Wellness Plans & WA Law: What to Know

In 2016, WSDA learned that a common practice employed by Washington’s dentists to attract and retain patients without insurance—“wellness,” “discount dental,” or “membership” plans—were coming under scrutiny by the Washington State Office of the Insurance Commissioner (OIC). WSDA immediately set out to determine what the problem was and how to solve it.

Put simply, medical providers, including dentists, cannot offer discounts in exchange for a membership fee without running afoul of state insurance laws. Because OIC investigations are generally complaint-driven, nearly two years later, dentists are still being contacted by OIC about these types of plans while many have not yet been contacted at all. 

If your office has such a plan, please consider the following:

The OIC has strongly prohibited any pre-payment format or pay-for-your-discount format. While such programs may be legal in other states, it is outside the bounds of Washington State law for a patient to pay for services to be provided in the future. In Washington, these arrangements are considered to be “insurance” and would need to be regulated as such. 

Instead, consider restructuring your program in any or all of the following ways:

• Buy one, get the next one at X percent off
• After a service is provided, include a free X percent off voucher, a free $X in-office treatment gift card, or any other incentive vouchers for future services
• To encourage regular preventive care, give the vouchers an expiration date that corresponds with the appropriate time to receive the service

Learn more about dental wellness plans and your options in Washington state.