Health Care Reform for Brokers and Consultants

When it comes to health care reform and dental coverage, we’ve got your clients covered with valuable dental coverage at affordable rates.

With dental plans that meet and complement the Affordable Care Act’s (ACA) required essential health benefits (EHBs) for pediatric dental care, we are your go-to for offering quality benefits on and off state exchanges.

We can give you the tools to help your clients make confident and responsible decisions about their dental benefits package, whether they want to:

  • Keep an existing plan,
  • Purchase a new plan,
  • Bundle separate dental and medical plans
  • Create other coverage combinations.

What you need to know

Your clients have options with Delta Dental. They can choose to:

  • Purchase a stand-alone, ACA-compliant1 Delta Dental pediatric dental plan within most state exchanges, or
  • Keep their traditional Delta Dental plan and add a stand-alone, ACA-compliant pediatric dental plan

Inside most state exchanges, Delta Dental offers several ACA-compliant plan options. Outside state exchanges, most states will allow insurers like Delta Dental to offer stand-alone pediatric dental plans that meet the ACA requirements when coupled with an ACA-compliant medical policy.

Important Purchasing Factors

  • Supplemental dental benefits plans (like our family plans) cover adults and adult dependents, as well as provide children’s benefits not typically covered by an ACA-compliant pediatric plan.
  • Important purchasing factors for your clients:
    • Choosing only an embedded plan (a medical plan that includes the EHB pediatric oral care requirement) may appear to be an easy way to meet the ACA requirement; however:
      • The dental portion won’t cover adults or children age 19 and over
      • Dental expenses may not be covered until a combined medical/dental deductible is met, which can be as high as $2,000 per person annually
      • Enrollees may have to change dentists to obtain services
    • Bundled medical/dental plans (separate dental and medical policies sold together to meet ACA requirements sold in some states) offer the same advantages as a separate stand-alone dental plan — a lower deductible and out-of-pocket maximum for dental — but with more meaningful dental coverage for children when compared to embedded dental plans.
    • Many medical insurers embed a pediatric EHB benefit in their policies. However, your clients can usually request that a medical insurer accept reasonable assurance2 to allow them to purchase a stand-alone, ACA-compliant dental plan. Usually, stand alone dental plans will have lower deductibles and out-of-pocket maximums, than embedded plans, allowing dental enrollees to benefit from coverage sooner that with embedded (integrated) coverage.

Helping Your Clients Choose Plans

Marketing our ACA-compliant plans is easy; however, before you help your clients choose a plan, you should consider the following:

  • You must be appointed by Delta Dental before marketing plans on the exchange. You will not receive commission if you market a plan before completing the exchange registration.
  • How to market plans offered on state exchanges:
    • Most states allow brokers to assist their clients in purchasing exchange-certified, stand-alone dental plans. Visit healthcare.gov to find the marketplace for your state.
  • How to market plans offered outside state exchanges:
    • In many states, Delta Dental sells EHB plans through a network of medical partners. To learn more about these plans, contact your Delta Dental Account Executive.
    • Your group clients can purchase plans through our Small Business Program or our medical partners.

We’re Here to Help

We have dental plans that meet and complement the ACA’s defined essential health benefit (EHB) requirement for pediatric dental care.

  • Within most state exchanges (and for small businesses, both in and outside the SHOP Marketplace3), we offer:
    • Coverage for families with plans that include the pediatric dental EHB requirement, but also provide benefits for adults
    • Coverage for children with plans covering only pediatric dependents

We’re happy to help you market ACA-compliant dental coverage as your dental benefits experts!

Note: If You’re Marketing Plans for Small Businesses, please consider the following:

Starting in 2016, some states will change their definition of small business from 50 employees to include those that employ up to 100 employees. Some things for you and your clients to consider:

  • Many more employers in states that expand their definition to the new size will be required to purchase an ACA-compliant health plan.
  • Most states will keep the definition of up to 50 employees, and not open their SHOP to the larger group size. This is due to the passage in Congress of the PACE Act, signed by President Obama in October 2015.
  1. 1ACA-compliant health plans include the required 10 essential health benefits (EHBs), one of which is pediatric oral care to age 19. Check with a Delta Dental sales representative about your state's requirements.
  2. 2Reasonable assurance is a declaration from a health policy purchaser to a policy insurer that verifies that the purchaser either has or will obtain an exchange-certified pediatric stand-alone plan. There may be great variation in what state regulators will accept as reasonable assurance, and some states may not accept reasonable assurance at all.
  3. 3Plan availability varies by state.