ADA Asks Senate Finance to Let States Regulate Self-Funded Dental Plans

Edited by Dentaltown staff

The American Dental Association has asked the Senate Finance Committee to let states extend their dental insurance protections to employer self-funded dental plans. The request came in Sept. 29 comments responding to a request for information from Ranking Member Ron Wyden, D-Ore.

The request for information, titled “Health Coverage That Works for Everyone,” seeks input on reforms across the individual, employer, and public insurance markets. It asks whether states should have waiver authority to regulate portions of the self-insured market. The ADA said it strongly supports the concept. It urged the committee to let states, through their insurance regulators, seek federal approval to apply specified dental protections to self-funded plans and the entities that administer them.

According to the letter, states have enacted 400 dental insurance reforms addressing prompt payment, noncovered services, assignment of benefits, network leasing, prior authorization, and retroactive denials. The ADA said carriers and administrators of self-funded plans frequently assert that the Employee Retirement Income Security Act preempts them from following those laws. The protections the association wants extended include:

• prompt-payment standards

• limits on fees for noncovered services

• prior authorization rules

• limits on retroactive denials and recoupments

• network-leasing transparency

• provider-directory accuracy

The ADA also asked for dental-specific standards for prior authorization, claims, denials, appeals, and payment. It said clinical dental determinations should be made or reviewed by a U.S.-licensed dentist. It also said a benefit should not be denied solely because preauthorization was not obtained when the patient otherwise qualifies, and that routine diagnostic and preventive services should not face unnecessary preauthorization.

Other recommendations fall into three areas:

• Administrators. Greater oversight of third-party administrators and of entities that lease dental networks or reprice claims.

• Loss ratios. Public loss-ratio reporting for stand-alone dental plans, which are generally exempt from the Affordable Care Act’s medical loss-ratio requirements.

• Medicare Advantage. Closer oversight of supplemental dental benefits, including reporting on spending, utilization, denials, and network participation. The letter also says dentists should be able to opt out of Medicare Advantage networks rather than being enrolled automatically through a plan sponsor’s commercial network.

ADA President Richard Rosato and Executive Director Nader Nadershahi signed the letter. It also restated the association’s support for H.R. 7931, the Improving Dental Administration Act, which would exempt certain state dental benefit laws from ERISA preemption.

Sources:
American Dental Association, letter to Senate Finance Committee Ranking Member Ron Wyden, Sept. 29, 2026: ada.org/september_29_2026_letter_to_senate_finance.pdf
ADA News, “ADA urges Senate Finance Committee to include dental in insurance reforms,” Sept. 30, 2026: adanews.ada.org/2026/october/senate-finance-dental-insurance-reforms