As the dust continues to settle from the first round of Affordable Care Act sign-ups, nuanced compliance issues may start to bubble up that brokers should not only be aware of, but may be able to help carriers and employers fix before next year’s open enrollment begins.

One of those matters involves the pediatric dental requirement in the ACA, which says that medical plans on the exchanges and also off the exchanges for individuals and small businesses must include this benefit in order to be deemed fit for sale to Americans. What this regulation didn’t factor in is that many small business employers already provide dental benefits for entire families including children, oftentimes through a dental carrier separate from the medical plan offered.

An amendment to President Barack Obama’s signature health law later clarified that if a standalone dental plan was available on a state’s public exchange, medical policies could be sold to individuals and small businesses on those marketplaces without the pediatric dental component. However, it left the requirement in-tact for off-exchange purchases, which Chris Pyle, vice president of marketing and government relations at Delta Dental of Virginia, says is an oversight mostly affecting small employers. The ACA defines small businesses as those with 100 or fewer employees.

“It’s wise and in the best interest of consumers of individual and small-group insurance to be allowed to shop for dental benefits in the way they used to be able to,” Pyle says. “Many employers, and thus employees, are used to purchasing dental separate from their health plan. It’s just the way the market works and it’s a more competitive environment that way with conceivably more choice and more cost-effective items for consumers and employers.”

Pyle says fixing the issue falls in each state’s jurisdiction. Virginia’s state legislature passed a law saying that if a standalone dental carrier exists in the off-exchange market, then medical policies sold to individuals and small businesses need not contain the pediatric dental plan. Wisconsin, Iowa, New Mexico and Arkansas have made similar changes in their states through regulatory mandates by their respective insurance commissioners, according to Pyle.

“Brokers have a crucial role to play in advising their clients as to the effect of the law in their state,” Pyle says. If, for example, a medical carrier that operates in multiple states tries to sell a small employer in Virginia a 2015 medical policy that includes the bundled pediatric dental product, a broker can raise a red flag to their client that this is no longer a requirement and they can continue to purchase dental care elsewhere if they’d like.

‘Tidal wave’

As benefit brokers and advisers know all too well, most small groups chose to renew benefits early — in December 2013 — to avoid premium rate hikes widely anticipated as an effect of the ACA. As such, Roanoke-Va.-based benefit broker Amy Mutter says she hasn’t dug into this issue yet because she won’t be quoting her small-group clients, the bulk of her business, until later this year.

Also see: Save your small-group revenue

“I think there’s going to be a tidal wave of people trying to figure this out in the fall,” says the incoming president of the Virginia Association of Health Underwriters and account executive at Benefits Group Inc. “It’s confusing for brokers and groups to understand what they need. You have the dental coverage for adults in one place, so this [change in Virginia for pediatric dental] would make sense to me.”

She says that many employers want to provide standalone dental to their employees. “For a lot of reasons that make good sense, you want to be on the same product. You don’t want to deal with mom and dad having access over here and then the children on the other end. And, with some pediatric dental plans I’ve seen with medical carriers, they’re subject to the medical deductible. It could just be very confusing for a family to consider what they have.”

She says she’d like to understand more about this issue, as it will likely be a crucial discussion when her groups start renewing this fall. “I think the broker community is still trying to wrap their hands around this — we’ve been caught up in exchange enrollment and this has been one of the less urgent pieces, but it’s intriguing to me.”

She adds, however, that she will take conversations on this topic on a client-by-client basis because in some cases the pediatric dental bundling with medical plans could be a good fit.

Pyle says brokers advising clients should keep in mind that this issue is really on the carriers: “A really important point is that the requirement is on the health carriers— it defines what carriers can and cannot sell. It doesn’t tell small groups what they can and cannot buy. The enforcement is at the state insurance department level and that’s why brokers should be aware of how states are starting to change this.”

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