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Board approves 2026 Delta Dental rates amid member complaints about dentists leaving network
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Summary
The SFHSS board approved 2026 dental rates that maintain the active PPO administrative fee but increase self-funded PPO total cost by 12.4% (driven by reduced stabilization buy-down); retirees' insured PPO rates increase 2%. Public commenters and unions pressed Delta Dental for answers about providers leaving the network.
The San Francisco Health Service Board on Thursday approved the Health Service System’s recommended dental rates for plan year 2026 while hearing multiple public complaints about dentists leaving Delta Dental’s network.
Staff and Aon actuary Mike Clark explained that most of the 2026 increase for the self‑funded active employee PPO (a 12.4% total‑cost increase) reflects a reduced drawdown of a stabilization reserve rather than a sudden rise in claims. The board was asked to maintain the administrative fee for the active PPO at $4.82 per employee per month and to adopt a clinical change extending sealant coverage for first molars through age 15. For the retiree Delta Dental PPO, staff recommended a 2% insured rate increase; the two dental HMOs (DeltaCare/UnitedHealthcare) proposed no change.
Public comment dominated this agenda item. Several speakers, representing Protect Our Benefits and unions including Local 21 and IFPTE, described members who have lost long-standing dentists after providers left the Delta network. Testimony alleged that dentists are increasingly “insurance independent,” that reimbursement levels are too low and that some members face substantial out‑of‑pocket bills when a familiar dentist leaves the network. Fred Sanchez, president of Protect Our Benefits, urged a more extended public process for the dental program because many members feel their real costs have increased despite coverage.
Delta Dental’s representative described the data tracking provider terminations, saying reasons include retirement, voluntary departure from networks and other attrition. He said Delta continues to recruit new dentists and has begun provider outreach and advisory work to address concerns.
Board members acknowledged the member frustration. President Howe and others said SFHSS will continue to press Delta Dental for details and indicated Aon and staff will perform a pre‑analysis and claim‑comparison work before any future RFP or vendor decisions in the fall.
How the board voted: the motion to approve the 2026 Delta Dental plan rates passed 4–1. Commissioner Kremen voted no, while President Howe, Vice President Zavansky, Supervisor Dorsey and Commissioner Howard voted to approve.
Why it matters: Dental access and out‑of‑pocket costs are important to members’ overall health; the network disruptions prompted calls for a deeper analysis of provider reimbursement, regional network capacity and alternatives for members.
Details of the approved rate actions • Active employee PPO (self-funded): administrative fee maintained at $4.82 per employee per month; 12.4% increase in total cost rates driven mainly by a smaller stabilization reserve buy‑down in 2026. The plan will expand sealant coverage through age 15 for first molars. • Retiree PPO (fully insured): 2% increase in 2026 insured rates (third year of a prior multi‑year rate commitment). • Active HMOs (DeltaCare USA and UnitedHealthcare): no rate change for 2026.
Next steps: SFHSS staff and Aon will produce a claims and network analysis this year to inform possible RFP design or procurement options; staff said they will revisit network impacts and vendor performance in fall procurement planning.
