Pediatric Dental

[RayNY]

Well, I've searched the forums high and low, called carriers and the exchange, and can't get a straight answer or reference.

I know Pediatric Dental is an EHB. I know carriers are not required to offer it if a stand-alone option is available. I'm having some issues with specific cases, and I'm starting to get annoyed at the exchanges "well if it's there it's right" answer, because obviously, most of their stuff isn't right and I'm not trying to get sued by an angry client who got a penalty. The fact that they say dumb things like "pediatric dental is required so it's free" reinforce the fact that they aren't always right.

Moral of the story: some carriers have it on some products, some don't. Those that do, offer it on all tiers. Depending on which quote source you go to, sometimes it's shown, sometimes it's not.

1) Who specifically is required to carry Pediatric Dental? My exchange states that only Individual/Child and Family plan policyholders must have it, and only if they have a child that would qualify (under 19 years old). The law (as far as I understand) says everyone must, as it's an EHB and without it, the plan is non-compliant and generates a penalty. I've seen fact sheets from carriers that state no one is required to purchase it. ADA says you only have to purchase it off-exchange.

2) Does failure to have compliant Pediatric dental generate a penalty? In what scenarios (have a child, don't have a child, etc.)?

 

[houcoogster]

If you don't have a stand alone dental plan they will add the cheapest one to the plan. I don't think they charge more for it, its kinda baked into the rates. That's BCTX.

Yes all plans have to have it even if no one can use it.

 

[AllenChicago]

Well, I've searched the forums high and low, called carriers and the exchange, and can't get a straight answer or reference.

1) Who specifically is required to carry Pediatric Dental? My exchange states that only Individual/Child and Family plan policyholders must have it, and only if they have a child that would qualify (under 19 years old). The law (as far as I understand) says everyone must, as it's an EHB and without it, the plan is non-compliant and generates a penalty. I've seen fact sheets from carriers that state no one is required to purchase it. ADA says you only have to purchase it off-exchange.

2) Does failure to have compliant Pediatric dental generate a penalty? In what scenarios (have a child, don't have a child, etc.)?

Regarding Item #1. You're right, Ray. Every family is required to carry Pediatric Dental, even if they have no children in the home. Our state's largest carrier gives the applicant the option to opt-out of obtaining at application time, if the applicant certifies that the family is covered by Dental elsewhere. But, if they don't have it and don't need it, the family must still choose to add the coverage. However, the cost is $0 for the "Dental For Kids" basic dental plan. It satisfies the EHB requirement that all Major Medical plans must have dental.

I wonder why carriers didn't just build Dental into all plans, like they did with the other Essential Health Benefits?

 

[dgoldenz]

Here's what Anthem told me:

-If plan is bought through exchange, pediatric dental not required (go figure)
-If plan bought off-exchange, pediatric dental is required to avoid the penalty

Anthem seems to be the only company in VA that has plans available off-exchange without the pediatric dental. For their gold plan, adding the dental can be anywhere from $20-100/month, even if there are no kids on the policy. Weird.

 

[RayNY]

So,

Hou says all plans (unless you have stand-alone)
AC says family (unless you have stand-alone. I presume parent/child is also included)
Dgoldenz says all plans off-exchange (unless there is a stand alone)

FYI, Cigna's release said the same thing as Dgoldenz, my gut agrees with Hou, and my exchange agrees with AC.

Has anyone seen any official guidance on this? I've been looking for a while, and haven't found anything concrete, which is quite rare for me. I'm gifted with tracking things down on the internet.

 

[HealthGuy]

You have got to be kidding me...If I sell an OFF EXCHANGE health plan with all EHBs for a family and you don't add a dental option it triggers a tax penalty? WTF, really?
How do you know if its a part of the plan a family buys OFF EXCHANGE? I thought all plans HAD to HAVE the pediatric dental with pricing built in (mandated) without paying extra in order for the plan to be considered a qualified health plan ?

BUT MAYBE NOT...oh man, ridiculous...More clarity here please.

 

[Yagents]

You have got to be kidding me...If I sell an OFF EXCHANGE health plan with all EHBs for a family and you don't add a dental option it triggers a tax penalty? WTF, really?
How do you know if its a part of the plan a family buys OFF EXCHANGE? I thought all plans HAD to HAVE the pediatric dental with pricing built in (mandated) without paying extra in order for the plan to be considered a qualified health plan ?

BUT MAYBE NOT...oh man, ridiculous...More clarity here please.

Assurant plans include pediatric dental, just look at the SBC after writing a client

 

[HealthGuy]

yes I noticed that Bill but what about the other companies?

 

[houcoogster]

Man guy's come on here. If you sign a thing saying you already have it elsewhere you're good. If you do not buy a dental plan with the policy and don't sign the alternate coverage thing then they tack on the cheapest pediatric dental plan. Don't make it hard.

 

[xrac]

You have got to be kidding me...If I sell an OFF EXCHANGE health plan with all EHBs for a family and you don't add a dental option it triggers a tax penalty? WTF, really?
How do you know if its a part of the plan a family buys OFF EXCHANGE? I thought all plans HAD to HAVE the pediatric dental with pricing built in (mandated) without paying extra in order for the plan to be considered a qualified health plan ?

BUT MAYBE NOT...oh man, ridiculous...More clarity here please.

You have got to be kidding. This is the work of whacked out liberals who hate our country and embrace communism.