ESHB 1846

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Amended by the Senate

Title: An act relating to stand-alone dental coverage.

Brief Description: Concerning stand-alone dental coverage.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representatives Schmick, Cody and Ryu).

Brief History:

Committee Activity:

Health Care & Wellness: 2/21/13, 2/22/13 [DPS].

Floor Activity:

Passed House: 3/11/13, 97-0.

Senate Amended.

Passed Senate: 4/15/13, 47-1.

Brief Summary of Engrossed Substitute Bill

  • Requires the Insurance Commissioner to establish requirements and procedures for stand-along pediatric oral coverage outside of the exchange.


Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 16 members: Representatives Cody, Chair; Jinkins, Vice Chair; Schmick, Ranking Minority Member; Hope, Assistant Ranking Minority Member; Angel, Clibborn, Green, Manweller, Moeller, Morrell, Riccelli, Rodne, Ross, Short, Tharinger and Van De Wege.

Staff: Jim Morishima (786-7191).


I. The Washington Health Benefit Exchange.

Under the federal Patient Protection and Affordable Care Act (PPACA), states must establish a health benefits exchange through which consumers may compare and purchase individual and small group coverage. If a state does not establish an exchange, the federal government will operate the state's exchange. Washington established its exchange, known as the Washington Healthplanfinder, in 2011 as a public-private partnership.

II. Essential Health Benefits.

The PPACA requires qualified health plans offered in the exchange to cover 10 categories of essential health benefits. In order to determine the benefits that must be offered in each of the categories, federal law allows states to designate a benchmark plan and supplement that plan to ensure that all 10 benefits of essential health benefits are covered. Washington has designated the largest small group plan in the state as its benchmark and the Insurance Commissioner is currently adopting rules to supplement the plan to ensure that all 10 essential health benefit categories are included.

III. Pediatric Oral Coverage.

One of the essential health benefits categories in the PPACA is pediatric oral care. The PPACA also allows stand-alone dental coverage to be offered in an exchange. If a stand-alone dental plan is offered in the exchange, another health plan offered in the exchange is not disqualified from becoming a qualified health plan if it does not include pediatric oral coverage.

Under state law, the Washington Healthplanfinder must allow stand-alone dental plans to be offered in the exchange. To assure transparency to consumers, dental benefits offered in the exchange must be priced separately.

Washington's essential health benefits benchmark plan does not cover pediatric oral services. The Insurance Commissioner is currently in the process of adopting rules that will supplement the benchmark plan to include pediatric dental. Under these proposed rules, a health plan must cover pediatric oral services as an embedded set of services, offered through a rider or as a contracted service. If a health plan is subsequently certified as a qualified health plan, this requirement is met if a stand-alone dental plan covering pediatric oral services is offered in the exchange. Unless otherwise prohibited by federal law, the Insurance Commissioner must allow health carriers to offer pediatric oral services within the health benefit plan in the non-grandfathered individual and small group markets outside of the exchange.

Summary of Engrossed Substitute Bill:

For the benefit years beginning with January 1, 2015, and only to the extent permitted by federal law and guidance, the Insurance Commissioner must establish by rule review and approval requirements and procedures for pediatric oral services when offered in stand-alone dental plans in the non-grandfathered individual and small group markets outside of the exchange.


The amendment allows a health maintenance organization to provide coverage for pediatric oral services that are substantially equal to the essential health benefits benchmark plan using noncontracted providers. Subjects amounts paid for insurance coverage for pediatric oral services that qualify as coverage for the minimum essential coverage requirement under the Patient Protection and Affordable Care Act to premium tax. Exempts amounts paid for other dental coverage offered by health maintenance organizations or life and disability insurers from premium tax.

Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.

Staff Summary of Public Testimony:

(In support) Stand-alone dental plans may be offered inside of the exchange, but may not be offered outside of the exchange. Federal guidance indicates that stand-alone dental coverage will be allowed outside the exchange. This bill will level the playing field and change state law to allow stand-alone dental coverage to be offered outside the exchange.

(With concerns) Health carriers must continue to be allowed to offer embedded dental coverage outside of the exchange.

(Opposed) None.

Persons Testifying: (In support) Representative Schmick, prime sponsor; Denny Eliason, Washington Dental Service; and Melissa Johnson, Willamette Dental Group.

(With concerns) Len Sorrin, Premera; and Chris Bandoli, Regence.

Persons Signed In To Testify But Not Testifying: None.