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Common Questions

 

All employers are impacted by the ACA; however, the requirements differ depending upon 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) - which includes pediatric dental and vision coverage for children to age 19. For small employers, maintaining your existing dental benefits may minimize disruption and require less administrative work.

 

 

Employers may be subject to penalties if they do not meet ACA requirements. Please consult your Broker, Consultant or Tax Advisor for more information.

 

 

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 do not include pediatric dental coverage if medical carriers are "reasonably assured" employers have obtained stand-alone dental coverage from a dental carrier.

 

 

A set of 10 categories of services that certain health insurance plans must cover under the Affordable Care Act. 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 devices,
  • preventive and wellness services and chronic disease management,
  • and pediatric services, including oral and vision care.
 

 

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 is 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

 

 

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 elect not to receive dental coverage and participants must pay an additional premium for that coverage.

 

 

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

 

 

Also known as Exchanges, these marketplaces allow small businesses to compare costs and different types of features for products sold on the exchange. However, MetLife believes it will be possible for your business to meet the essential health benefits requirement for pediatric dental without going through health insurance marketplaces.

 

 

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

 

 

The out-of-pocket annual maximum is the most 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 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 providers.

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 dental plans containing the pediatric dental essential health benefit.

 

 

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 moratorium on the ACA fee for calendar year 2017, and it is uncertain whether the fee will continue to be imposed in future years. The ACA fee is not a tax deductible expense, which increases the cost of doing business from the perspective of health insurers.

 

 

Depending on qualifications, such as number of employees and average income, your business may qualify for a small business tax credit. Employers 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.

 

 

The "Cadillac Tax" is an excise tax employers may have to pay depending on the value of their 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.

 
 
 
 
 
 

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