Posted November 18, 2013
The Affordable Care Act (ACA) launches in January 2014. Do you know whether it will affect your dental and vision benefits?
Health care reform and the ACA will change the face of medical coverage for many Americans.
But here’s the good news: You do not need to make any changes to your dental and/or vision plan, and you can keep your current benefits at least until your 2014 renewal.
As a dental and vision insurance carrier, Ameritas has tracked health care reform since its beginning. And we want to make sure you have the facts about dental and vision coverage in relation to the ACA, so you can maintain the coverage you and your employees need.
Small employer and individual requirements
Beginning Jan. 1, 2014, insurers are required to offer Essential Health Benefit (EHBs) packages to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. EHB packages include pediatric dental and vision, typically up to age 19. In the small employer market, medical carriers must include pediatric vision in their plans. Pediatric dental and family dental coverage can be sold in separate dental policies in most states in or out of exchanges.
All consumers, with a few exceptions, are required to have medical coverage in 2014, regardless of the size of their employer. If they don’t have Minimum Essential Coverage, they will be subject to a fine.
Choices for employers
Employers are not required to purchase health coverage for employees and their dependents through a health insurance exchange, which means they may keep their medical, dental and vision benefits with their current insurance carriers.
Employers can replace the pediatric dental coverage in their current Ameritas stand-alone dental plans with pediatric exchange-certified pediatric dental EHB. Or they simply may add the pediatric dental EHB, and Ameritas will process pediatric dental claims through both plans – traditional and EHB – and pay the better of the two benefits. Ameritas offers exchange-certified pediatric dental EHB in most states. In states where we do not offer exchange-certified pediatric dental EHB, we offer benefits that match EHB standards.
Other key points to know (in most states)
- Within the exchange, the medical plan can exclude dental if the exchange offers a stand-alone dental plan providing the required pediatric dental benefits.
- In the private market, the medical plan can exclude dental if the medical carrier is reasonably assured that individuals have obtained pediatric dental benefits through a certified stand-alone dental plan.
- No purchase of pediatric dental is required if it is offered in an exchange on a stand-alone basis; this means you can buy your family dental outside the exchange.
- Traditional pediatric orthodontia coverage may not be available in state exchanges or EHB packages. Currently only orthodontia declared medically necessary (for example, coverage related to a cleft palate condition) would be covered as an EHB. Children currently undergoing a traditional orthodontia treatment program that extends beyond 2013 may be impacted significantly if their coverage is moved to an EHB or exchange plan. Some plans may offer additional options with pediatric orthodontia coverage, but benefits and providers may differ from existing plans.
The goal of health care reform is to extend benefits to more Americans for better health. For updates on dental and vision insurance within the ACA, visit our Affordable Care Act section. You can also compare stand-alone dental coverage versus a medical plan with pediatric dental coverage.