Delta Dental and the ACA: Questions for Your Medical Carrier

by Jason 10/9/2013 9:32 AM

In Missouri or South Carolina, medical carriers can offer health plans with or without the pediatric dental essential health benefit ON the FFM-SHOP exchange, because pediatric essential dental benefits will be available from Delta Dental, a stand-alone dental plan.... more...

Delta Dental and the ACA: Purchasing Dental Benefits for Small Groups – (Part 2)

by Jason 10/8/2013 2:39 PM

Following up on my previous post, the chart below shows a simplistic view of how the FFM-SHOP process may work. An employer will start out with the SHOP exchange online at Plans are available to review, compare and select a preference, based on the offering elements of plan designs, networks and premiums. The employer – or the employer’s broker – then comes to Delta Dental for a quote.   Delta Dental will provide a SHOP quote for dental benefits. Once implemented, employees will enroll, and – with Delta Dental – enjoy the peace of mind of the best customer care in the industry. An employer is not required to purchase the pediatric oral essential health benefit through the SHOP. The employer may purchase medical benefits and opt out of the pediatric dental offered within the SHOP – and just go directly to Delta Dental for traditional dental coverage. The process for an OFF-exchange purchase more closely resembles the current, pre-ACA process. The employer, probably with support from a broker, will determine the group’s approach to dental benefits, considering the group’s needs for coverage, and how the pediatric essential oral health benefit will be provided. Medical carriers may include or exclude pediatric essential oral health benefits OFF the exchange, as long as the medical carrier has reasonable assurance that the pediatric dental benefit is being purchased through an exchange-certified plan.  Remember, OFF the exchange, the individual MUST PURCHASE the pediatric essential benefit. Delta Dental will provide that assurance to the medical carrier.   The current market process is followed to find the most appropriate plan for the group. The employer, or the broker, requests a quote from Delta Dental, and evaluates the options for plan design, network and premiums – just as before. Delta Dental can provide a quote, as requested: either a status-quo quote for the group’s current plan, or an ACA exchange-certified plan with similar adult benefits, along with the required pediatric essential oral health benefit.   Once implemented, employees will enroll, and – with Delta Dental – enjoy the peace of mind of the best customer care. Through either process, small group employers may turn to Delta Dental to find plan designs, networks and pricing that will match the needs of the dental benefits program.

Small Groups and Dental Benefits in the ACA (Part 2)

by Jason 9/27/2013 9:29 AM

Employers with 50 or fewer employees do not, by law, have to purchase health insurance for their employees. The new law states that individuals have to be covered by the Essential Health Benefits, (unless covered by a grandfathered large group employer or government program).

If small group employers do chose to offer health care benefits in 2014 – for all the valid reasons of attracting and retaining employees, just as before – they will now have to comply with the new ACA regulations. Small group employers may purchase health benefits from their current markets, or beginning with coverage for 2014, they may purchase benefits through the Federally Facilitated Marketplace (FFM), an online program that will be operated by the U.S. Department of Health and Human Services.... more...


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