All legal residents who can afford insurance are required to obtain coverage 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.
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. Individuals without other affordable insurance coverage have access to health and dental benefits through these public marketplaces.
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.