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Health Care Reform and Your Dental Plan. What do you need to know?. Ten Essential Benefits Required. Ambulatory Patient Services Emergency Services Hospitalization Maternity & Newborn Care Mental Health & Substance Abuse Disorder Services, including Behavioral Health Treatment
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Health Care Reform and Your Dental Plan What do you need to know?
Ten Essential Benefits Required Ambulatory Patient Services Emergency Services Hospitalization Maternity & Newborn Care Mental Health & Substance Abuse Disorder Services, including Behavioral Health Treatment Prescription Drugs Rehabilitative & Habilitative Services & Devices Laboratory Services Preventive & Wellness Services & Chronic Disease Mgmt Pediatric Services, including Oral & Vision Care
What is a Pediatric Oral Benefit? 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
January 1, 2014 with a Qualified Health Plan 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!
Why would I need Delta Dental if my QHP has embedded dental? 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.
