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Health Care Exchange (Marketplace) for small business

Health Care Exchange (Marketplace) for small business

Find dental plans that meet and complement the Affordable Care Act¹ (ACA) required essential health benefits (EHBs) for pediatric dental care.

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When it comes to the Health Care Exchange (Marketplace) and dental coverage, Delta Dental is experienced, knowledgeable and proactive — and committed to providing great dental coverage for small businesses at affordable rates. Our plans meet and complement the Affordable Care Act’s¹ (ACA) required essential health benefits (EHBs) for pediatric dental care.

We can help you make confident and responsible decisions and maximize your dental coverage budget, whether you want to:

  • Keep your existing plan
  • Purchase a new plan
  • Bundle separate dental and medical plans
  • Create other coverage combinations

What you need to know

Coverage requirements

In 2015, the definition of a small business was defined as an organization that employed up to 50 employees. Starting in 2016, some states will change their definition of small business to include those that employ up to 100 employees. Some things for you to consider:

  • If you are an employer of 51 – 100 employees, located in a state that expanded their definition to the new size, you will be required to purchase an ACA-compliant health plan.
  • Most states will keep the size standard at 50 employees, and will not open their Small Business Health Options Program (SHOP) exchange to the larger group size. This is due to the passage in Congress of the PACE Act, signed by President Obama in October 2015.

Small businesses (defined by your state as those with either up to 50 or 100 employees) are subject to ACA mandates to include essential health benefits (EHBs) in group health coverage.

  • Small business owners who wish to purchase health and dental benefits that meet all of the ACA’s requirements can do so using convenient, online state- or federally-administered SHOP exchanges.
  • Small business owners can purchase combined medical and dental coverage in the SHOP to offer all 10 EHBs — one of which is pediatric dental care.
  • Small business owners can purchase separate medical and dental coverage through the exchange.

Delta Dental can help

We have dental plans that meet and complement the Affordable Care Act’s EHB requirement for pediatric dental care. Our product portfolio includes options to:

  • Cover only children with an ACA-compliant pediatric dental plan
  • Supplement an ACA-compliant pediatric dental plan included (embedded) in a medical policy with dental coverage for adults and dependents age 19 and above.
  • Fill any gaps in dental coverage for small businesses that have ACA-compliant dental coverage embedded in a medical plan. This can be a great option if high deductibles and out-of-pocket maximums for embedded dental care make insured dental care difficult to access.

Good to know

  • Businesses with fewer than 25 full-time equivalent employees may receive tax credits for up to 50% of the employer’s contribution toward their employees’ premium costs (up to 35% for tax-exempt employers) provided that:
    • As a group, employees’ average wages are fewer than $50,000
    • The employer covers at least 50% of the cost of employee-only health care coverage for each of their employees
    • The employer purchases insurance through the SHOP exchange
  • Businesses that currently offer an existing Delta Dental plan may keep it, and/or:
    • Within most state exchanges, buy a stand-alone, pediatric, ACA-compliant Delta Dental plan
    • Outside state exchanges in most states, add a stand-alone, pediatric, ACA-compliant Delta Dental plan to their traditional Delta Dental plan.
  • Delta Dental also offers supplemental dental benefits both in and out of state exchanges to cover adults and adult dependents, as well as children’s benefits not typically covered by a pediatric, ACA-compliant plan.

Where to purchase

Delta Dental sells stand-alone, ACA-compliant dental plan options inside most state exchanges. Outside state exchanges, most states allow insurers like Delta Dental to offer stand-alone, pediatric dental plans that meet the ACA requirements when coupled with an ACA-compliant medical policy.

Good to know

  • Medical insurers may automatically include or “embed” a pediatric dental benefit in their plans. Small businesses can request that the insurer accept “reasonable assurance”² if they already have, or prefer to purchase, a separate ACA-compliant pediatric Delta Dental plan. If the medical insurer is able to omit the pediatric EHB dental benefit from the medical plan, small businesses may have more flexibility to select the coverage options that meet their objectives for cost and coverage.

How to find coverage

You’ll find a variety of Delta Dental plan options as you comparison shop for dental coverage:

  • Within state and federal exchanges, you’ll find the Small Business Health Insurance Options Program (SHOP) exchange. In most areas, Delta Dental offers family plans that include the pediatric dental requirement. (In some states, pediatric dental coverage is sold separately.) These Delta Dental plans can be purchased alongside a medical plan. Go to healthcare.gov/get-coverage to find the exchange in your state.
  • Outside the exchanges, you can:
    • Renew an existing plan to retain coverage for adults and children to age 26 (and to supplement the dental care EHB included in the medical plan for children under age 19).
    • Purchase stand-alone dental plans to add adult benefits and coverage for dependent children ages 19–26. Adult dental coverage (age 19 and older) is not required to be included in either dental or medical ACA-compliant coverage.³
    • Purchase a medical/dental combination policy from one of our medical plan partners.

