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