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Product: No Child Left Behind … in ACA

Questions continue to be asked about the Affordable Care Act’s requirements of Pediatric Oral Essential Health Benefits (POEHB). What benefits must be offered? What about ortho? What are Delta Dental’s solutions?Product: No Child Left Behind … in ACA

First, the Pediatric Oral Essential Health Benefit (POEHB) is one of the 10 essential health benefits of medical plans offered to individuals or employers with 50 or fewer employees in 2014, and 100 or less in 2016. Federal guidance places POEHB compliance solely on medical carriers. The POEHB must be available within the medical plan, or on a standalone basis from specialty carriers such as Delta Dental.

In today’s market, most dental coverage is purchased through standalone dental plans. The ACA allows individuals and groups to continue to get dental coverage through these standalone plans.

Dental is an excepted benefit under the Affordable Care Act, and in Wisconsin, medical carriers marketing coverage to individuals and small groups need only to disclose whether or not the medical plan includes POEHB. This satisfies the ACA’s “reasonable assurance” requirement. Employers and individuals are not required to purchase POEHB to satisfy the minimum essential benefits requirements.

  • What benefits must be covered? In Wisconsin, the MetLife FEDVIP plan established the benchmark that defines what benefits are included as part of POEHB. But it does not establish the level of benefits (e.g. coinsurance).
  • What about orthodontia? Only medically necessary orthodontia services are covered requirements as part of POEHB. However, a waiting period can be applied. The FEDVIP benchmark plan includes a two-year wait on ortho and CMS affirmed this waiting period can be applied to medically necessary ortho.
  • What POEHB solutions will Delta Dental offer? Delta Dental group plan offerings can be found in our ACA Product Guide. Delta Dental has POEHB plans available on a standalone basis or in tandem with one of two Delta Dental PPO Plus Premier plans. However, realize that in most instances, a conventional Delta Dental plan can be purchased instead – and may be more affordable than a POEHB plan. Individuals looking for dental coverage should visit www.deltadentalcoversme.com for options.

Your Delta Dental sales representative is here to assist. We understand ACA in Wisconsin and can help you compare costs and find the plan that’s right for your situation.

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