Many businesses have been classified as "employers of choice" because they took good care of their customers and employees. They researched health care plans and provided several choices that fit employees' needs. Employees needed only to review plan summaries and check boxes on their insurance enrollment forms.

Now the ACA is placing decisions regarding health care choices directly in employees' hands. Under this model, "employers of choice" will be those that help employees find the insurance coverage they need. In addition, they should provide information about health care changes and plans, and remind employees regularly to take advantage of plan benefits.

Affordable Care Act Rules Change

According to new ACA regulations released on July 2, 2013, larger employers offering benefits to employees have until 2015 to meet the ACA employer-mandate insurance obligation. In addition, the requirement to offer and report on Minimum Essential Coverage (MEC) or pay a penalty also was deferred until 2015. MEC does not include dental or vision insurance.

However, beginning Jan. 1, 2014, the requirements are different for individuals currently without insurance and employers of fewer than 50 employees that choose to provide benefits. Insurers are required to offer Essential Health Benefit Packages (EHBPs), unless their prior plans are grandfathered. EHBPs include pediatric dental and vision, typically up to age 19.

Small employers are not required to purchase such health coverage for employees and their dependents through a health insurance exchange, which means they may keep their current medical, dental and vision benefits with the same insurance carriers.

Individuals are not required to purchase any health coverage through a health insurance exchange. Plans may be purchased as stand-alone or in a private exchange through an employer, individual coverage or public exchange options. Individuals will be charged a penalty for not having health coverage, unless they have a specified exemption. The penalty for not purchasing medical coverage is at least $47.50 per child for the first year, with increases based on income.

It's important to note that in a public exchange marketplace, medical plans with dental coverage likely will cover only members under the pediatric age (19 in most states). This means that adults who purchase pediatric dental coverage for their kids will need to purchase their own dental plan separately. Adults and dependents with dental through an exchange or EHBP could then have different benefit plans, networks and insurance carriers.

Understanding State Exchange Plans

Employers and individuals exploring benefit options through a state exchange or private marketplace should review the plan design carefully to understand the coverage options. Plan choices will be limited and employers will not be able to customize plans.

Plans in an exchange may not be cheaper than those offered by an insurance carrier in a private exchange market. Premiums probably will be based on limited criteria instead of utilization trends that are typically used from within an employer's industry or claim experience. Since insurance carriers will be charged by state and federal administrators to participate in exchanges, these fees likely will be included in the premium costs.

Ameritas Dental and Vision Solutions

With the EHBP inclusion of pediatric dental and vision for small employer markets, health professionals are concerned that parents will purchase vision and dental coverage for their children, but not for themselves. Recent statistics from the American Dental Association indicate a decline in adults visiting the dentist (41 percent in 2003 to 37 percent in 2010), but hospital emergency rooms report more than 2 million visits for dental problems in 2010. Unfortunately, emergency treatment does not provide the preventive care and early detection afforded by regular dental checkups.

The National Association of Dental Plans states that 98 percent of Americans with dental coverage have a dental benefit policy separate from their medical policy. Dental and vision benefits sold in stand-alone policies are not subject to most (ACA) provisions.

Ameritas specializes in stand-alone dental and vision insurance that meets ACA requirements and is designed to fit employee needs, including pediatric dental coverage that matches Essential Health Benefits, adult-only options and plans that feature a higher payout and better benefit for members. Ameritas offers robust coverage, exceptional customer service and efficient claims processing, which means employers receive fewer complaints.

And we actually encourage employees (and family members) to schedule regular dental checkups and vision exams. During these visits, doctors often can detect serious oral, vision and medical concerns at an early stage, which may contribute to lower medical bills as well as healthier and more productive employees.

Develop Effective Communication Strategies

Employers may have varying benefit options or required offers based on their size. All employers need to develop communication strategies to assist employees in understanding benefit decisions. The following summaries of the issues on employees' minds may be helpful:

Single: Younger employees in good health may not see a need for medical insurance or dental and vision coverage. Instead they want to delay these purchases until they are older, when they've had a chance to work, pay off any college debts and start putting money away.

Conversely, older single individuals readily recognize the value of dental and vision coverage. But they are extremely concerned about costs and wonder how they can stretch their limited finances to cover the ACA insurance requirements and the higher premiums they've heard discussed by the news media.

Married: This group also is concerned about how to balance housing costs, car and student loans, and other expenses. If both spouses work, they need to decide whether to purchase insurance coverage as an individual through their employers, private exchanges or public marketplaces, or whether one will purchase family coverage, if available at work. Depending on their ages and health status, some may be willing to forgo dental and vision coverage until finances are stable.

Single parents with children: Many may have concerns similar to single individuals, but with the added responsibility of meeting ACA obligations for their children. They may not understand pediatric EHBPs, including age requirements, covered services and prices, but recognize the potential impact on their monthly budget. Single parents may feel they can afford only the required medical, dental and vision coverage for their children, and delay investing in these plans for themselves. Instead they will handle any serious health problems through urgent or emergency care providers.

Married with children: Insurance costs weigh heavy on the minds of married individuals with children. Juggling daily family expenses is challenging, not to mention providing for their kids' health care needs. Just like single parents with children, married parents may not understand pediatric EHBPs and how ACA insurance requirements will impact their budgets. Parents may consider providing medical, dental and vision coverage for their children, but not purchase similar plans for themselves.

Sometimes employees want to defer purchasing dental and vision coverage in order to save money on monthly premium expenses, but in reality they may risk developing serious health concerns and incurring significant bills for medical services. Surveys show that people with dental and vision insurance tend to use their benefits, including scheduling regular checkups and exams when doctors can evaluate the healthiness of their teeth and eyes and develop a treatment plan to address concerns. Bottomline, employers should help employees understand the value of dental and vision coverage and the wisdom of paying a small monthly fee for insurance to protect their health and that of their family members.

For information about Ameritas dental and vision plans, contact Michael Scheetz, vice president—group marketing, [email protected]. For updates on health care reform, visit www.ameritasgroup.com/reform.