health care reform and your dental plan
Post on 25-Feb-2016
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Health Care Reform and Your Dental Plan
What do you need to know?
1. Ambulatory Patient Services2. Emergency Services3. Hospitalization4. Maternity & Newborn Care5. Mental Health & Substance Abuse Disorder Services, including
Behavioral Health Treatment6. Prescription Drugs7. Rehabilitative & Habilitative Services & Devices8. Laboratory Services9. Preventive & Wellness Services & Chronic Disease Mgmt10. Pediatric Services, including Oral & Vision Care
Ten Essential Benefits Required
How is this defined by CMS?• Only covers children under age 19.• Benefits that help pay for the cost of visits to a dentist
for basic or preventive services, like teeth cleaning, X-rays, and fillings.
• Benefits must be substantially similar to the FEDVIP program in South Dakota
What is a Pediatric Oral Benefit?
Does your new plan include the essential pediatric dental benefit?
• Yes! Great – your children under age 19 are covered for basic services.
But what about your children age 19 – 26 or you and your spouse?
• You can keep the dental you have today!
January 1, 2014 with a Qualified Health Plan
This is a great question!• Dental plans that are embedded in your QHP cover
only your child/ren under age 19 with limited benefits. • Ortho is only covered for very specific medical necessity.
• Your child/ren age 19 – 26 are not covered. • You and your spouse are not covered.
Why would I need Delta Dental if my QHP has embedded dental?
Questions and Answers
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