Confused Individual Policyholder In IL (Can Someone Help Clarify Pediatric Dental?)

[Suburban Gal]

My name is Elizabeth and I reside in Northeastern IL. I live in the northern suburbs of Chicago.

I just signed up for a bronze BCBS PPO plan outside of the federal run Marketplace. I have a stand-alone indemnity/FFS dental plan with Assurant Health.

I've read that the Affordable Care Act ("ACA") requires insurance companies to be reasonably assured that I and each member on the policy has coverage for pediatric dental services, which has since been deemed as an essential health benefit, and that the ACA requires this benefit even if there's no one on the policy who is eligible for that service.

In addition, it appears you can get around that by signing up through the federal and state run exchanges, which I have no immediate plan of doing. (I'm quite leery of accepting any subsidy and going that route.)

I'm quite happy with my stand-alone indemnity/FFS dental plan with Assurant Health and don't see a point in paying for pediatric dental services since I'm not married and don't have any children at this stage in my life.

It's my understanding that the states were given [a lot of] leeway as to the decision of exactly what dental services would be offered.

I've done a lot of googling and am having a hard time deciphering the information out there. A lot of the information is confusing to me and some of it is even muddled.

Just what is the deal in regards to IL with pediatric dental? Do I need to have it? Will I be penalized if I don't have it and continue with a stand-alone dental plan? Why am I being asked to pay for something I really don't need and want to have?

I'm not a very happy camper right now and am upset I had to give up my CoreMed plan with Assurant Health for a stupid metallic plan with BCBS (the metallic plans with Assurant were way too expensive for my pocketbook). IMHO, they should've left well enough alone.

This isn't right. I can't tell you just how pissed off I am over all this.


Hoping someone will be quite helpful in my endeavor to gain some clarity to all this.

 

[AllenChicago]

My name is Elizabeth and I reside in Northeastern IL. I live in the northern suburbs of Chicago.

I just signed up for a bronze BCBS PPO plan outside of the federal run Marketplace. I have a stand-alone indemnity/FFS dental plan with Assurant Health.

I've read that the Affordable Care Act ("ACA") requires insurance companies to be reasonably assured that I and each member on the policy has coverage for pediatric dental services, which has since been deemed as an essential health benefit, and that the ACA requires this benefit even if there's no one on the policy who is eligible for that service.

In addition, it appears you can get around that by signing up through the federal and state run exchanges, which I have no immediate plan of doing. (I'm quite leery of accepting any subsidy and going that route.)

I'm quite happy with my stand-alone indemnity/FFS dental plan with Assurant Health and don't see a point in paying for pediatric dental services since I'm not married and don't have any children at this stage in my life.

Just what is the deal in regards to IL with pediatric dental? Do I need to have it? Will I be penalized if I don't have it and continue with a stand-alone dental plan? Why am I being asked to pay for something I really don't need and want to have?

I'm not a very happy camper right now and am upset I had to give up my CoreMed plan with Assurant Health for a stupid metallic plan with BCBS (the metallic plans with Assurant were way too expensive for my pocketbook). IMHO, they should've left well enough alone.

This isn't right. I can't tell you just how pissed off I am over all this.

Hello Elizabeth,

My name is Allen. I'm a licensed broker with BCBS-IL who lives in the NW suburbs not too far from you.

The Affordable Care Act requires that all individuals have Pediatric dental coverage. Illinois follows the ACA guidelines to the letter. Both On-Exchange and Off-Exchange are the same here in that regard.

You can keep any stand-alone dental plan that you now have. No need to get rid of it. On the BCBS-IL enrollment form, you check the box that says you already have dental coverage and don't need BCBS dental.

If you didn't have dental, and don't want dental, you would simply choose the "Pediatric Dental 4 Kids" option, to stay in compliance with the law. It's 100% free.

Also, be aware that there are two levels of BCBS-IL Bronze. One is the "Blue Choice PPO" and the other is the "Blue PPO". If you chose the Blue Choice option, be certain that your doctor(s) and local hospitals are in that plan's PPO network. The Blue Choice PPO plans cost much less than the Blue PPO plans, but 60% of Illinois doctors and hospitals do not participate in Blue Choice.
Go here to make sure: https://public.hcsc.net/providerfinder/search.do?corpEntCd=IL1&WT.svl=FADButton

I hope this feedback was helpful for you, Elizabeth.
-allen

 

[Suburban Gal]

The Affordable Care Act requires that all individuals have Pediatric dental coverage. Illinois follows the ACA guidelines to the letter. Both On-Exchange and Off-Exchange are the same here in that regard.

Yes. I've noticed that the plans offered on the Marketplaces are the same as those off it. The prices may vary slightly, but they're essentially the same plans on and off.

You can keep any stand-alone dental plan that you now have. No need to get rid of it. On the BCBS-IL enrollment form, you check the box that says you already have dental coverage and don't need BCBS dental.

