Dental Plan Blog

What health care reform means for your dental benefits

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We all know that the Patient Protection and Affordable Care Act (aka PPCA or "health reform legislation") will bring about some major changes in the health care arena. But what about your dental plan?

Although the legislation won't have as profound an effect on dental benefits as it will on medical benefits (and there doesn't appear to be an immediate impact on dental coverage), employers still should take note of one vital thing. The law will affect their dental plans.

However, so many of us are still confused as to how. That's why we've put together this synopsis for you. We've itemized the various PPCA provisions that may, may not and absolutely will not impact your dental benefits.

Let's start off with a rundown of the provisions that won't impact your dental plan. These provisions apply to medical plans only and are as follows:

• Extension of Dependent Age Limit to 26
• Removal of Lifetime Dollar Limits
• Removal of Annual Maximums
• Tax on high-value benefits plans (aka "Cadillac Tax")

Now, on to the provisions that will impact dental coverage. There are two in particular that employers should be aware of. Although the earliest of these provisions doesn't take effect until 2013, employers should definitely take note of them so they can start planning and budgeting for future implications.

These provisions are as follows:

1) New Annual Fee on Health Insurance providers:

Starting in 2013, health insurers will be subject to a new fee to help fund the reform. Each insurer's fee will be based on their specific 2013 market share (total insured premium for health, dental and vision).

Potential impact: Carriers may increase dental benefit prices to reflect the newly assessed fee.

2) Pediatric dental coverage provisions (starting in 2014):

Health insurers will be required to package dental and vision benefits for children with the medical plan as part of "Essential Health Benefits Package" (EHBP). These inclusions are required in both the individual and Small Group market. At this point, standalone dental plans sold through the state-sponsored insurance Exchanges (to be established in 2014) can be used to satisfy the pediatric dental requirement.

Potential impact: Details around this provision are still being clarified although it will potentially impact both the purchase and administration of standalone dental insurance plans. We will certainly keep you up to date on this provision as further details surface.