Health Insurance Reform – What Does It Mean for Dental and Vision Plans?

May 26, 2011
By

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Dental Insurance for Seniors UCT understands that with rising Healthcare costs, employees are dealing with reduced health benefits, loss of health benefits completely or they have to pay more to keep their health benefits. Basic Medicare does not cover dental, vision or hearing expenses. Some Medicare supplement policies may provide some coverage, but not all. From big businesses to the self-employed to retired individuals, we are all feeling the effects of these rising costs. UCT knows the importance of dental, vision and hearing care and the impact these have on a person’s overall health.

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Vision and dental coverage is often an integral part of your client’s group health benefits package for employees and dependents. For many, there is still some confusion about how the Patient Protection and Affordable Care Act (PPACA) impacts vision and dental plans, both in terms of how they are offered and when plans are exempt from the new health care reform law.

When does PPACA reform apply to dental and vision plans?

Both the provisions in PPACA and Health Insurance Portability and Accountability Act (HIPAA) view limited scope benefits plans, such as dental and vision offerings, as either an integral part of the overall health benefit plan or as an “exception”.

  • Included. If the limited benefit plan is included in a bundle of health insurance benefits and the employee does not have the ability to opt out of the coverage, the dental and vision benefits will be subject to the same terms and conditions as the overall health insurance benefits, including PPACA reform requirements.
  • Excluded. If the limited scope benefit plan is offered on a stand-alone basis or is separated from the overall health insurance benefit package, the dental and vision plans (the separate limited benefit benefits) can be treated differently and do not need to comply with many of changes that have been or will be required due to the passage of PPACA.

What is the statutory test that decides whether the dental and vision plans are included in the definition “medical care” and are “exempted”?

PPACA employs the definitions that already were in existence in HIPAA1, which defines “medical care” very broadly and contains an exception for limited benefit plans. HIPAA regulations were issued on December 13, 2006 and further defined “limited scope benefit plans”2 as benefits that are substantially for treatment of the mouth, and “limited scope vision benefits” as benefits primarily for treatment of the eye. If benefits meet the definition of limited scope dental or vision benefits, they may not be subject to HIPAA or PPACA if they either are:

i)  Provided under a separate policy, certificate, or contract of insurance; or
ii) Not an “integral part” of a group health plan.

Are there any official “FAQs” that the federal government has published addressing this issue?

Yes, the concept of an “excepted” limited scope benefit plan is further illuminated by an FAQ3 that the Department Of Labor published on its website, which reads:

Q6: What if my dental (or vision) benefits are structured as excepted benefits under HIPAA? Does that exemption except my dental (or vision) plan from the Affordable Care Act’s market reforms?

Yes. If benefits constitute excepted benefits under HIPAA, the requirements of PPACA’s market reforms do not apply. Under HIPAA, dental (and vision) benefits generally constitute excepted benefits if they:

  • Are offered under a separate policy, certificate, or contract of insurance; or
  • Are not an integral part of the plan. For dental (or vision) benefits to be considered not an integral part of the plan (whether insured or self-insured), participants must have a right not to receive the coverage and, if they do elect to receive the coverage, must pay an additional premium.

Accordingly, if a plan provides its dental (or vision) benefits pursuant to a separate election by a participant and the plan charges even a nominal employee contribution towards the coverage, the dental (or vision) benefits would constitute excepted benefits, and the market reform provisions would not apply to that coverage.4

Does it matter if the limited plan is offered pursuant to a fully insured or self-insured arrangement?

Not really. The over-all criteria described in this legislative alert appear to apply to both fully funded and self-funded health arrangements. Here are some illustrative examples:

  • If the limited benefit plan is insured or self-insured under the same policy as the health insurance benefit, in most cases PPACA applies.
  • If the health benefit plan is insured and the dental and/or vision benefits are under separate insurance policies, and if an employee may opt out of the limited benefit plan coverage(s), the limited benefit plan likely would be eligible as an exception and would not be subject to the health insurance reform provisions of the PPACA.
  • If the health care benefit is self-funded, employees must be able to choose the comprehensive plan and the limited benefit plan separately, and pay a different premium for the different levels of coverage for the limited plan to be exempt.
  • If one plan is “fully insured” under one policy and the other plan is “self-funded” under another policy, in most cases that would directly support the fact that the plans are “separate” policies with different cost sharing arrangements and election options.

What are some of the PPACA provisions that will apply to dental and vision plans?