I did confirm I had dental coverage elsewhere and listed who the carrier of the policy was, i.e. Assurant health, however it's an indemnity/FFS plan and I'm the only one on that policy.

It's my understanding that if you choose to confirm you have dental coverage with another insurance company, then you're attesting that each person listed has coverage for children's dental essential health benefits through another dental QHP.

My dental plan with Assurant Health is just that, a dental plan. It's NOT considered a pediatric plan. However, it's a plan that I can add children to if I ever had children so they'd be able to receive the dental care they needed. Obviously, many dental plans can be purchased as a single individual, a two-person (e.g. married couple, single parent and child) or as a family plan in which everyone is covered.

That said, am I in compliance with the ACA?

Also, be aware that there are two levels of BCBS-IL Bronze. One is the "Blue Choice PPO" and the other is the "Blue PPO". If you chose the Blue Choice option, be certain that your doctor(s) and local hospitals are in that plan's PPO network. The Blue Choice PPO plans cost much less than the Blue PPO plans, but 60% of Illinois doctors and hospitals do not participate in Blue Choice.

Believe me, I found out the hard way. I already signed up for a blue choice metallic plan when I learned my provider and choice hospital were dropping the blue choice plans altogether so I had to re-submit a new application for a blue PPO metallic plan.

I hope this feedback was helpful for you, Elizabeth.

Yes, somewhat. Thank you.

 

[AllenChicago]

Elizabeth,

When you complete your FY2014 income taxes, you'll have to answer whether or not you owned an Affordable Care Act health insurance plan in 2014. Strictly speaking, your policy is NOT in 100% compliance with the Affordable Care Act.

To avoid having to potentially pay an IRS penalty-tax when you complete your FY2014 taxes, simply call Blue Cross @ 1-800-538-8833 and tell the customer service person that you'd like to add Free Pediatric Dental to your newly purchased Blue PPO Bronze plan. You can then put this concern behind you.

-Allen

 

[HealthGuy]

What if a family purchases a plan on exchange without pediatric dental and they don't choose a stand alone pediatric dental plan on exchange either?
How is this fair that their on exchange plan offers no pediatric dental for free (built into the plan) but all off exchange plans have to include it to comply with the law?
Makes no sense.

 

[Suburban Gal]

When you complete your FY2014 income taxes, you'll have to answer whether or not you owned an Affordable Care Act health insurance plan in 2014. Strictly speaking, your policy is NOT in 100% compliance with the Affordable Care Act.

To avoid having to potentially pay an IRS penalty-tax when you complete your FY2014 taxes, simply call Blue Cross @ 1-800-538-8833 and tell the customer service person that you'd like to add Free Pediatric Dental to your newly purchased Blue PPO Bronze plan. You can then put this concern behind you.

At this point in time, I don't give a rat's ass if it's NOT in compliance. It's bad enough I have pediatric dental on my plan.

I'm a single person. I have no children. I should be EXEMPT from having pediatric vision and dental.

 

[Suburban Gal]

How is this fair that their on exchange plan offers no pediatric dental for free (built into the plan) but all off exchange plans have to include it to comply with the law?
Makes no sense.

It's my understanding that if I don't want pediatric dental, then I can buy coverage through the Marketplace Exchanges; however, if I choose to buy it on my own directly from the insurance company, then I need to make sure I have it.

You're right. It makes no frackin' sense at all.

This is all ridiculous if you ask me as a consumer. It almost makes me want to go without any healthcare coverage altogether.

I hate to say it, but people like me are the ones getting the shaft in wake of all this.

 

[TxOnline]

Elizabeth:

If you decide to make ANY further changes to your 2014 plan, you should consider using Allen...as a FREE agent (to you).

He's a conscientious agent & will do what's RIGHT for you (in addition to being a valuable resource for you now and into the future).

Also consider referring him to your friends & family.

I have NO dog in this hunt!
Just KNOW that he's a SUPER agent (from reading his posts over the years).

You can PM Allen for his contact details.....(send him a private message on this forum).

 

[Ann H]

At this point in time, I don't give a rat's ass if it's NOT in compliance.

Hi Suburban Gal - You may care if it's not in compliance when you file your 2014 taxes, because the penalty is the greater of $95 or 1% of your income. Free dental is better than a penalty/tax on 1% of your income.

AllenChicago is a fine agent, well-educated and experienced. Using a professional like this is also free to you, because the cost is the same whether you go direct to Blue Cross or list him as your agent/broker. You can do that with a simple Broker of Record letter, and I recommend that you do. Allen will help you steer around the many landmines in this law, and you'll be glad you made that decision.

 

[Bob_The_Insurance_Guy]

AllenChicago is a fine agent, well-educated and experienced. Using a professional like this is also free to you, because the cost is the same whether you go direct to Blue Cross or list him as your agent/broker. You can do that with a simple Broker of Record letter, and I recommend that you do. Allen will help you steer around the many landmines in this law, and you'll be glad you made that decision.

I second that. To the original poster: according to Nancy Pelosi, these plans are better, and you just don't realize it yet.