ADA comments to Congress on the Employee Retirement Income Security Act

Association expresses support for Dental and Optometric Care Access Act

The American Dental Association has filed comments in advance of the 50th anniversary of the Employee Retirement Income Security Act (ERISA), in response to a request for information from the House Committee on Education and the Workforce as it explores ways to increase coverage accessibility and access to care.  
In a March 13 letter addressed to Rep. Virginia Foxx, R-N.C., chairwoman of the House Committee on Education and the Workforce, the ADA expressed support for legislative efforts to prohibit “noncovered services” provisions in dental and vision plan contracts that are governed by ERISA. This includes the Dental and Optometric Care Access Act, which would prohibit dental and vision plans from setting the fees network doctors may charge for services not covered by insurers, as well as from forcing doctors to sign contracts longer than two years.  
The bill would ensure patients using self-funded dental plans have the same protection from insurer interference that exists for patients using fully insured plans in most of the states.  Self-funded plans typically use an insurance carrier for certain administrative services, but the employer bears the cost of any employees’ health care claims.  
“We do not believe state laws regulating how plans can limit what providers charge for non-covered services should trigger preemption, and therefore such laws should apply to all plans regardless of whether a plan is self-funded,” reads the letter, which was signed by ADA President Linda Edgar, D.D.S., and Executive Director Ray Cohlmia, D.D.S.
The ADA emphasized the importance of passing the Dental and Optometric Care Access Act, H.R. 1385, which the letter said would increase access to patient care by helping to curb anti-patient and anti-competitive practices of dental insurance plans.  
“This legislation is crucial to bring a needed balance to contract negotiations between providers, who are often small business owners, and large dental insurance companies who can leverage their greater market share to push doctors into accepting provisions, such as non-covered services, as part of their ‘take it or leave it’ contracts,” the letter concludes. “Passage of H.R. 1385 would balance the scales and bring equity to insurer/provider contracting at the federal level.” 
The ADA believes that most state laws designed to protect patients and providers are not preempted by the Employee Retirement Income Security Act. Nevertheless, ERISA plans continue to ignore state statutes and their persistence in this has made some states reluctant to enforce such laws. The letter notes that the ADA will continue to push for “federal laws on issues such as non-covered services to provide the protection that patients and providers need while avoiding any potential arguments about ERISA preemption.”  
Visit the Driving Dental Insurance Reform: Understanding ERISA advocacy page for more information from the American Dental Association on efforts to protect patients and providers. 

Recommended Content


© 2023 American Dental Association