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Understanding Health Care Reform


What does Health Care Reform mean for you?

You've heard a lot about the Affordable Care Act (ACA), commonly known as Health Care Reform, and, by now, you may have an idea of how it impacts your business and your clients.

What's important to share with your clients is that, for most of them, no major changes are needed, and having "grandfathered"  -plans will minimize the ACA's impact for many of them.

With a few updates to the benefits they offer, your clients can continue to offer their existing plans to current and new employees . Once your clients make certain significant changes to their plan, additional provisions of the ACA will be triggered.

New out-of-pocket annual maximums1

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.

Keep essential pediatric dental benefits separate from medical for greater savings and value.

The ACA requires employers with fewer than 50 employees (or fewer than 100 employees in some states) to offer a medical plan consisting of 10 essential health benefits, including pediatric dental benefits.

However, pediatric dental benefits don't have to be embedded with the other essential health benefits in a medical plan. In fact, we believe it's better if dental benefits are not embedded in a medical plan. Here's why.

Your small business  clients are impacted the most.

When it comes to your small business  clients, you may reassure them that maintaining their existing plans is a good option. Your small business clients will be affected by the ACA the most with the addition of the essential health benefits  mandate and the creation of health insurance marketplaces . None of this, however, necessitates a switch in coverage, carriers or how and where their insurance is purchased.

While some of your small business clients will decide to offer their benefits through an exchange, they may be able to find a broader selection of plan designs, including ACA-compliant benefits, outside the state exchange marketplace.

Maintaining dental benefits may require the least amount of change.

Fully insured dental benefits offered through stand-alone dental carriers, like MetLife, are largely exempt from the requirements of the ACA if the dental plan qualifies as an excepted benefit  under HIPAA rules.

We're here to help.

That's why we added the pediatric dental benefit requirements to our small employer dental benefit plans and started selling group dental products on select  public marketplaces beginning October 1, 2013 for January 1, 2014 effective dates.

The ACA presents your clients and your business with many challenges, but it also provides you with the opportunity to establish yourself as a valued advisor for today and the long-term. And we are here to help you. If you have any questions, contact your MetLife representative.

1The out-of-pocket annual maximum applies only to covered children under the age of 19 (covered people under the age of 19 in New Jersey and California). It is the most a participant pays during a Plan Year in cost-sharing for covered services provided by an in-network dentist before we begin to pay 100% of the maximum allowed charge. This limit does not include premiums, balance billing charges, the cost of services we do not cover or services provided by out-of-network dentists.


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