Self-funded EHB Compliant Pediatric Dental Coverage Requirements?
Our small business has 2 FTE’s and 1 PTE. One FTE seeks a waiver from our company-sponsored health insurance yearly, due to being covered under his spouse’s employer’s plan. We have always paid out-of-pocket for all of our family’s dental needs (which includes 2 children, 18 and under). Are we still required to purchase Pediatric Dental Coverage from a stand-alone company if we contract for an ACA health insurance plan that exists outside of the Marketplace? If so, why? Our dental receipts prove that all of our children’s dental needs are being met (including oral surgery and orthodontia) on a yearly basis; buying additional insurance will surely raise our current costs. Can we claim any kind of exemption from the EHB requirements for Pediatric Dental Coverage?
Answer
A plan has to offer pediatric dental coverage. That being said, the recipients of the plan can deny dental or vision. So it's the insurer that has to offer. If you are offering a plan as a small business or self funded plan, then you'll need to offer qualifying health coverage (that means pediatric dental and vision included, or offered as a standalone). So essentially as the recipient of a plan, you can deny dental or take it as a standalone, as the one offering a plan it must include pediatric dental and vision as an essential health benefit.