Coverage for pediatric dental care is considered an essential health benefit under the Affordable Care Act (ACA).

Pediatric Dental Care in Virginia

Breaking News regarding pediatric dental coverage for health plans in Virginia starting in 2015!

Several months ago we wrote about pediatric dental coverage in Virginia (click here to read the original post).

To summarize briefly, all 2014 individual and small group (50 or fewer employees) health insurance policies sold outside the federal exchange are required to include coverage for pediatric dental care.  But for policies sold through the exchange, the mere presence of a stand-alone dental carrier option on the exchange has been interpreted to mean medical plans on the exchange are exempt from the requirement to include coverage for pediatric dental care.

Dual System for Pediatric Dental Benefits in 2014

Inadvertently, the law created a dual system of sorts — one for people buying insurance on the exchange and one for people buying outside the exchange.

Individuals and small employers (with 50 or fewer employees) buying coverage outside the exchange in Virginia in 2014 face a few hurdles when it comes to pediatric dental coverage:

  • Coverage for pediatric dental care must be included (and paid for) in a health insurance policy even if the applicant has no children.
  • Coverage must be included (and paid for) even if the applicant has chosen to have (and pay for) a stand-alone dental plan.
  • Parents may be misled into dropping their children from stand-alone coverage.  But in fact, the coverage included (or embedded) into a medical plan is typically not as comprehensive, may not include the family’s dentist in its network, and is subject to the medical plan’s (often large) deductibles.

New Laws in Virginia for 2015

Last month, the Virginia Assembly passed two bills into law: HB33 and SB484.

The new laws clarify the requirement for pediatric dental coverage and eliminate the dual system.

According to the new laws, individual and small group plans (50 or fewer employees) effective in 2015 and beyond do NOT have to include pediatric dental benefits as long as two conditions are met:

  1. There is at least one dental plan available for purchase that offers the minimum essential pediatric dental benefits, AND
  2. The health carrier discloses that pediatric dental benefits are not included in the plan.

Good News for Virginia Residents

At Virginia Medical Plans, we are pleased Virginia’s legislature has addressed the issue of pediatric dental coverage.

Starting with 2015 coverage, selecting the best dental coverage at the best price will be more straightforward for our individual and small group clients.

Give our office a call if you have any questions or need more information about dental coverage.  We can be reached by phone (800-867-0800) or email (jkatz@vamedicalplans.com).

short-term health insurance can bridge a gap in coverage

Short-term health insurance can be used to bridge a temporary gap in coverage. But it is important to understand characteristics of short-term coverage before you buy it.

Now that the window of opportunity to purchase 2014 Affordable Care Act (ACA)-compliant health insurance has closed, many people are wondering how they can be protected in the event of an illness or injury this year.

In most cases, if you did not purchase a 2014 policy before the March 31 deadline, your option for the remainder of 2014 is to purchase what’s known as short-term insurance.  (*See notes below for some exceptions.)

What is Short-Term Health Insurance

Short-term health insurance (also known as temporary coverage) has been around for a long time.  These are policies typically geared toward recent college graduates, people who may be between jobs, new employees waiting for group coverage to kick in, or anyone else needing coverage for a defined window of time.  Just as the name suggests, the coverage is intended to be temporary, for the short term.

Characteristics of Short-Term Health Insurance

If you missed the March 31 deadline to buy a 2014 policy and you are currently uninsured, being covered under a short-term policy is better than having no coverage at all.  As you research your options, however, it is important to understand the characteristics of short-term insurance.

  • Short-term plans are not subject to the rules of the Affordable Care Act (ACA).  Therefore, they typically provide less coverage than ACA-compliant plans.  Since they do not meet ACA minimum essential coverage requirements they typically do not cover things like preventive care, immunizations, maternity care, allergies, etc.
  • Short-term coverage can be denied for anyone who is sick.
  • Pre-existing conditions are usually not covered by short-term policies.
  • A short-term policy does not have guaranteed renewal.  This means if you buy, for example, a 60-day plan, the carrier is not required to renew your coverage at the end of 60 days.  If you get sick during those 60 days, your request to renew can be denied.
  • If you get sick during your initial policy period and your carrier does permit you to renew, that sickness is now considered a pre-existing condition under your new policy.  Any treatment for that condition will be denied.
  • Since they do not meet minimum essential coverage requirements, short-term plans do not satisfy ACA’s individual mandate.  This means if you have a short-term policy, you may still be subjected to a tax penalty under ACA.

Should You Buy Short-Term Health Insurance?

If you are reading this during an open enrollment period for health insurance under the Affordable Care Act (Nov 15, 2014 – Jan 15, 2015 for 2015 coverage), we would steer you away from short-term coverage in favor of an ACA-compliant plan with more robust coverage.

However, if you are reading this outside of open enrollment and you are currently uninsured, then we recommend a short-term policy as your best option.  After all, if you get sick or are injured and you have no health insurance, the financial impact could be tremendous.  Short-term coverage is definitely better than no coverage at all.

How to Buy Short-Term Health Insurance

To research your options for short-term coverage, visit the links below or contact our office for assistance.  You can reach us by phone 1-800-867-0800 or email jkatz@vamedicalplans.com.

Remember, short-term coverage is better than none at all.  Get in touch with us today!

 

*If you were “in line” using the federal health insurance exchange (healthcare.gov) on or before March 31, you have until approximately April 15 to complete your application.

*If you experience a qualifying event — e.g., change in marital status, change in job status, certain changes in income, birth/death/adoption of a child — you can purchase an ACA-compliant policy during what is known as a special enrollment periodClick here to read more.