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Board briefed on 2026 dental changes: child deductible waiver and expanded TMJ coverage
Summary
Staff proposed aligning Uniform Dental Plan benefits for PEBB members beginning Jan. 1, 2026: waiving the deductible for children under age 15 and expanding temporomandibular joint (TMJ) services (annual max to $1,000, lifetime to $5,000). Funding was included in the 2025–27 operating budget; the board discussed reimbursement differences for composite vs. amalgam fillings.
Laura Tepfer, account manager for dental contracts, presented proposed plan-year 2026 changes to the Uniform Dental Plan intended to align PEBB benefits with other portfolios. She said the first change will waive the $50 per-person/$150 family deductible for children under age 15 for all services and the second will increase TMJ benefit limits (an enhanced annual maximum of $1,000 and a lifetime maximum of $5,000 under the SEBB-like design). "The deductible does not apply to services for children under age 15," Tepfer said.
Staff noted the funding for these two changes was included in the 2025–27 operating budget and described remaining differences between PEB and SEB portfolios, such as crowns and composite filling reimbursement baselines. Board members raised questions about market practice and whether most dentists still place amalgam fillings; staff said many providers now offer composites and that aligning reimbursement for composite posterior fillings is on the agency's radar but may require additional analysis or budget action. The board will consider related resolutions later in July.
