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August 04, 2015 at 07:35 AM
As a result of implementation of the Patient Protection and Affordable Care Act (PPACA), it’s important for employers to recognize that traditional dental plans can be very cost-effective.
More than ever, people are evaluating their health insurance options and many are wondering how dental benefits fit in the mix. As employers continue to evaluate the impact of PPACA and communicate benefit structures to employees, the following four key tenets should be kept in mind, according to Delta Dental.
1. On the public health care exchange, medical plans may include dental benefits for children.
The Pediatric Oral Essential Health Benefit (POEHB) provides:
- Coverage up to age 19;
- Coverage for preventive and restorative dental care;
- No annual or lifetime benefit maximum;
- Annual out-of-pocket limit of $700 per child or $1,400 per family, and;
- Coverage for medically necessary orthondontia (such as for cleft palate).
Some medical plans on the exchange may include the above dental benefits. Medical plans can also exclude children’s dental benefits as long as it is stated in the coverage description. Plus, a traditional dental plan, off-exchange, can additionally provide optional orthodontia and cover dependents to age 26.
2. Not all medical plans pay children’s benefits equally and you do not have to purchase pediatric dental care from a medical carrier.
Many misconceptions remain in the marketplace surrounding the necessity of coverage — the plans are not required to be purchased, only required to be offered.
