Family on Exchange Without Dental ?

[Yagents]

PD is an EHB. They offer non PD plans, giving consumers the ability to purchase a separate one. Tecnically, NO PD = fine. But, how the hell they gonna track it. Plus, the penalty amount is less than the cost of adding PD in a number of situations.

Also, HC.gov client got PD added to their Health Net plan, after the fact, by HC.gov. The $50/mo increase for 60 yr old woman was not a fund conversation. She only makes $20k, penalty is $200. Adding PD is $600

I shun Health Net as much as possible, absolute nightmare.

 

[AllenChicago]

Yesterday's BCBS-IL agent newsletter (we've been getting 1 a day this week!) says that if a family with children opts out of Pediatric Dental, or wants to cancel Pediatric Dental after purchasing it, they NOW need to submit PROOF that they have Pediatric Dental in-force from another source.

Before this week, just checking off the "dental attestation" box was all that was needed to avoid purchasing PD. Or, simply calling BCBS-IL and canceling it. Either HHS, or the BCBS-IL attorney's put the ka-bosh on this practice.
ac

 

[kgmom219]

I love exchange biz....

This is what I understand:

1. If you are ON exchange AND receiving a subsidy, you don't have to have peds dental

2. If you are ON exchange WITHOUT a subsidy, you have to have peds dental

3. If you are OFF exchange, you have to have peds dental

 

[Ann H]

I love exchange biz....

This is what I understand:

1. If you are ON exchange AND receiving a subsidy, you don't have to have peds dental

2. If you are ON exchange WITHOUT a subsidy, you have to have peds dental

3. If you are OFF exchange, you have to have peds dental

Makes sense to me

 

[Ann H]

I found information on a Delta Dental website that answers some of the questions. See the attached pdf.

 

[Ann H]

So, tonight I've been reading a lot about this Pediatric Dental thing. Here are some things I learned:

1. Embedded vs Stand-alone. Some consumer advocates say Embedded is better because Stand-alone can have OOPs of $700 ($1400 family). Dental carriers say stand-alone is better, because if the dental is embedded in the medical plan and you have a high deductible (like $6,350 / $12,700 for instance), the kid will never get dental benefits.

2. I guess the law says that unless your state requires it, you do NOT have to buy pediatric dental if you give reasonable assurance that you have purchased it elsewhere. However, the "elsewhere" that you purchase it from must be a plan that is certified by the exchange. This is for small group & IFP.

3. If you purchase it stand-alone, there is no subsidy for that premium.

4. However, if your state's benchmark (2nd lowest cost Silver) plan is a plan without Ped Dental, you're out-of-luck on that part of the subsidy anyway. That happens here in AZ. Our 2nd lowest cost Silver is a plan that doesn't have Ped. Dental. I was so confused as to why all the quote engines, Kaiser's subsidy calculator, and healthcare.gov all used this benchmark plan, even when children are enrolling. But I guess a state's 2nd lowest cost Silver can be without Ped Dental, and since the subsidy is based on that benchmark plan, then you won't get extra money for the cost of Pediatric Dental whether it's embedded or stand-alone.





Health reform: Is childhood dental insurance required? That all depends | OregonLive.com

https://www.cdhp.org/resources/165-faqs-pediatric-oral-health-services-in-the-affordable-care-act

Legal Loopholes Leave Some Kids Without Dental Insurance : Shots - Health News : NPR

There's a hitch, advocates say: States that opt to offer stand-alone dental policies do not have to require parents to purchase them. While some states, such as Washington and Nevada, are making it a requirement, others are not, according to Colin Reusch, a senior policy analyst with the Children's Dental Health Project. So in effect, although pediatric dental benefits are "essential," they will not be mandatory in all states. Kids

http://www.ameritasgroup.com/OCM/GetFile?doc=374205

https://brokernet.kp.org/broker/res...ewsletter/2013/pediatric-dental-coverage.html

Covered Calif. To Require Pediatric Dental Coverage Starting in 2015 - California Healthline - I guess in California, only 27% of families with kids even bought Ped Dental, so next year the People's Republic of CA is going to mandate it.

 

[HealthGuy]

so the states decide if you get a penalty for not carrying ped. dental ?