The Affordable Care Act (ACA), sometimes referred to as “healthcare reform” or “Obamacare,” establishes a Health Insurance Marketplace to help individuals obtain health insurance coverage and help small businesses with less than 50 employees purchase insurance through SHOP (Small Business Health Options Program).
The ACA mandates that each state’s Marketplace must offer coverage for 10 Essential Health Benefits (EHB). One of those EHBs is pediatric dental benefits for children 18 and under. This means that pediatric dental coverage must be available in each state’s Marketplace, either embedded in a medical plan or as a standalone dental plan.
Delta Dental of New Jersey plans to participate in the following ways:
In Connecticut, we will administer pediatric dental benefits embedded in a health insurance product offered by HealthyCT. This new health insurance cooperative will offer a variety of plans to individuals, families, and small businesses. HealthyCT plans will be available directly and through Access Health CT, Connecticut’s public health insurance Marketplace. Open enrollment will begin in all states’ Marketplaces on October 1. Coverage goes into effect January 1, 2014, for plan selections made by December 15.
In New Jersey, we will offer stand-alone dental coverage for individuals and small employers outside of the Federally-Facilitated Marketplace (FFM) or “public exchange.” Those plans will include qualified stand-alone dental plans which provide the pediatric essential health benefit coverage for children 18 and under as required by the Affordable Care Act. While we will not participate in the FFM in New Jersey beginning January 1, 2014, we do intend to participate in the FFM in New Jersey in 2015.
Do you have questions for us about the ACA? Leave them in the comments.