October 09, 2013
In Missouri or South Carolina, medical carriers can offer health plans with or without the pediatric dental essential health benefit ON the FFM-SHOP exchange, because pediatric essential dental benefits will be available from Delta Dental, a stand-alone dental plan.
So, what are the options for medical carriers?
- Medical carriers may include pediatric essential dental benefits and waive some or all of the dental deductible, or separate it from the medical deductible, which could possibly provide adequate dental benefits in the medical plan for children.
- They may subject pediatric essential dental to a single, combined medical and dental deductible or out-of-pocket maximum, thus not really providing adequate dental benefits for covered children, since those amounts are rarely reached.
- Or, they may exclude pediatric essential dental to reduce premium costs of the medical plan – as long as a stand-alone dental plan is offered on the exchange.
- On the SHOP exchange, an employer is NOT required to purchase the pediatric oral essential health benefit. The only requirement is thatit be offered.
Delta Dental will have small-group products in 2014 to meet each of these medical-carrier strategies. To help determine which approach an employer might follow, the following questions may be asked of the group’s medical carrier to develop the dental strategy:
Is the medical plan covering the pediatric dental essential health benefits requirement?
If yes – then ask “How?”:
- Is the medical plan embedding the dental benefit and waiving or separating the dental deductible?
- Or is the pediatric dental benefit subject to a single, combined annual medical/dental deductible, thus providing inadequate pediatric dental benefits?
- Is pediatric dental subject to a single, combined medical/dental out-of-pocket maximum or is it separated from the medical deductible?
- Here is a KEY question: What is the medical plan’s dental network? (Remember: Out-of-network claims do not count toward the out-of-pocket maximums in the pediatric essential oral health benefit, and that means potentially higher out-of-pocket costs for members.)
- Are adults age 19 and older covered with a quality dental plan?
Depending on the answers to these questions, an employer needs to decide:
- How does the employer plan to offer a quality dental benefit to employees?
- Does the employer want an ACA-compliant dental plan or a traditional plan?
- And where does the employer want to purchase the dental plan – ON the SHOP or OFF the exchange?
Armed with this valuable information, the employer, or the broker, can come to Delta Dental to select the dental benefit plan that best meets the needs of the employer and the group’s employees and covered members. The dental experts at Delta Dental are prepared to help our small group clients navigate the options and unknowns of the Patient Protection and Accountable Care Act.