If the dental and vision plans are covered, most of PPACA’s normal requirements will apply, including:

  • No annual and lifetime dollar limits on benefits
  • Employees’ children remain eligible until age 26
  • Mandatory coverage of preventive services with no cost sharing
  • Mandatory external review of adverse claims decisions
  • No preexisting condition exclusions
  • No waiting periods exceeding 90 days

If the limited benefit plan is not excluded, the lifetime benefits that limited scope benefit plans often have must be deleted. Consequently, this will likely increase the cost of the limited benefit plan to the employer.

Can limited scope benefit plans be offered on a stand-alone basis though a state exchange?

Yes, under section 1311 of PPACA, there does appear to be an exception to allow a stand-alone “dental” benefit plan to be offered within a state exchange. In addition, “pediatric dental benefits” will likely be included as part of the “minimum essential benefits” requirements for qualified health plans.5

However, the ability to offer other limited scope benefit plans is still being sorted out. The National Association of Specialty Health Organizations (NASHO) is asking regulators to think about vision plans, behavioral health plans, and other types of specialty plans as the federal and state governments move forward with the exchanges. “One of our main concerns is, with the exception of dental, no other specialty health organizations were listed in the [reform] bill to be a part of the exchanges. Vision was in there, but it was taken out as one of the last amendments,” says Julian Roberts, Executive Director of the National Association of Specialty Health Organizations.6

In relation to specialty benefits, what happens after January 1, 2014 when all qualified health plans must offer the essential benefit package through the exchange?

Regarding dental coverage, the National Association of Dental Plans, makes the following observations:

By January 1, 2014, all health insurance issuers offering health insurance coverage in the Individual or small group market (with the exception of grandfathered plans) must ensure that the coverage includes the essential health benefits package, including pediatric dental benefits.

Outside of the new health insurance exchanges: Although stand?alone dental plans are specifically exempt from the requirement to offer all essential benefits, for health plans to be recognized as meeting the essential benefits package in the individual and small group market, they must offer pediatric dental benefits.

Inside of the new health insurance exchanges: By 2014, states are to establish health insurance exchanges to provide access to affordable health insurance options for individuals and small employers. (By 2017, states can allow large employers to obtain coverage through an exchange.) Plans must include all essential benefits to be offered in the exchange. However, stand?alone dental plans are allowed to offer the required pediatric dental benefits. If a stand?alone dental plan offering required pediatric dental benefits is available in an exchange, a health plan without these benefits that offers all other essential benefits can be treated as a qualified health plan to offer coverage in the exchange.7

As referenced in the prior Q&A, the impact of other specialty benefits still needs to be sorted out.

What can brokers do for their clients?

Brokers can do a number of things to help their clients sort out the applicability of limited scope benefit or plan offerings. In cases where a dental or vision plan is or will be exempted, brokers should encourage employers to communicate in writing to the enrollees in the limited scope benefit plan and explain that it is an exempted benefit plan and that the health insurance reform provisions of the PPACA provisions do not apply to the limited benefit plan(s). Brokers should also provide some insights on the advantages (e.g., ease of administration) and disadvantages (e.g., likely higher cost) of combining specially benefits in the comprehensive policy.

In some cases, brokers may need to provide advice based upon the specifics of each case. The regulations do not provide a definitive answer in each situation as to whether a limited benefit offering is included or exempted under PPACA. However, you can begin by forwarding applicable part of this legislative alert to your clients. In cases that are more difficult, HHS or a PPACA benefit consultant should be contacted for guidance.

With some care and planning, your clients can protect their limited benefit plans from any of the potential negative effects of health insurance reforms in PPACA. BenefitMall will keep you updated on any additional changes to the “specialty health” requirements in the coming months.

(ii) OFFERING OF STAND-ALONE DENTAL BENEFITS.–Each Exchange within a State shall allow an issuer of a plan that only provides limited scope dental benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986 to offer the plan through the Exchange (either separately or in conjunction with a qualified health plan) if the plan provides pediatric offer the plan through the Exchange (either separately or in conjunction with a qualified health plan) if the plan provides pediatric dental benefits meeting the requirements of section 1302(b)(1)(J)).

28 Responses to Health Insurance Reform – What Does It Mean for Dental and Vision Plans?

  1. Tracy Succop on March 15, 2012 at 11:57 am

    Wow that was odd. I just wrote an extremely long comment but after I clicked submit my comment didn’t show up. Grrrr… well I’m not writing all that over again. Anyways, just wanted to say fantastic blog!

