As open enrollment season begins for health care insurance, a new article advises employers to retain their dental plans to ensure full coverage.
Dental Coverage in the new Health Care Insurance Environment
“The Guardian Life Insurance Company of America (Guardian), one of the nation’s largest mutual life insurers and a leading provider of employee benefits, today announced it is offering a comprehensive suite of dental benefits that meets requirements of the Affordable Care Act (ACA). In anticipation of the January 1, 2014 implementation of ACA, Guardian is committed to providing its customers with high-quality dental coverage sold both on and off the small business health care exchanges.”
“Businesses and consumers could risk losing many of the dental benefits they have come to rely on if they mistakenly believe the oral health EHB is equivalent to a stand-alone dental plan.
“Under the new law, carriers that market to small businesses with 50 or fewer employees must include 10 essential health benefits (EHBs), which include pediatric oral health services, to be ACA-compliant. The required pediatric oral health services may be included within a medical plan or obtained as part of a stand-alone dental plan.”
Affordable Dental Health Care Insurance Options Should Include:
“… the required pediatric dental essential health benefits…ensuring members receive the greater benefit between traditional coverage and the required pediatric benefits.
“Employers who select medical coverage that includes the pediatric dental essential health benefit can keep their current plan or opt for Guardian’s comprehensive coverage that excludes pediatric preventative care. By excluding just preventive care, members under 19 will be covered for basic and major services under their Guardian plan without being subject to the medical plan’s deductibles and out-of-pocket maximums.
“According to Jolynne Williamson, Assistant Vice President, Group Dental Products, of Guardian, consumers will be faced with new options for their dental coverage this enrollment season. There are a number of advantages to purchasing a stand-alone dental plan, rather than relying solely on the pediatric benefit that comes within a medical plan.
“Businesses and consumers could risk losing many of the dental benefits they have come to rely on if they mistakenly believe the oral health EHB is equivalent to a stand-alone dental plan,” explained Williamson. Among the hidden pitfalls are:
- “The oral health EHB applies to members up to age 19, but not to adults, so children may be covered for dental but not their parents. This means adults may need to purchase separate dental insurance that could require them to go to a different dentist than their children.
- “When the pediatric dental benefit is part of a medical plan, a member may end up paying more out-of-pocket costs for dental services than with a stand-alone dental plan, due to having to meet their medical deductible or medical out-of-pocket maximum before being able to access their full dental benefits.
- “Medical insurers are not experts in dental care, and are unlikely to provide the size of network, level of coverage and streamlined processes for handling claims that dental insurers do.
- “Keeping dental separate lessens the impact of the Cadillac Tax which will be imposed on medical plans beginning in 2018 – stand-alone dental carriers are exempt from the tax.”
While Guardian is highlighted in this article, perhaps you’ve been approached by your own dental insurer with similar dental health care insurance coverage. Please share your dental insurance experience in the comments section below or on our facebook page.
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