October 08, 2013
Following up on my previous post, the chart below shows a simplistic view of how the FFM-SHOP process may work.
- Plans are available to review, compare and select a preference, based on the offering elements of plan designs, networks and premiums.
- The employer – or the employer’s broker – then comes to Delta Dental for a quote.
- Delta Dental will provide a SHOP quote for dental benefits.
- Once implemented, employees will enroll, and – with Delta Dental – enjoy the peace of mind of the best customer care in the industry.
An employer is not required to purchase the pediatric oral essential health benefit through the SHOP. The employer may purchase medical benefits and opt out of the pediatric dental offered within the SHOP – and just go directly to Delta Dental for traditional dental coverage.
The process for an OFF-exchange purchase more closely resembles the current, pre-ACA process.
- The employer, probably with support from a broker, will determine the group’s approach to dental benefits, considering the group’s needs for coverage, and how the pediatric essential oral health benefit will be provided.
- Medical carriers may include or exclude pediatric essential oral health benefits OFF the exchange, as long as the medical carrier has reasonable assurance that the pediatric dental benefit is being purchased through an exchange-certified plan. Remember, OFF the exchange, the individual MUST PURCHASE the pediatric essential benefit. Delta Dental will provide that assurance to the medical carrier.
- The current market process is followed to find the most appropriate plan for the group.
- The employer, or the broker, requests a quote from Delta Dental, and evaluates the options for plan design, network and premiums – just as before.
- Delta Dental can provide a quote, as requested: either a status-quo quote for the group’s current plan, or an ACA exchange-certified plan with similar adult benefits, along with the required pediatric essential oral health benefit.
- Once implemented, employees will enroll, and – with Delta Dental – enjoy the peace of mind of the best customer care.
Through either process, small group employers may turn to Delta Dental to find plan designs, networks and pricing that will match the needs of the dental benefits program.