Dental and Vision Coverage
Dental coverage for adults (single or married) and children is available through family dental plans. Adults with and without children can enroll in family dental plans, but they must purchase a health plan through Covered California to be eligible.
Dental coverage for children is considered an essential health benefit, so all health plans purchased through Covered California include dental coverage for members under age 19. Some parents may choose to enroll their children in an optional family dental plan for additional dental coverage.
The participating dental carriers are Access Dental Plan, Anthem Blue Cross, California Dental Network, Delta Dental of California, Dental Health Services, Liberty Dental Plan and Premier Access.
Dental coverage for adults is not an essential health benefit, so dental coverage for adults is offered separately from health insurance plans. No financial assistance is available to purchase these dental plans. There is no maximum out-of-pocket limit for enrolled adults.
Family dental plans may offer a wider range of dental service providers than what is offered through the dental coverage included with the child’s health plan. When children are insured by both a health plan and a family dental plan, the two plans will “coordinate benefits.”
Family Dental Plan Details
Covered California offers two types of dental plans: HMO (health maintenance organization) plans and PPO (preferred provider organization) plans.
Preventive, diagnostic and treatment services are covered at no cost for both adults and children. Family dental plans include an out-of-pocket maximum of $350 per child per year and $700 per family if more than one child is enrolled.
Refer to the plan’s policy or its “Evidence of Coverage” for a complete list of covered services provided and any exclusions and limitations on those services.
Dental HMO Plans
There is no deductible and no annual limit on what the plan will pay for a member’s care. The costs for fillings, root canals, crowns and other major treatments and services are shared by the consumer and the plan, according to a defined set of copays for services. Costs for dental work performed by dental providers outside the plan’s network are not covered.
Premiums are typically lower for dental HMO plans than for dental PPO plans.
Vision benefits for children are included in all health plans through Covered California. Vision care for adults is not considered an essential health benefit and is not offered in Covered California plans, but Covered California contracts with EyeMed and VSP to offer coverage directly to consumers.
EyeMed has an expansive network of independent eye care professionals — national and regional retail providers like LensCrafters, Pearle Vision, Target Optical, Sears Optical and JCPenney Optical, as well as online options like Contactsdirect.com and Glasses.com.
VSP® Vision Care offers Covered California members full-service individual vision plans with annual premiums starting at just $15.16 a month. Choose from two plan options, plus the largest national network of independent doctors and convenient retail chains.
VSP offers award-winning service and low out-of-pocket costs. VSP is the largest not-for-profit vision insurance company in the nation, and covers more Californians than any other vision provider.
Call us at (800) 650-0922 if you have questions or need enrollment assistance.