A dental working group at the District of Columbia Health Benefit Exchange Authority has published a dental options report that illustrates some of the choices exchange builders are making.
The Patient Protection and Affordable Care Act (PPACA) requires federal regulators to work with officials in the District of Columbia and all 50 states to set up exchanges, or Web-based health insurance supermarkets, for individuals and small groups by Oct. 1.
Each plan sold in an exchange is supposed to offer coverage for an “essential health benefits” (EHB) package. PPACA requires the package to include pediatric dental benefits.
Jurisdictions can decide whether to set up their exchanges or have the federal government do the job. The District of Columbia is setting up its own exchange.
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The U.S. Department of Health and Human Services (HHS) has decided that the carriers that sell medical insurance through an exchange need not include the pediatric dental benefits in the benefits package if exchange users can also use the exchange to buy stand-alone dental plans that include the required pediatric dental benefits.
The HHS secretary has said that a stand-alone dental plan sold through an exchange can offer coverage for adults, if an exchange and its regulators allow that.
“D.C. law does not require it,” the D.C. working group said in its report.
The working group said all of its members agreed that insurers selling stand-alone pediatric dental plans through the exchange should also be able to sell non-pediatric dental benefits.
The working group said one controversy concerns “reasonable out-of-pocket maximums” — or the total amount an enrollee can spend on deductibles, co-payments and coinsurance amounts for in-network care each year.