While Delta Dental now offers a Pediatric Oral Essential Health Benefit (POEHB) plan on Wisconsin’s Federally Facilitated Marketplace (FFM) of Individual and SHOP exchanges available at healthcare.gov, we would like to point out that off-exchange, more comprehensive dental benefits are available.

In the wake of ACA, it’s important for employers to recognize that traditional dental plans can be very cost-effective. More than ever, people are evaluating their health insurance options and many are wondering how dental benefits fit in the mix.

As employers continue to evaluate the impact of ACA and communicate benefit structures to employees, the following four key tenets should be kept in mind.

1. On the exchange, medical plans may include dental benefits for children.

The Pediatric Oral Essential Health Benefit (POEHB) provides:
• Coverage up to age 19;
• Coverage for preventive and restorative dental care;
• No annual or lifetime benefit maximum;
• Annual out-of-pocket limit of $700 per child or $1,400 per family, and;
• Coverage for medically necessary orthodontia (such as for cleft palate).

In Wisconsin, medical plans on the exchange may include the above dental benefits. Medical plans can also exclude children’s dental benefits as long as it is stated in the coverage description.

Delta Dental points out that a traditional dental plan, off-exchange, can additionally provide optional orthodontia and cover dependents to age 26.

2. Not all medical plans pay children’s benefits equally and you do not have to purchase pediatric dental care from a medical carrier.

On Wisconsin’s exchange, it is possible to purchase the pediatric dental benefit through a medical carrier or a standalone dental plan through a dental benefits carrier. Many misconceptions remain in the marketplace surrounding the necessity of coverage – the plans are not required to be purchased, only required to be offered.

And because many medical plans may require the policy’s annual deductible and out-of-pocket maximums be met before paying dental benefits, a standalone dental policy may expand benefits and reduce overall expenses.

3. Adult dental coverage is also an option.

Medical plans are not required to offer any dental benefits for adults, but they can be purchased through a standalone dental carrier.

Adult dental coverage should be strongly considered. If you can afford to cover yourself, in addition to your child, why wouldn’t you do it? In addition to its relatively low cost compared with medical coverage, dental coverage encourages regular preventive dental check-ups, which not only helps protect dental health but also can detect as many as 120 different diseases in their earliest stages, when they are most effectively treated.

4. It’s important to evaluate carrier differences.

Even though coverage may be similar between different carriers, there are still differences to consider. Some questions to ask include:

• Which dentists belong to the network(s) offered by the carrier? The larger the network, the greater the chance that employees won’t have to switch from their current dentist. For example, 90 percent of Wisconsin’s dentists belong to Delta Dental’s Premier Network. Members save money since network dentists have agreed to negotiated fees which are lower than their usual fees, and they cannot bill beyond that negotiated fee.

• Customer service is king. Employers should consider service statistics, such as how quickly calls are answered and issues are resolved. Delta Dental of Wisconsin, for example, was recently named North America’s No. 1 Call Center (small-size category) by Purdue’s Benchmark Portal.

Business-as-usual. It’s a straight-forward and easy approach, in a benefits environment that has become anything but simplified.

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