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Common Questions


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.

In addition, in 2015 MetLife has been approved to offer qualified EHB dental plans outside of the public exchanges in nine new states* - Alabama, Delaware, Kansas, Maine, Oklahoma, Mississippi, Nebraska, Tennessee and West Virginia.

*Pending final certification from CMS.



The Affordable Care Act (ACA), or Health Care Reform, was passed in March 2010. Beginning in 2014, it requires that individuals and small employers must have access to affordable health coverage.



All employers are impacted by the ACA; however, the requirements differ depending upon the number of employees you have. Beginning in 2014, 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 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.



Starting in 2015, employers may be subject to penalties if they do not meet the 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 consisting of Essential Health Benefits (EHB) including pediatric dental and vision coverage for employers with fewer than 50 full-time employees (or fewer than 100 employees where required). However, medical carriers may sell products that do not include pediatric dental coverage if medical carriers are "reasonably assured" that employers have attained stand-alone dental coverage.



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.


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 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)**effective January 1, 2014. This means that you will be able to continue offering dental benefits like you do today. 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 eliminate many of the complicated ACA regulations.

**Not available in all states



The pediatric EHB 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 will allow small businesses to compare costs and different types of features for products sold on the exchange. However, MetLife believes that it will be possible for your business to meet the essential health benefits requirement for pediatric dental without going through health insurance marketplaces. Starting in 2014, small businesses were provided access to health and dental benefits through public 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.



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.



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 that employers may have to pay, starting in 2018, 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." Please consult your Broker Consultant or tax advisor for more information.


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