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Common Questions

 

HCR is intended to provide individuals with access to affordable health coverage, including pediatric dental and vision coverage for children up to age 19.

 

 

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.

*Recent changes to the tax code, which will become effective in 2019, eliminate the fine assessed under the Affordable Care Act for lack of coverage.  However, insurance coverage is still required under the law.

 

 

Under HCR pediatric dental insurance must be available until your child is age 19.

 

 

No. MetLife added the pediatric dental benefit to many of MetLife's small-group dental plans (plans for employers with fewer than 50 employees, or fewer than 100 employees in some states) to ensure compliance with HCR.

 

 

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.

 

 

There are three types of Public Health Insurance Marketplaces, or Exchanges.

  • State run exchanges: The state creates and administers all aspects of the exchange.
  • The federal exchange: The state defines plan design, but the federal government administers the plans.
  • State-federal partnerships: The state defines plan design, but shares the administrative responsibility with the federal government.
 

 

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
  • pediatric services, including oral and vision care
 

 

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.

 

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