CDA-Sponsored Legislation to Clarify the Payment Responsibility of Secondary Payers
On January 1, 2008, Assembly Bill 895 became law. This CDA-sponsored bill clarifies and places new requirements in law on how dental plans coordinate paying for patients' benefits.
CDA sponsored AB 895 to address the issue of dual dental coverage and the inability of spouses and domestic partners to receive the benefit for which they or their employers have paid. CDA often heard complaints from dental offices of patients who have dual coverage that they were unsure what both plans would pay when coordinating payments. Some dental plans do not declare their coordination of benefits policies to their enrollees, and until AB 895’s enactment, such declarations were not required by law. In addition, increasingly over the past few years, many dental plans adopted non-duplication of benefit clauses that declared that the plan would pay nothing as a secondary payer if the primary payer has paid what it would have paid had the secondary payer been primary. The result of non-duplication of benefit policies has been that plans have used primary payers to cover their obligations to their enrollees, resulting in a situation where the employer or employee pays dual premiums for dual coverage while getting the benefit of only one coverage plan.
The following links provide information on the requirements of the new law. CDA members and office managers should familiarize themselves with the requirements of the new law, and use the information linked below to challenge a secondary plan when they claim they owe nothing in a coordination of benefits situation.
Frequently Asked Questions about AB 895 and coordination of benefits