DOI issues Pediatric Dental Benefits Bulletin Update

| June 27, 2013 | Comments (0)

Excerpt from recent Division of Insurance Bulletin 2013-07:

On and after January 1, 2014, Carriers that make health plans available to eligible individuals and eligible small employers must include in the health plans those Essential Health Benefits (“EHBs”) that Massachusetts has selected to meet the benefit requirements outlined in the ACA, including coverage for pediatric dental benefits.  These plans are referred to as Qualified Health Plans (“QHP”), and in offering such plans, Carriers must comply with the following federal requirements::

“Section 1302 of the Affordable Care Act outlines the requirements for health plans to cover the ten categories of the essential health benefits. The only exception permitted under 1302 of the Affordable Care Act is for QHPs to exclude coverage of the pediatric dental EHB if there is a standalone dental plan offered in the Exchange.  Section 1311 of the Affordable Care Act requires all Exchange stand-alone dental plans to cover the pediatric dental EHB.  In this way, sections 1302 and 1311 of the Affordable Care Act require that the full set of [EHBs] be offered to people purchasing coverage through the Exchange.  However, nothing in this rule requires the purchase of the full set of EHB if the purchase is made through an Exchange. Thus, in an Exchange, someone (with a child or without) can purchase a QHP that does not cover the pediatric dental EHB without purchasing a stand-alone dental plan.

Category: Consumer & Industry News

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