Politics aside, the Patient Protection and Affordable Care Act has changed the employee benefits landscape.
While health insurance has dominated the conversation, there seems to be some confusion and uncertainty regarding dental. I'd like to clear a few things up today.
As one of the Essential Health Benefits, you'd naturally assume that pediatric dental is a required purchase and that you have to get it through the health plan. But that's not always the case. The options for small employers who want to provide pediatric EHB dental coverage are many.
- Client situation: In some states, small employers with non-grandfathered health plans have the option to delay offering ACA-compliant coverage. If your client's health plan is renewed in one of these states under the transitional policy guidelines, then…
Options to consider: Their traditional dental benefit plan can be retained because they are not required to have pediatric EHB dental benefits at this time. - Client situation: If your client's health plan complies with the ACA EHB requirements and, as part of that, includes pediatric dental benefits, then…
Options to consider: You might be thinking they don't need a separate dental plan. But it might still be wise to also offer a traditional dental plan to avoid unexpected out-of-pocket expenses. Furthermore, if the client wants to provide dental coverage to the adults but doesn't want to have duplicative benefits for the children, consider a stand-alone dental plan that excludes coverage for children under 19. - Client situation: If your client's health plan complies with the PPACA EHB requirements but does not include pediatric benefits (yes, this can happen and is still considered compliant with the law), then…
Options to consider: Offer a stand-alone family dental plan that includes pediatric EHB benefits or, at a minimum, offer a stand-alone child only EHB dental policy.
It frustrates me when people say that the small-case dental market is no longer attractive. That's just not accurate. The market is alive and booming with opportunity.
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As you think about options, it's easy to gravitate toward solutions that just satisfy the requirements of the law, which includes a pediatric EHB dental benefit. But don't skip past dental coverage for adults and children ages 19-26. And, remember pediatric EHB dental doesn't necessarily equal full dental coverage for children under age 19.
Orthodontia coverage, for example is only covered if it's medically necessary. What happens if the pediatric dental benefits go toward satisfying the health plan deductible first? That could mean unexpected out-of-pocket expenses for employees. That's where offering a traditional dental benefit that covers all family members may make good sense.
The beauty of all this is that there are options available in the market for almost any situation. Still, few carriers, if any, provide every option in every state, and health carriers are handling the pediatric dental benefit differently, which is why it can be confusing and uncertain. But, when it comes to insurance, uncertainty is never a good thing. Reach out to your carrier rep today for assistance in finding the right solution for any client's situation or need.
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