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Dental Insurance


Dental ACA Requirements:


•  Dental sold in stand-alone policies are not subject to most ACA provisions. Only pediatric dental benefits are part of the Essential Health Benefit Packages (EHBPs), which are required to be offered to individuals and small employers, unless their medical plans are grandfathered.

•  Medical coverage offered within an exchange must include a pediatric dental benefit, unless the same exchange offers a stand-alone dental plan providing the required pediatric dental benefit. In that case, the medical plan has the option to exclude the benefit.

•  When the pediatric dental benefit is offered in an exchange on a stand-alone basis, employers and individuals are not required to purchase (by federal law, but a few states may say otherwise).

•  Traditional orthodontia coverage may not be available in essential pediatric dental benefits in state exchanges or EHBPs. Currently only orthodontia declared medically necessary will be covered through an exchange or EHBP.


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