California exchange frees plans from dental mandate

PPACA requires all QHPs to cover basic EHB package that includes pediatric dental benefits. Officials at the U.S. Department of Health and Human Services (HHS) have ruled that a QHP need not offer pediatric dental benefits if the exchange offers stand-alone dental plans, Lee said in the letter.

Lee told insurance regulators that actually requiring a QHP to provide pediatric dental benefits would conflict with PPACA requirements.

“Our federal colleagues have confirmed that Covered California must permit offering QHPs without pediatric dental in multiple conversations,” Lee said. “They were reluctant to provide written guidance on this point because they believed the text of the statute and regulations are so clear.”

Because the Covered California QHP solicitation process did not require QHPs to include pediatric dental benefits, none of the QHPs selected for the individual exchange program do so, and implementing the requirement in the original version of the emergency regulations “would cause a delay of Covered California’s health plan solicitation process, possibly by several months,” Lee said. 

See also:

• Stand-alone dental and the PPACA exchanges
• D.C. exchange chews on non-pediatric dental proposals
• Feds: Exchanges can set up life, disability alliances