Other key points (in most states):

Within the exchange, the medical plan can exclude dental if the exchange offers a stand-alone dental plan providing the required pediatric dental benefits.
In the private market, the medical plan can exclude dental if the medical carrier is reasonably assured that individuals have obtained pediatric dental benefits through a certified stand-alone dental plan.
No purchase of pediatric dental is required if it is offered in an exchange on a stand-alone basis. This means you can buy your family dental outside the exchange.
Traditional pediatric orthodontia coverage may not be available in state exchanges or EHB packages. Currently only orthodontia declared medically necessary (for example, coverage related to a cleft palate condition) would be covered as an EHB. Children currently undergoing a traditional orthodontia treatment program that extends beyond 2013 may be impacted significantly if their coverage is moved to an EHB or exchange plan. Some plans may offer additional options with pediatric orthodontia coverage, but benefits and providers may differ from existing plans.

Ameritas stand-alone dental plans provide:

Dental expertise
Dental-focused customer service
Accurate pricing
Flexible and customizable benefits
Claims-paying systems designed specifically for dental
Nationwide, credentialed provider network
Dental wellness knowledge

Adults need their own dental and vision coverage, too.

EHBPs from medical carriers likely will cover only members of pediatric age (under age 19 in most states). With these plans, adults would need to purchase dental and vision plans separately for themselves and dependents age 19 and older. This means that family members may have different benefit plans, networks and insurance carriers. By keeping stand-alone dental and vision coverage with Ameritas, the entire family can stay together on the same plan and continue with their current providers.

No flexibility offered in public exchanges for dental and vision. Employers and individuals exploring benefit options through a state exchange or private marketplace should review the plan design carefully to understand the coverage options. Plan choices will be limited, and employers will not be able to customize plans.

Plans in an exchange may not be cheaper than those offered by an insurance carrier in a private exchange market. Premiums probably will be based on limited criteria instead of utilization trends that are typically used from within an employer's industry or claim experience. Since insurance carriers will be charged by state and federal administrators to participate in exchanges, these fees likely will be included in the premium costs.

Focus on dental and vision as a wellness benefit. Surveys show that people with dental and vision insurance tend to use their benefits, including scheduling regular checkups and exams so doctors can evaluate the health of their teeth and eyes and develop a treatment plan to address concerns.

Employees may think that deferring the purchase of dental and vision coverage will save money, but in reality they may risk developing serious health concerns and incurring significant bills for medical services.

Instant Insights /

Will Dental and Vision Coverage Change Under the Affordable Care Act?

More From HR Executive

Related Stories

Recommended For You