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Common Questions


Your business should not be largely impacted by the ACA regulations; however, your small business clients may have questions to work through. While some of your small business clients may be contemplating offering their benefits through a public health marketplace or exchange, they may be better off providing their employees with ACA-compliant insurance without going to the exchanges. Maintaining their existing dental benefits may minimize disruption and require less administrative work.
Your larger clients may eventually need to make changes to their current plans; however, they may be considered "grandfathered" and may continue to offer their existing plans to current and new employees in the manner in which they offer them now, until they make these changes.


The ACA regulations largely impact medical benefits and to a lesser extent dental and vision.
Your small business clients should know that there's no reason for them to change the way they purchase insurance.  If they have fully insured dental benefits offered through stand-alone dental carriers, like MetLife, they are largely exempt from the requirements of the ACA, if the dental plan qualifies as an excepted benefit under HIPAA rules.


Businesses who pay 50% or more of health insurance premiums for their employees and who have the appropriate combination of 25 or fewer employees with $40,000 or less in average income, may qualify for a tax credit for up to 35% of the employer's cost for health insurance. Employers who think they might qualify are encouraged to go through the steps in the IRS Small Business Healthcare Tax Credit Worksheet to see if they are eligible for a credit.


You can inform your small business clients that MetLife added the pediatric dental benefit requirements to many of MetLife's small-group dental plans. You can also let them know that they can meet the essential health benefits requirement for pediatric dental without changing the way they purchase today or going through health insurance marketplaces.


To help our small-business customers comply with ACA, MetLife added the pediatric dental benefit requirements to many of MetLife's dental benefit plans under 50 lives (or under 100 lives where required) effective January 1, 2014. This means that your clients will be able to continue offering dental benefits like they do today. There is no need for them to bundle their dental benefits with their medical coverage. In fact, maintaining their dental benefit as a fully-insured stand-alone plan may eliminate many of the complicated ACA regulations. Please refer to the "Stand-Alone Dental" slipsheet for more information.


The pediatric dental EHB plan design and related cost varies by state. Any potential cost for the need to modify a plan's pediatric benefits will be applied during the standard renewal process. Please contact your MetLife Account Representative for more details.


No. As MetLife is a stand-alone dental carrier, our dental benefits are designed to supplement comprehensive medical coverage and are considered “excepted” benefits, which are not subject to all regulations set forth by the ACA. Please refer to the "Stand-Alone Dental" slipsheet for more information.


This law was passed in March 2010 and requires that, beginning in 2014, individuals and small employers must have access to affordable health coverage. To achieve this goal, the law requires health plans to offer a comprehensive package of items and services, known as Essential Health Benefits (EHB) – which includes pediatric dental and vision coverage for individuals up to age 19.


The 10 EHBs include:
  • ambulatory 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 devises,
  • preventive and wellness services and chronic disease management,
  • and pediatric services, including oral and vision care.


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. To account for the lower out-of-pocket maximums, all carrier plans were required to modify coinsurance/copay levels and deductibles of their 2015 plans.


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.


Starting in 2014, individuals and small businesses will have access to health and dental benefits through public marketplaces, also known as exchanges. However, MetLife is currently making it possible for your clients to meet the essential health benefits requirement for pediatric dental benefits off the health insurance marketplaces.


On-exchange dental plans are purchase through public marketplaces, which are also referred to exchanges. Off exchange refers to dental plans that are purchased outside of public exchanges through traditional sales channels.


These are insurance plans that were in effect when the Affordable Care Act was enacted, provided that the plans do not make significant changes to the benefits offered or the amount members must pay.


Affordable Care Act (ACA) legislation imposes an annual assessment on health insurers, including dental and vision insurers, beginning in 2014. The health insurance industry fee (ACA 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. The ACA fee is not a tax deductible expense, which increases the cost of doing business from the perspective of health insurers.


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