Under the provisions of the ACA, individuals and small groups (defined as businesses with 50 or fewer employees, until 2016 when this rises to under 100 employees) must have a basic level of health coverage (called “essential health benefits”) beginning January 1, 2014.
The ACA requires that all plans offered within state exchanges and outside of exchanges (by private companies) cover these important basic services for individuals and small businesses. Large businesses, by contrast, are required to provide Minimum Essential Coverage (MEC), which may or may not include pediatric oral services.
If you already have a medical plan that includes pediatric dental coverage, you will not have to do anything, though you can add supplemental dental coverage to get more comprehensive benefits for you and/or your spouse and children.
Starting January 1, 2014, if you need to acquire ACA-compliant coverage for children, it can be acquired in one of these ways:
Please note: Inside state exchanges, pediatric oral services will be offered to small groups and individuals. Outside exchanges, all health plans approved to sell EHBs will automatically include pediatric oral services (unless “reasonable assurance” is provided to certify that an individual has purchased a separate exchange-certified stand-alone pediatric dental plan).
There are exceptions to ACA requirements. Visit your state’s exchange to determine if any exceptions apply to you, and in many state exchanges, pediatric oral services will be offered on an optional basis, not a mandated one.
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