ACA – Individual Mandate, Smaller Employers Currently, the ACA affects individuals and employers with fewer than 50 eligible employees that choose to offer health insurance benefits.

Individual mandate. All consumers, with a few exceptions, now are required to have medical coverage, regardless of the size of their employer. If they don't have Minimum Essential Coverage (MEC), they may be subject to a fine. MEC does not include dental and vision coverage.

Small employer and individual requirements. Medical insurers are required to offer Essential Health Benefits Packages (EHBPs) to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. EHBPs include pediatric dental and vision, typically up to age 19.

Purchasing coverage. Employers are not required to purchase health coverage for employees and their dependents through a health insurance exchange. They can typically keep their medical, dental and vision benefits with their current insurance carriers. The medical plan may change and may include the specified pediatric dental benefits. The family dental plan in place can still stay as is providing added value without medical plan parameters. If the medical plan changes, but does not include the specified pediatric dental benefits, the family dental plan can be modified to include them.

The ACA has focused on the distinct needs of pediatric family members, with the requirement of EHBPs that include dental and vision benefits. In most cases, EHBPs from medical carriers cover only pediatric family members, leaving adults to purchase any dental and vision plans separately for themselves and their dependents age 19 and older.

2015 Employer Mandate Beginning in 2015, employers with 100 or more employees will be subject to the employer mandate. Employers in this group will need to offer MEC (in other words, typical employer-sponsored medical coverage) to 70 percent of their full-time employees. MEC does not include dental or vision so employers can keep the dental and vision plans they have.

Employers with 50 to 99 employees will not be subject to any employer mandates, including offering MEC or EHBPs, until 2016.

Family Dental and Vision Needs

In most families, members have different needs for dental and vision care. For example:

• Dependents age 19 and older may need LASIK, or the option of purchasing new eyeglasses annually or teeth whitening coverage, in addition to routine dental and vision exams.
• Adults often experience changes in their oral and vision health as they age, which may require services beyond preventive care to help them enjoy good overall health in their senior years.
• Children may need additional dental coverage for cosmetic orthodontia, because EHBs will cover only medically necessary orthodontia, such as cleft-palate conditions.

Families need flexible dental and vision coverage that can be customized to their specific needs. Benefit surveys show that people with dental and vision coverage tend to use their benefits. They are likely to schedule regular checkups and exams so doctors can evaluate the health of their teeth and eyes, and develop a treatment plan to address concerns.

The Atlantic recently reported that 77 million people have difficulty understanding common health-related reading materials. Employers need to invest time helping employees get familiar with their dental and vision coverage, recognize the importance of these benefits to their overall health, and appreciate the value of paying a small monthly fee for insurance to protect their health and that of their family members.

Understanding Stand-Alone Plans Stand-alone dental and vision benefits are sold independently from medical coverage, and these policies are not subject to most ACA provisions. (Remember that only pediatric dental and vision benefits are part of EHBs, which medical carriers are required to offer to most individuals and small employers in 2014.) According to the National Association of Dental Plans, about 98 percent of Americans with dental coverage have a dental benefit policy separate from their medical policy.

At Ameritas, we focus primarily on stand-alone dental and vision plans that can be customized to employee group needs. We specialize in offering:

• Dental and vision expertise
• Customer service focused only on dental and vision coverage
• Accurate pricing, not misleading low introductory rates followed by shocking rate increases
• Flexible and customizable benefits
• Claims-paying systems designed specifically for dental and vision
• Nationwide, credentialed provider network
• Dental and vision wellness knowledge

Exchange-Certified Pediatric Dental Benefits Currently, many medical carriers are asking employers to verify that their stand-alone dental plan offers exchange-certified pediatric dental benefits that meet federal standards. If not, the medical plan may add pediatric dental.

Ameritas offers exchange-certified pediatric dental benefits that meet federal standards, which can be added to stand-alone plans – now or at renewal. (Plan availability varies by state: http://ameritasgroup.com/about/5510.asp) Employers can replace the pediatric dental coverage in their current Ameritas stand-alone dental plans with Ameritas exchange-certified pediatric dental. Or they simply may add the exchange-certified benefits, and Ameritas will process pediatric dental claims through both plans – traditional and EHB – and pay the better of the two benefits.

ACA Focus The goal of health care reform is to extend benefits to more Americans for better health. At Ameritas, this has been our mission all along. For more information about Ameritas dental and vision plans, contact Michael Scheetz at [email protected] or an Ameritas representative in your area (http://www.ameritasgroup.com/producer/1314.asp). For updates on the ACA, visit www.ameritasgroup.com/reform.

To learn more about the differences between stand-alone dental and a medical plan with pediatric dental coverage, review this document: http://www.ameritasgroup.com/OCM/GetFile?doc=374205.