OCT 25, 2013
Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn't provide proof that he has it they will automatically enroll him in a plan. We don't have children, so why would we have to have pediatric dental insurance?
A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.
But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.
Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.”
It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.
For more information about how to get the best dental care insurance deal for your family, please call John Caris at 707 935 6294 x103 or Email.