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Common Questions

 

As of October, 2015, the decision as to the definition of small business will be left up the states. They can choose to expand the definition to include employers with up to 100 employees, or maintain the current definition of small employer (companies with 50 or fewer employees).

In 2014, the U.S. Department of Health and Human Services (HHS) mandated 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 essential health benefits (EHB) dental plans beginning January 1, 2015.

 

 

The out-of-pocket annual maximum is the most participants 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 does not include premiums, balance billing charges, the cost of health care services not covered by the plan or services provided by out-of-network dentists.

 

 

 

 

Health Care Reform, also known as the Affordable Care Act (ACA) or Obamacare, provides individuals with access to affordable health coverage, including pediatric dental and vision coverage for children up to age 19.

 

 

All legal residents who can afford insurance were required to obtain coverage by January 2014 or pay a fine to help offset the costs of caring for uninsured Americans. If affordable coverage is not available, you may be eligible for exemptions or government help.

 

 

Under the new regulation pediatric dental insurance must be available until your child is age 19.

 

 

It depends on the type of coverage you have and if your coverage is part of your medical insurance plan or not. Please contact your HR Benefits Consultant or your dental carrier for more details.

 

 

No. MetLife added the pediatric dental benefit requirements to many of MetLife's small-group dental plans (plans for under 50 employees) effective January 1, 2014.

 

 

If you have dental and health benefits through your work, then your employer is responsible for providing you with affordable insurance that complies with the new law. If you do not have access to affordable benefits through work, you have access to dental and health insurance benefits through public health insurance marketplaces.

 

 

Also known as Exchanges, these marketplaces will allow consumers to compare costs and different types of features for products sold on the exchange. As of 2014, individuals without other affordable insurance coverage were provided access to health and dental benefits through public marketplaces.

 
 
 
 
 
 

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