Health plans in Virginia for groups of fewer than 50 employees will no longer have to offer pediatric dental benefits if certain conditions are met, according to a law recently passed by the state Legislature.
Insurers offering plans in the small group or individual market may omit pediatric benefits for 2015 if a qualified dental plan is available to the group or individual and the carrier discloses that pediatric dental care is not covered in the health plan, according to an IFAwebnews.com story.
One of the unintended consequences of the Patient Protection and Affordable Care Act is that employers with 50 and fewer employees, and people who shopped for insurance on their own, were effectively required to purchase pediatric dental coverage as part of their medical plan whether or not they had children and whether or not they already had a family plan with the dentist and plan design they preferred.
With the launch of insurance exchanges this year, people have access to two different marketplaces to shop for insurance. But there are significant differences in the rules between the on- and off-exchange markets. Carriers are offering exchange certified dental plans both on and off of the exchanges in Virginia.
In the exchanges, people can purchase all of the 10 required essential health benefits, but they can opt not to purchase pediatric dental coverage. Offering standalone dental coverage on an exchange relieves medical insurers of the obligation to provide pediatric dental coverage and relieves adults without children from being required to buy pediatric dental coverage.
Outside the exchanges, individuals and small employers were effectively required to purchase pediatric dental insurance as part of their larger health insurance plan.
This year, medical insurers can imbed pediatric dental coverage in their medical plans for individual and small employers, and require that a high medical deductible be met before any dental benefits are paid. In such situations, parents would take their children to what they thought was a covered dentist appointment only to discover that they had failed to meet their medical deductible.
In cases in which children are covered by a medical plan, parents might have been tempted to drop their children from the family's current dental plan only to discover that their child's dentist was no longer in network.
A recent survey showed that nearly half of Virginians (48%) said they would be at least somewhat likely to drop their own dental coverage if their children were covered through their medical plan, according to the story.
