Slideshow ACA pediatric dental compliance: 4 strategies for brokers

Published
  • January 13 2014, 12:16pm EST
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Overview

Much of the conversation about the ACA focuses on health insurance, but pediatric dental is part of the equation, too. Health benefits offered by small businesses (50 or fewer employees) must include the pediatric dental essential health benefit, either embedded in the medical plan or in stand-alone dental. As employers seek solutions that balance what they need with what they want, they continue turning to brokers for assistance, says Warrington.

Strategy No. 1: Optimal choice in coverage

Select a medical plan with the embedded pediatric dental EHB, alongside a traditional, stand-alone full family dental plan. This strategy provides optimal choice in dental coverage for individuals of all ages, explains Warrington. It may create some overlap in services offered for the pediatric population, but it also offers several advantages, including full family dental coverage, continued access to the existing dental provider network, assurance of ACA pediatric dental EHB compliance, and more.

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Strategy No. 2: Lower cost compliance

Select a medical plan with the embedded pediatric dental EHB and a stand-alone dental plan that covers only individuals age 19 and older. This option, according to Warrington, balances coverage with affordability by offering full family dental coverage without overlap for the pediatric population. Because individuals 19 and older are covered separately from those 18 and younger, the stand-alone plan can exclude certain pediatric-only benefits, such as sealants or root canals on baby teeth, to further control costs. In states where this strategy is not approved, look for dental plans with tiered rates.

Strategy No. 3: Coverage with uncertainty

Select a medical plan without the pediatric dental EHB, and a stand-alone, exchange-certified dental plan. This strategy comes with greater uncertainty, says Warrington, because dental coverage will need to be scrutinized closely to ensure compliance. ACA regulations for this strategy vary, depending on whether the plan is on or off the public SHOP exchange. Medical plans on the SHOP can only exclude the pediatric dental EHB if there is a stand-alone pediatric dental EHB option on that exchange. Off the SHOP, medical plans can only exclude the pediatric dental EHB if the medical carrier is “reasonably assured” that all individuals covered by that medical plan have obtained exchange-certified pediatric dental coverage elsewhere.

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Strategy No. 4: Employee choice

Cost-conscious employers can send employees to the SHOP to make the choice. Under this strategy, Warrington says brokers can offer a medical plan without the pediatric dental EHB, and a stand-alone dental plan with the pediatric dental EHB, on the SHOP. In most states, employers can send employees to the SHOP to purchase the medical plan, and employees can then opt in or out of the stand-alone pediatric dental EHB plan that is also available on the SHOP (the stand-alone option must be made available on the SHOP, but individuals are not required to purchase it). Additionally, under this strategy, brokers and their small business clients can continue to offer a traditional, stand-alone full family dental plan off the SHOP.