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C.E. Credit
Commercial Dental Benefit Plans Charles D. Stewart, DMD AUTHOR Charles D. Stewart, DMD, is the president, CEO and chairman of the board of directors for Aetna Dental of California Inc. and the senior dental director for Aetna Inc., both CVS Health companies. He is also the chairman of the California Association of Dental Plan’s (CADP) quality management committee, a member of the CADP board of directors and the lead instructor for the CADP’s quality assurance consultant certification courses. Dr. Stewart is credited with the development and implementation of the CADP computerized shared quality assurance assessment warehouse program. He is the 2021 recipient of the NADP Gabryl award for lifetime achievement in the dental benefits industry. Conflict of Interest Disclosure: None reported.
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ommercial dental benefit coverage has been identified by many terms, including dental insurance, dental benefits, private dental insurance and dental plans. The model refers to dental benefits offered through an arrangement with an employer or employer group or individually purchased coverage. The plans offered through an employer or employer group are standardized for that employer and may have varied coverages, benefits, exclusions and limitations. Individual plans are more standardized and structured with specific benefit levels and coverages. These individual plans rarely permit any options or changes to the standard offering. Dental coverage as we know it today began because of the International Longshoreman’s Union/Pacific Maritime Association’s (ILWU-PMA) desire to add a dental plan as an employee or member benefit. In 1954, these organizations consulted with the California, Oregon and Washington dental associations to work on developing some type of dental coverage.1 The result of this collaborative effort was the development of a benefit model where certain dental benefits were prepaid in the form of capitation to the dentist and other dental benefits were reimbursed by an established patient copayment that was paid by the patient directly to the dental office. This effort resulted in the formation
of a subsidiary of the Washington Dental Association, named Washington Dental Service (WDS), later to become a Delta Dental plan, to administer this new prepaid dental benefit. Though many would suggest the Delta Dental plans are an indemnity plan, they do share many characteristics of that model, differing by their regulatory oversight. This regulatory oversight has associated requirements for benefits, quality and oversight. In 1959, the Continental Casualty Company (CCC) became the first commercial insurer to offer dental insurance.2 The indemnity or private model of commercial dental benefits grew dramatically following the development by the CCC. The early model had rich coverages with specific annual maximums. A common complaint today is that the annual maximum appears seemingly frozen at a level close to what it was at the inception of the benefit model. The early dental health maintenance organization (DHMO) model worked well and provided valuable experience and learning opportunities for WDS. Today’s DHMO model resulted from evolution of this early WDS model of dental coverage. Some of the experiences learned proved that “dental is different” and that a traditional medical HMO model and operation did not fit or work well in a dental office setting. The dental HMO JULY 2 0 2 2
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