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Update: Factors to Consider – Results of the Affordable Care Act

By Anne Treankler, Director, Actuarial Services

Update: Factors to Consider – Results of the Affordable Care ActAs we reflect on changes that occurred as a result of the Affordable Care Act (ACA), lingering uncertainty and confusion still exists. Just when you think you have heard the latest information, it may change. Delta Dental has been at the forefront of this changing landscape with a dedicated team to answer your questions from plan bundling information, to what is going to happen with dental pricing, or, when are non-compliant plans really expiring? Here are the changes that we can anticipate as a result of ACA:

  • The rating practices of health insurance issuers for individual and small group products have changed. Issuers may only vary the premium rate charged for a non-grandfathered medical plan in the individual or small group market by the following factors:
    • Age (maximum of 3:1)
    • Geography (rating area)
    • Family size (individual or family)
    • Tobacco use (within a ratio of 1.5:1)

All other rating factors are prohibited. This means that issuers who previously applied discounts to the medical insurance premium tied to the sale of additional ancillary lines are specifically prohibited from doing so. These rating changes do not apply to dental plans.

  • Insurance carriers are no longer allowed to apply discounts to the medical insurance premium when purchasing ancillary insurance – such as dental or vision – for the small group and individual markets. Bundling discounts are still allowed for non-medical plans such as dental and vision. Now may be the right time to revisit whether ancillary benefits that were originally bundled and sold alongside medical plans are still the best fit for your clients.
  • The deadline for issuers to renew non ACA-compliant medical plans – those that include the 10 Essential Health Benefits – has been extended to October 1, 2016 for plans that were in force on or before October 1, 2013. However, the limitation in rating attributes for medical plans still went into effect with 2014 renewals. Rest assured, dental insurance is considered an excepted benefit, so your current dental plan is now and will remain compliant. The good news is you can expect the same stable rates from Delta Dental.

No matter how you choose to deal with dental benefits in the ACA changing landscape, Delta Dental of Wisconsin is here with the tools and the people to simplify things. It’s the way we’ve done business for more than 50 years.

In This Issue

Beyond Benefits: Delta Dental Takes Part in WDA’s Mission of Mercy

Resources: Coming Soon! Employer Connection Updates

Product: Avoid the Unknown with Small Group Sales in 2015


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