Coverage for pediatric dental care is considered an essential health benefit under the Affordable Care Act (ACA).
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
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:
- There is at least one dental plan available for purchase that offers the minimum essential pediatric dental benefits, AND
- 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 (firstname.lastname@example.org).