Good to know

Choosing only an embedded plan (a medical plan that includes the EHB pediatric oral care in a single policy) may appear to be an easy way to meet the ACA requirement; however

  • The dental portion won’t cover adults or children age 19 and over.
  • Usually, a combined medical-dental deductible applies, which can be as high as $2,000 per person before the plan covers any dental costs, making it difficult for members to have meaningful dental coverage.
  • Members may be required to switch from their current Delta Dental dentist, if their dentist may not participate in the dental plan embedded in the medical policy. Out-of-pocket annual maximums can be as high as $6,350 per person ($12,700 per family) before services are fully covered. Purchasing medical and dental plans separately, or choosing a bundled medical/dental plan option (separate dental and medical policies sold together to meet ACA requirements) offers a separate, lower deductible and out-of-pocket maximum for dental, helping to ensure that children receive meaningful dental coverage.
  • Choosing a bundled medical/dental plan (separate dental and medical policies sold together to meet ACA requirements) offers a separate, lower deductible and out-of-pocket maximum for dental, helping to ensure that children receive meaningful dental coverage.

Your purchase options

Keep your existing dental coverage

How to get a Delta Dental plan:

Renew your Delta Dental policy.

Why Delta Dental?

Quality coverage for the whole family

No need for members to change dentists

Provides coverage for dependent children ages 19 to 26 and supplemental coverage for children with EHB coverage

Other considerations

The ACA mandates that small business or individual plans purchased outside an Exchange must include pediatric dental benefits. This can be provided by an exchange-certified pediatric dental policy. Such a policy can be purchased stand-alone, alongside your ACA-compliant medical plan, and will not cost much more

Keep your existing dental coverage

How to get a Delta Dental plan:

Why Delta Dental?

Renew your Delta Dental policy.

Quality coverage for the whole family

No need for members to change dentists

Provides coverage for dependent children ages 19 to 26 and supplemental coverage for children with EHB coverage

Other considerations

The ACA mandates that small business or individual plans purchased outside an Exchange must include pediatric dental benefits. This can be provided by an exchange-certified pediatric dental policy. Such a policy can be purchased stand-alone, alongside your ACA-compliant medical plan, and will not cost much more

Outside exchanges: Purchase group health coverage from one or more insurers

How to get a Delta Dental plan:

Purchase a separate stand-alone EHB pediatric Delta Dental plan and a separate medical plan (without pediatric dental) to fulfill the requirement to purchase all 10 EHBs

Or:

Purchase a combined medical/dental plan (Delta Dental’s medical plan partners may be able to provide options in your area)

Why Delta Dental?

Quality coverage for the whole family.

Meet the EHB pediatric requirement

Complement the required EHBs with robust benefits

Other considerations

When you purchase a stand-alone EHB pediatric Delta Dental plan, you will need to provide reasonable assurance to your medical plan that you have obtained this coverage. With reasonable assurance in place, you can exclude the EHB pediatric coverage from your medical policy.

The definition of reasonable assurance is determined by state regulators, and will vary from state to state (in a few states it may not be accepted).

Important note: Plan options vary by state. Check with your Delta Dental sales representative, general agent or broker for more information.

Outside exchanges: Purchase group health coverage from one or more insurers

How to get a Delta Dental plan:

Why Delta Dental?

Purchase a separate stand-alone EHB pediatric Delta Dental plan and a separate medical plan (without pediatric dental) to fulfill the requirement to purchase all 10 EHBs

Or:

Purchase a combined medical/dental plan (Delta Dental’s medical plan partners may be able to provide options in your area)

Quality coverage for the whole family.

Meet the EHB pediatric requirement

Complement the required EHBs with robust benefits

Other considerations

When you purchase a stand-alone EHB pediatric Delta Dental plan, you will need to provide reasonable assurance to your medical plan that you have obtained this coverage. With reasonable assurance in place, you can exclude the EHB pediatric coverage from your medical policy.

The definition of reasonable assurance is determined by state regulators, and will vary from state to state (in a few states it may not be accepted).

Important note: Plan options vary by state. Check with your Delta Dental sales representative, general agent or broker for more information.

Inside exchanges: Purchase group health coverage through the Small Business Health Insurance Options Program (SHOP)

How to get a Delta Dental plan:

Purchase a stand-alone pediatric Delta Dental plan, coupled with a stand-alone medical plan.

Why Delta Dental?

Meet the EHB pediatric oral care requirement.

Members may not need to change dentists.

Ensure a low, separate dental deductible and out-of-pocket maximum.

Members are usually covered by benefits sooner than a combined medical/dental plan

Other considerations

Businesses with fewer than 25 full-time equivalent employees may receive tax credits up to 50% of an employer’s contribution toward their employees’ premium costs (scroll up for full details)

Inside exchanges: Purchase group health coverage through the Small Business Health Insurance Options Program (SHOP)

How to get a Delta Dental plan:

Why Delta Dental?

Purchase a stand-alone pediatric Delta Dental plan, coupled with a stand-alone medical plan.

Meet the EHB pediatric oral care requirement.

Members may not need to change dentists.

Ensure a low, separate dental deductible and out-of-pocket maximum.

Members are usually covered by benefits sooner than a combined medical/dental plan

Other considerations

Businesses with fewer than 25 full-time equivalent employees may receive tax credits up to 50% of an employer’s contribution toward their employees’ premium costs (scroll up for full details)

  1. ACA-compliant health plans include the required 10 essential health benefits (EHBs), one of which is pediatric oral care to age 19.
  2. Reasonable assurance is a declaration from a health policy purchaser to a policy insurer that verifies that the purchaser either has or will obtain an exchange-certified, pediatric stand-alone plan. There may be great variation in what state regulators will accept as reasonable assurance, and some states may not accept reasonable assurance at all.
  3. In California, stand-alone EHB Delta Dental plans are not offered outside the state exchange, due to exchange regulations.