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Broker News | September 2014 | Vol. 9 No. 10
Broker News | September 2014 | Vol. 9 No. 10

Pediatric Dental Compliance Update for Small Groups

Beginning January 1, 2015, Dental Blue Options, Dental Blue Classic and Smile Saver plans will no longer satisfy the requirements of the Affordable Care Act (ACA) for pediatric dental benefits. These dental plans are no longer compliant because they do not meet the requirements of the ACA that stand-alone dental plans be offered both on and off the exchange, and include an out-of-pocket maximum on pediatric dental benefits.

How is pediatric dental different from other essential benefits?
Although similar to the maternity care or pediatric vision essential benefits, because most medical health insurance carriers do not administer dental plans, the pediatric dental benefits can be carved out from medical coverage and provided by an exchange-certified, stand-alone dental carrier.

How can employer groups ensure their compliance?

1. Purchase a medical plan with pediatric dental benefits included

OR

2. Purchase a qualified pediatric dental plan in addition to their medical plan

Ensuring compliance for 2015 renewals
Existing small groups who purchased plans directly through Excellus BCBS (off-exchange) that did not include pediatric dental benefits, will be automatically mapped to a compliant plan upon renewal, beginning 1/1/15.

 

If your group has: What should you do?
An Excellus BCBS plan with embedded pediatric dental coverage No action required
An Excellus BCBS plan without embedded pediatric dental coverage No action required. Starting 1/1/15, we will automatically map existing groups upon renewal to the same medical plan that includes pediatric dental coverage
Compliant pediatric dental coverage through a different carrier, they can remain in their existing Excellus BCBS medical plan without pediatric dental coverage
  • Submit an Attestation Form with the name of the other carrier
  • To simplify the enrollment process, Attestation Forms must be submitted by these dates.
Please note: Forms not received by the dates above will require additional paperwork (i.e., new rate sheet, benefit summary) and will take approximately 1-2 weeks to process.


More information about all dental options available for your groups will be coming soon.

See our Pediatric Dental Frequently Asked Questions for more details.

Please contact your dedicated Account Consultant if you have any questions relating to this update.

 

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