  2. Jeannine Berninger on March 16, 2012 at 7:00 am

    I savor, cause I discovered exactly what I used to be taking a look for. You’ve ended my 4 day lengthy hunt! God Bless you man. Have a great day. Bye

    • Vaggelhs on April 23, 2012 at 10:19 am

      I’d recommend find a icsruanne broker ( agent those guys work icsruanne company). independent broker knows ‘s out state advise .I add seldom worthwhile dental icsruanne individual. through employer worthwhile. info dental plans dentist look . dentist knows mouth kind treatment ‘ve needed past. look dental expenses over time, look provisions premium informed whether a worth .One more thing dental discount plans out . icsruanne.plans. Dentists sign up a list agree a reduced fee schedule. always ( ) dentists tend bait switch non-covered services. I’d avoid discount plans.Steve Bornfeld, DDS Was this answer helpful?

    • Syahrial on April 25, 2012 at 6:48 am

      Persons who receive medaicl treatment are called patients . they are not a tapped income source. They’re not really consumers, even though free market principles, including choice, apply. It’s the treatment received that is beneficial, considering the type of payment plan. Medicare is too similar to managed care. It’s better than nothing though.

  3. Frauke, zahnimplantate on March 24, 2012 at 2:45 am

    Vision and dental coverage is often an integral part of your client’s group health benefits package for employees and dependents. For many, there is still some confusion about how the Patient Protection and Affordable Care Act (PPACA) impacts vision and dental plans, both in terms of how they are offered and when plans are exempt from the new health care reform law.

    When does PPACA reform apply to dental and vision plans?

    Both the provisions in PPACA and Health Insurance Portability and Accountability Act (HIPAA) view limited scope benefits plans, such as dental and vision offerings, as either an integral part of the overall health benefit plan or as an “exception”.

    Included. If the limited benefit plan is included in a bundle of health insurance benefits and the employee does not have the ability to opt out of the coverage, the dental and vision benefits will be subject to the same terms and conditions as the overall health insurance benefits, including PPACA reform requirements.
    Excluded. If the limited scope benefit plan is offered on a stand-alone basis or is separated from the overall health insurance benefit package, the dental and vision plans (the separate limited benefit benefits) can be treated differently and do not need to comply with many of changes that have been or will be required due to the passage of PPACA.

    What is the statutory test that decides whether the dental and vision plans are included in the definition “medical care” and are “exempted”?

    PPACA employs the definitions that already were in existence in HIPAA1, which defines “medical care” very broadly and contains an exception for limited benefit plans. HIPAA regulations were issued on December 13, 2006 and further defined “limited scope benefit plans”2 as benefits that are substantially for treatment of the mouth, and “limited scope vision benefits” as benefits primarily for treatment of the eye. If benefits meet the definition of limited scope dental or vision benefits, they may not be subject to HIPAA or PPACA if they either are:

    i) Provided under a separate policy, certificate, or contract of insurance; or

    ii) Not an “integral part” of a group health plan.

    Are there any official “FAQs” that the federal government has published addressing this issue?

    Yes, the concept of an “excepted” limited scope benefit plan is further illuminated by an FAQ3 that the Department Of Labor published on its website, which reads:

    Q6: What if my dental (or vision) benefits are structured as excepted benefits under HIPAA? Does that exemption except my dental (or vision) plan from the Affordable Care Act’s market reforms?

    Yes. If benefits constitute excepted benefits under HIPAA, the requirements of PPACA’s market reforms do not apply. Under HIPAA, dental (and vision) benefits generally constitute excepted benefits if they:

    Are offered under a separate policy, certificate, or contract of insurance; or
    Are not an integral part of the plan. For dental (or vision) benefits to be considered not an integral part of the plan (whether insured or selfinsured), participants must have a right not to receive the coverage and, if they do elect to receive the coverage, must pay an additional premium.

    Accordingly, if a plan provides its dental (or vision) benefits pursuant to a separate election by a participant and the plan charges even a nominal employee contribution towards the coverage, the dental (or vision) benefits would constitute excepted benefits, and the market reform provisions would not apply to that coverage.4

    Does it matter if the limited plan is offered pursuant to a fully insured or selfinsured arrangement?

    Not really. The over-all criteria described in this legislative alert appear to apply to both fully funded and self-funded health arrangements. Here are some illustrative examples:

    If the limited benefit plan is insured or self-insured under the same policy as the health insurance benefit, in most cases PPACA applies.
    If the health benefit plan is insured and the dental and/or vision benefits are under separate insurance policies, and if an employee may opt out of the limited benefit plan coverage(s), the limited benefit plan likely would be eligible as an exception and would not be subject to the health insurance reform provisions of the PPACA.
    If the health care benefit is self-funded, employees must be able to choose the comprehensive plan and the limited benefit plan separately, and pay a different premium for the different levels of coverage for the limited plan to be exempt.
    If one plan is “fully insured” under one policy and the other plan is “self-funded” under another policy, in most cases that would directly support the fact that the plans are “separate” policies with different cost sharing arrangements and election options.

