Dental for Kids

[thebig_j]

For a 2014 plan do you HAVE to buy dental for kids. I thought pediatric dental and vision were "included in QHP's." However when I completed a app with bcbs it said BUY child dental and it wasn't cheap.

So is this how its included? Is it tacked on at the end with all carriers like it was at BCBS? should we tell clients to expect it to be addd on at time of sale?

If they chose "other coverage" and don't have any (baby only 2 months old... no teeth) will they be penalized?

This was Off exchange

Thanks as always

 

[RayNY]

-You DO have to have pediatric dental if a qualifying individual on the plan (parent/child or family plan where the child is <19 years old at time of enrollment). We interpreted the law as meaning everyone must have the benefit, but my Exchange has informed me you only need it if there is a qualifying child on the policy.

-It does not have to be "included", just "offered". Some carriers are "including" or "embedding", but under law, that is not required, but is allowed. The onus of compliance is on the individual.

-Some carriers will tack it on at the end, some have it embedded. Some use their own product, some use a 3rd party dental provider. You will likely need separate appointment to receive comp if a 3rd party is used. You have to check each carrier, and product, both on and off exchange (as it differs in many cases) to know which is which.

-If they (clients) choose "other coverage", and knowingly lie on their application, before signing and affirming they have not lied, knowing full well they have a child under age 19 on the plan, yes, they will be penalized, and possibly more.

These are legal contracts, and the coverage will likely be scrubbed for compliance by some gov't agency at some point. Don't presume it's just going to sit in a folder at the carrier for it's entire life.

 

[ActuaryGuy]

On a recent call, one of the CMS reps stated in no uncertain terms that EVERYONE was required to carry pediatric dental coverage to meet the minimum coverage requirements, just like everyone carries maternity.

Just what I heard. As we all know, this could easily be incorrect!

 

[TxOnline]

This makes NO sense at all, but most of the companies are telling agents that:
- ON-Exchange Plans are NOT required to include Pediatric Dental
- OFF-Exchange Plans MUST include Pediatric Dental

Some of the companies are automatically embedding it (into the benefits & pricing).
Others are tacking it on....AFTER they pick their Medical Plan...before checking-out...(with an option to certify that the children already HAVE a dental plan in force).

...

 

[TxOnline]

From Kaiser Q&A:

I can't afford the cost of a stand-alone dental plan in addition to buying major medical health insurance. Will I owe a penalty for not having Minimum Essential Coverage if I don't buy the separate dental plan?

No. You do not need to have pediatric dental coverage to avoid the penalty.

 

[taterpeeler]

My opinion only here based on what I have read in the law and cussed and discussed here.

With all due respect to txonline I don't know of this "most of the companies are telling agents" comment to be true. We both sell in Texas and we probably both sell BCBS as our main player.... they require it of attest to having other coverage that meets the specs.... attesting and just flopping a name of a carrier just flat wont work. So again, I am not aware of ANY carrier claiming we don't need it, it's the law.

Next, when doing an application at HC.GOV they tell you the plan you are purchasing does not have dental and request you select a dental plan. No they don't force you.

According to the statue it states pedi dental is required on all plans with kids otherwise you are not in compliance. I do feel with all the problems they winn not enforce this one but who knows.

Why is dental required on BCBS for only adults? My thought is because if the wife gets prego dental is required for the kid.... but the plan cost nothing until the baby pops out.

Also, dental with BCBS seems to be having problems and several have been pushed to the back burner on processing all probably because of the screw up with getting the health plans effective

 

[AllenChicago]

My opinion only here based on what I have read in the law and cussed and discussed here.


Why is dental required on BCBS for only adults? My thought is because if the wife gets prego dental is required for the kid.... but the plan cost nothing until the baby pops out.

Oh really? I heard that the plan is free until the baby's first tooth pops out the gum.

 

[taterpeeler]

Oh really? I heard that the plan is free until the baby's first tooth pops out the gum.

Riddle me this batman.... Are there tooth police now?.... My boy was born with toothfess.... My girl toothless.....what say you oh masked crusader

 

[thebig_j]

Oh really? I heard that the plan is free until the baby's first tooth pops out the gum.

? Is this true. Blue told me they still had to pay even though the kid is 2 months old

 

[AllenChicago]

Riddle me this batman.... Are there tooth police now?.... My boy was born with toothfess.... My girl toothless.....what say you oh masked crusader

Friend Tater, you have to fill out Tooth Affidavit, OMB Form 2201, have it notarized and uploaded to the Marketplace after the dentist certifies that baby's first tooth has cleared the gum-line by at least 1/22nd of an inch. Within 90 days, you'll receive a dental coverage authorization that you can send to the carrier for a bill that's retroactive back to the day that OMB-2201 was received by the Marketplace. Parents who do this will be 100% in compliance and not receive a visit from Uncle Sam's tooth fairy police.
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