist within a network and generally requires a referral to be seen by a specialist. Covered California family dental plans feature standard copayments, deductibles and coinsurance requirements. The children’s benefit designs have an actuarial value of 85 percent. An actuarial value is the overall average percentage of costs for benefits that a dental plan will cover. These premiums are for “stand-alone” plans, or dental benefit products that can be purchased by themselves to cover a specific service. Dental plans must follow Covered California standard benefit designs. Standardizing benefits ensures that the selected plans define what the consumers get and allows consumers to choose a plan that’s right for them based on quality, network and value. Key benefit features include comprehensive treatment services like root canals and crowns, and diagnostic along with preventive services available at no charge and not subject to deductible.


Family Dental Plan Standard Benefit Designs - DHMO
ENROLLEE PAYS - DHMO
Coverage Category Child Adult
Diagnostic and preventative
(includes X-rays, exams, cleanings and sealants)
$0 $0
Amalgam filling - one surface $25 $25
Root canal - molar $300 $300
Gingivectomy per quad $150 $150
Extraction - single tooth, exposed root or erupted $65 $65
Extraction - complete bony $160 $160
Crown - porcelain with metal $300 $300
Medically necessary orthodontia $350 not covered
Enrollee costs    
Deductible (waived for diagnostic and preventative) $0 $0
Annual benefit limit none none
Individual out-of-pocket maximum $350 N/A
Family out-of-pocket maximum (two or more children) $700 N/A
Office copay $0 $0
Waiting period none none



Family Dental Plan Standard Benefit Designs - DPPO
ENROLLEE PAYS - DHMO
Coverage Category Child Adult
Diagnostic and preventative
(includes X-rays, exams, cleanings and sealants)
0% 0%
Amalgam filling - one surface 20% 20%
Root canal - molar 50% 50%
Gingivectomy per quad 50% 50%
Extraction - single tooth, exposed root or erupted 50% 50%
Extraction - complete bony 50% 50%
Crown - porcelain with metal 50% 50%
Medically necessary orthodontia 50% not covered
Enrollee costs    
Deductible (waived for diagnostic and preventative) $65 $50
Annual benefit limit none $1500
Individual out-of-pocket maximum $350 N/A
Family out-of-pocket maximum (two or more children) $700 N/A
Office copay $0 $0
Waiting period none 6 mo.