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Common Questions

Answers to your common questions
What does the Affordable Care Act (ACA) mean to me as an employer? Collapsed Expanded

All employers are affected by the ACA. However, the requirements differ depending on the number of employees you have. All employers must offer affordable medical coverage to their full-time employees and their children up to age 26. 

Employers with fewer than 50 full-time employees (or under 100 employees where required by the state) must offer health plans that cover the 10 Essential Health Benefits (EHB). This includes pediatric dental and vision coverage for children to age 19. For small employers, maintaining your existing dental benefits may minimize disruption and mean less administrative work.

What happens if my business doesn’t comply with the ACA? Collapsed Expanded

Your business may be subject to penalties if it doesn’t meet ACA requirements. Please consult your Broker, Consultant or Tax Advisor for more information. 

If my business already offers dental and health coverage, do I need to do anything? Collapsed Expanded

It depends on the type of coverage your business offers. 

Medical carriers are required to offer a medical plan containing Essential Health Benefits (EHBs) including pediatric dental and vision coverage for employers with fewer than 50 full-time employees (or fewer than 100 employees where required by state law). 

However, medical carriers may sell products that don’t include pediatric dental coverage if medical carriers are "reasonably assured" that employers have obtained stand-alone dental coverage from a dental carrier.

What are the Essential Health Benefits (EHBs)? Collapsed Expanded

These are 10 categories of services that certain health insurance plans must cover under the Affordable Care Act. The 10 EHBs include:

  • out-patient services
  • emergency services
  • hospitalization
  • laboratory services
  • maternity and newborn care
  • mental health and substance abuse services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care
Can my business continue to offer MetLife Dental coverage? Collapsed Expanded

Yes. Most* businesses can meet the essential health benefits requirement for pediatric dental without going through health insurance marketplaces. 

To help the employees of our small-business customers comply with the ACA, MetLife added pediatric dental benefits to many of MetLife's dental benefit plans for employers with fewer than 50 employees (or fewer than 100 employees in some states)*. This means that you will be able to continue offering dental benefits like you have always done. There's no need to bundle your dental benefits with your medical coverage. In fact, maintaining your dental benefit as a fully-insured stand-alone plan may avoid many of the complicated ACA regulations.

*Not available in all states

How does a dental benefits plan qualify as an excepted benefit? Collapsed Expanded

To qualify as an excepted benefit, the dental plan must either: be offered under a separate insurance policy from the employer’s medical plan; or, if embedded in an employer's medical plan, must not be considered an integral part of the employer’s medical plan. 

To not be considered an integral part of the employer's medical plan, participants must have the right to choose not to receive dental coverage and participants must pay an additional premium for the dental coverage.

If my business currently offers MetLife dental insurance, will the cost of the plan increase with the addition of pediatric dental benefits? Collapsed Expanded

The cost for pediatric dental benefits varies by state. The cost for this benefit will be applied during standard renewal. Please speak to your Broker, Consultant or MetLife Account Representative for more details.

 

What are public health insurance marketplaces? Collapsed Expanded

Also known as exchanges, these marketplaces help small businesses compare costs and different types of features for products sold on the exchange. However, we believe it’ll be possible for your business to meet the essential health benefits requirement for pediatric dental without going through health insurance marketplaces.

What's the difference between on-exchange and off-exchange dental plans? Collapsed Expanded

On-exchange dental plans are bought through public marketplaces. Off-exchange refers to dental plans that are purchased outside of these public exchanges through traditional sales channels.

What is an out-of-pocket annual maximum? Collapsed Expanded

The out-of-pocket annual maximum is the most that participants are required to pay during a plan year in cost-sharing for covered children under the age of 19, before the carrier begins to pay 100% of the maximum allowed charge for covered services. 

This limit doesn’t include premiums, balance billing charges, the cost of health care services not covered by the plan or services provided by out-of-network providers.

The U.S. Department of Health and Human Services (HHS) instructed that individual out-of-pocket annual maximums will be $350 and family out-of-pocket annual maximums will be $700 (applies to two or more covered children) for all dental plans that include the pediatric dental essential health benefit.

What is the health insurance industry fee? Collapsed Expanded

The ACA imposed an annual assessment on health insurers, including dental and vision insurers. This health insurance industry fee and other fees contained in the ACA legislation are designed to help support cost-generating portions of the legislation like the individual insurance marketplace, state exchanges and health care research.

The ACA fee is allocated among insurers in proportion to their premiums for the preceding year and other factors. Congress put a freeze on the ACA fee for calendar years 2017 and 2019. There is uncertainty as to whether the fee will continue to be imposed in 2020 and beyond. The ACA fee is not a tax deductible expense, so for health insurers, it increases the cost of doing business. 

Will my business receive a tax credit for providing insurance to my employees? Collapsed Expanded

Depending on qualifications, such as number of employees and average income, your business may qualify for a small business tax credit. We encourage you to go through the steps in the IRS Small Business Healthcare Tax Credit Worksheet to see if you are eligible for a credit.

What is the "Cadillac Tax"? Collapsed Expanded

The "Cadillac Tax" is an excise tax you may have to pay, depending on the value of your insurance plan. Fully-insured stand-alone dental, vision and supplemental health products are not subject to the Cadillac Tax. The tax is currently scheduled to go into effect in 2020, unless it is repealed by the current administration. Please consult your Broker, Consultant or tax advisor for more information.