    What are some of the PPACA provisions that will apply to dental and vision plans?

    If the dental and vision plans are covered, most of PPACA’s normal requirements will apply, including:

    No annual and lifetime dollar limits on benefits
    Employees’ children remain eligible until age 26
    Mandatory coverage of preventive services with no cost sharing
    Mandatory external review of adverse claims decisions
    No preexisting condition exclusions
    No waiting periods exceeding 90 days

    If the limited benefit plan is not excluded, the lifetime benefits that limited scope benefit plans often have must be deleted. Consequently, this will likely increase the cost of the limited benefit plan to the employer.

    Can limited scope benefit plans be offered on a stand-alone basis though a state exchange?

    Yes, under section 1311 of PPACA, there does appear to be an exception to allow a stand-alone “dental” benefit plan to be offered within a state exchange. In addition, “pediatric dental benefits” will likely be included as part of the “minimum essential benefits” requirements for qualified health plans.5

    However, the ability to offer other limited scope benefit plans is still being sorted out. The National Association of Specialty Health Organizations (NASHO) is asking regulators to think about vision plans, behavioral health plans, and other types of specialty plans as the federal and state governments move forward with the exchanges. “One of our main concerns is, with the exception of dental, no other specialty health organizations were listed in the [reform] bill to be a part of the exchanges. Vision was in there, but it was taken out as one of the last amendments,” says Julian Roberts, Executive Director of the National Association of Specialty Health Organizations.6

    In relation to specialty benefits, what happens after January 1, 2014 when all qualified health plans must offer the essential benefit package through the exchange?

    Regarding dental coverage, the National Association of Dental Plans, makes the following observations:

    By January 1, 2014, all health insurance issuers offering health insurance coverage in the Individual or small group market (with the exception of grandfathered plans) must ensure that the coverage includes the essential health benefits package, including pediatric dental benefits.

    Outside of the new health insurance exchanges: Although stand alone dental plans are specifically exempt from the requirement to offer all essential benefits, for health plans to be recognized as meeting the essential benefits package in the individual and small group market, they must offer pediatric dental benefits.

    Inside of the new health insurance exchanges: By 2014, states are to establish health insurance exchanges to provide access to affordable health insurance options for individuals and small employers. (By 2017, states can allow large employers to obtain coverage through an exchange.) Plans must include all essential benefits to be offered in the exchange. However, stand alone dental plans are allowed to offer the required pediatric dental benefits. If a stand alone dental plan offering required pediatric dental benefits is available in an exchange, a health plan without these benefits that offers all other essential benefits can be treated as a qualified health plan to offer coverage in the exchange.7

    As referenced in the prior Q&A, the impact of other specialty benefits still needs to be sorted out.

    What can brokers do for their clients?

    Brokers can do a number of things to help their clients sort out the applicability of limited scope benefit or plan offerings. In cases where a dental or vision plan is or will be exempted, brokers should encourage employers to communicate in writing to the enrollees in the limited scope benefit plan and explain that it is an exempted benefit plan and that the health insurance reform provisions of the PPACA provisions do not apply to the limited benefit plan(s). Brokers should also provide some insights on the advantages (e.g., ease of administration) and disadvantages (e.g., likely higher cost) of combining specially benefits in the comprehensive policy.

    In some cases, brokers may need to provide advice based upon the specifics of each case. The regulations do not provide a definitive answer in each situation as to whether a limited benefit offering is included or exempted under PPACA. However, you can begin by forwarding applicable part of this legislative alert to your clients. In cases that are more difficult, HHS or a PPACA benefit consultant should be contacted for guidance.

    With some care and planning, your clients can protect their limited benefit plans from any of the potential negative effects of health insurance reforms in PPACA. BenefitMall will keep you updated on any additional changes to the “specialty health” requirements in the coming months.

