ADA proposes updates to ERISA to improve transparency in dental insurance markets

Leadership also asks for subcommittee support of federal noncovered services bill

The ADA proposed updates to the Employee Retirement Income Security Act of 1974 to ensure that fiduciary responsibility is mandated to be disclosed to consumers and providers.

This would clear up confusion on a state regulatory level as to the extent of ERISA preemption of the consumer protections found under state insurance laws, according to a May 16 letter to the chair and ranking member of the Health Subcommittee of the Committee on Energy & Commerce from ADA President George R. Shepley, D.D.S. and Executive Director Raymond A. Cohlmia, D.D.S.

In the letter to Rep. Brett Guthrie, R-KY, and Rep. Anna Eshoo, D-CA, Drs. Shepley and Cohlmia proposed updates to ERISA that would require insurers and plans to state expressly who is a fiduciary and is exercising discretion for the plan, which would help the relationship between the beneficiaries and the companies who process their claims. It would also help the authority of the states to regulate the companies who provide such services and clarify for state regulators and beneficiaries which plans do and do not offer the consumer protections found under state insurance laws.

“Historically, companies that manage claims for the ERISA plans have sought to avoid declaring their fiduciary status because they want to enjoy the benefits of being considered part of the plan (such as for preemption purposes) without incurring a fiduciary’s potential liability and restraints on profit-seeking behavior,” the letter said. “We believe that if carriers must be made to declare their fiduciary role much like financial advisors must, then consumers will ultimately benefit by being able to differentiate who to seek assistance from regarding the regulation of their plan, whether at the state or federal level. There has been confusion on a state regulatory level as to the extent of ERISA preemption of the consumer protections found under state insurance laws.”

Drs. Shepley and Cohlmia also asked the House subcommittee to support the Dental and Optometric Care Access Act, or DOC Access Act, that “would prohibit dental and vision plans from setting the fees network doctors may charge for services not covered by the insurers, from providing unreasonably minimal compensation for services rendered, and from forcing doctors into participating in contracts of excess of two years. This bill is narrowly drawn to apply only to the business of dental and vision insurance plans regulated by the federal government.” (See related story).

“Dentists and their patients are negatively impacted by the non-covered service provisions among entities in the health insurance industry, stifling competition,” they wrote. “Noncovered services provisions in dental and vision plans disadvantage enrollees and providers because they interfere with the patient-doctor relationship, skew the pricing charged to non-subscribers, and encourage the consolidation of the dental and vision insurance industries, resulting in higher premiums overall. … The ADA and the dentists we represent are not opposed to dental plans building strong networks and seeking discounts for their subscribers, but we seek less consolidation and greater competition.”

Drs. Shepley and Cohlmia emphasized that the ADA continues to support Congress’ work to improve transparency and consolidation in health care.

Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.