    • Elly on April 23, 2012 at 5:57 pm

      I’ve heard of some people using dttsines in other countries. Personnally, I’d prefer to have a local American dentist work on my teeth for a substantial discount. This way I’m still saving a good amount on my dental work, I don’t have to travel, I’m protected by U.S. laws, I’m keeping the money in our economy and many individuals may even get to use their own dentist, if they’re members of a discount plan. Just a few things to? think about. Thanks for your comment.Joe

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    • Rebekka on April 23, 2012 at 10:22 pm

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  19. William on April 18, 2012 at 10:56 am

    The U.S. Supreme Court is now considering the constitutionality of the Affordable Care Act because Republicans started down the wrong road with their critique of the defining domestic mark of the Obama administration.

    There are compelling reasons to oppose the 2010 law. But conservatives’ questioning of the legality of the requirement that individuals must buy health insurance is the wrong approach.

    For one thing, the mandate is not wild-eyed public policy. There are only three ways for America to ever achieve universal health care: requiring the government to provide health insurance, demanding that businesses offer it to employees or mandating that individuals purchase coverage.

    The individual mandate is one that even Republicans like Mitt Romney have included in their proposals to overhaul health care. It was part of Romney’s ballyhooed, but important, plan for universal coverage in Massachusetts.

    For another thing, there is disagreement even within conservative circles about whether Congress’ insistence upon individuals buying insurance represents a federal power grab. Law professors such as Georgetown University’s libertarian Randy Barnett believe it is a massive overreach. But conservative lawyers such as Charles Fried, who once served as Ronald Reagan’s solicitor general, strongly disagree.

    All in all, this is a risky strategy. Perhaps the court will agree that Congress has gone too far. But if it doesn’t, Republicans are left with a law that still has serious flaws.

    The real problem with this law, which I hope Congress and the next administration will fix, is finding a reliable way to finance the $900 billion measure. The financing of the system of vouchers and state exchanges largely depends upon an unelected panel of experts cutting Medicare’s growth in spending by $500 billion.

    That approach should worry us all, even those who favor universal coverage. Congress rarely has shown any appetite to control Medicare spending. It especially has shown little interest in limiting Medicare payments to doctors and health care providers. Legislators often retreat from those attempts, including just earlier this year.

    Even if the unelected panel makes real changes, there’s no guarantee Congress will stick to them. Legislators would face terrific lobbying pressure from doctors, hospitals and seniors. If you think I’m wrong, check out the April bulletin of the AARP (which I belong to for its great discounts!). It praised Congress for its recent decision to “avoid devastating cuts to physicians’ Medicare payments that could have reduced seniors’ access to their doctors.”

    It doesn’t take much imagination to know that similar calls would flood Capitol Hill if an unelected panel put big brakes on Medicare’s growth. And soon, lawmakers would overrule the commission, leaving the taxpayer on the hook for up to $500 billion.

    The government, of course, simply would run up more debt to fund the health care bill. That would be more debt on top of our current $15.6 trillion debt.

    We could have avoided this situation if Congress had paid for the Affordable Care Act through eliminating or restricting the subsidies that employers receive for offering health insurance. Congress then could have had ample money to overhaul health care.

    Trimming the subsidies also could have helped control health costs, which is another area in which the law comes up short. If subsidies for employers were cut or eliminated, companies and individuals would have a better feel for the costs of health care. That could lead more consumers to demand clear reasons from hospitals and insurers about why medical costs are so great.

    If changes like these are made, we would have a better system. And there is precedent for making them. The Obama administration already has been forced to drop the provision in the law that created a poorly financed way of offering long-term health insurance.

    So while all eyes are on the court and the individual mandate, I hope smart legislators will start looking at the way the bill is financed and the fact that it will do too little to control costs. Those are the real problems.

    Read more here: http://www.kansas.com/2012/04/18/2300591/gop-picked-wrong-fight-on-health.html#storylink=cpy

  20. Langley on April 21, 2012 at 10:33 pm

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  21. Zafer on April 23, 2012 at 2:12 pm

    Well there is a company cellad Ameriplan with a dental plan that comes withfree vision, prescription, chiropractic services for only $ 11.95/mo and you can also get the members of your household covered for $ 19.95/mo. I can honeslty say saves you alot of money; I never have to pay a deductible like you do with insurance ; there is no limit on how many visits or services and didn’t have to wait for 30 long days; as soon as my ameriplan card came in the mail it was already active.

  22. Dennana on April 25, 2012 at 5:43 am

    , notwithstanding, you admit and we all know the ovhwieelmrng costs that? are involved for any kind of a plan. I used a firm named America’s Medical Solutions in India for cheap dental repair of a bad mouth. Voila! Everyone is impressed. My mouth looks great, I feel great, and even with the airfare wallet is fatter. I wonder if you have seriously considered this? Thanks.