Why do I have to purchase Pediatric Dental if I don’t have kids or need it?

By Michelle AndrewsImage

OCT 25, 2013

Q. My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn’t provide proof that he has it they will automatically enroll him in a plan. We don’t have children, so why would we have to have pediatric dental insurance?

A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts. The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.  

Pediatric dental coverage is sometimes offered as part of a regular health plan, but it’s also often sold on a standalone basis. So even though the health law requires that children in individual and small group plans have access to dental coverage, people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it.

But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.   

Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.” 

It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.

Court Affirms Employer Mandate Constitutionality


Most of the health care reform news in the past week focused on the implications of a recent decision by the U.S. Treasury Department delaying enforcement of the Affordable Care Act’s (ACA) employer mandate until 2015.  Both politicians and media had widely diverging assessments of whether the decision is a helpful sign of flexibility or a harbinger of growing chaos surrounding implementation of the law. Less widely covered, but far more definitive, was a decision last week from the Fourth Circuit Federal Court of Appeals affirming the constitutionality of the employer mandate in a case brought by Liberty University. On the issue of the Commerce Clause, the court held that the employer mandate “is simply another example of Congress’s longstanding authority to regulate employee compensation offered and paid for by employers in interstate commerce.” The court also held that the ACA did not violate the plaintiffs’ religious freedom rights under the First Amendment because it was a “valid and neutral law of general applicability.”  In June 0f 2012, the U.S. Supreme Court upheld the ACA’s individual mandate.Liberty University now says it intends to pursue its case to the U.S. Supreme Court as well.

Two Important Changes to Implementation of ACA

MegaPhone-Breaking NewsTwo Important Changes to Implementation of ACA

In the past week, the U.S. Department of Health & Human Services, the Treasury Department, and the Obama Administration have announced two important changes to the implementation of the Affordable Care Act.

  1. Employer Mandate Postponed:   The ACA requirement for employers with at least 50 full-time employees to provide health coverage is now scheduled to take effect in January of 2015 instead of 2014. While some experts say the one-year delay of the employer mandate probably won’t have a huge impact on health reform implementation (because a majority of 50+ employers already offer health coverage), the postponement does give the Treasury Department and employers more time to work out the necessary coverage reporting requirements.
  2. Coverage and Income Verification Delayed:  The government also announced it will move to an “honor system” in 2014 for coverage and income verification. States operating marketplaces (i.e., exchanges) will not be required to confirm a consumer’s statement that he or she does not have employer-sponsored coverage, nor will states have to verify reported income, which determines a person’s eligibility for a premium subsidy. Income verification has been postponed until 2015. However, consumers who misrepresent their income on the application for exchange coverage are subject to a penalty of up to $25,000.

Be Well Insurance Solutions is committed to keeping you informed of important changes to the ACA and its implementation. Watch for other updates as information becomes available – or subscribe to our Blog on the  Be Well Insurance Solutions website.

Individual Penalty Transition Relief for Those Eligible to Enroll in Employer-Sponsored Coverage with a Plan Year That Begins in 2013 and ends in 2014

IRS Notice 2013-42

IRS Notice 2013-42

Individual Penalty Transition Relief for Those Eligible to Enroll in Employer-Sponsored Coverage with a Plan Year That Begins in 2013 and ends in 2014   

Because many employer-sponsored plans have non-calendar plan years, our clients have had questions regarding how to advise clients with employees and/or dependents who waived employer-sponsored coverage but would need to have minimum essential coverage beginning January 1, 2014 in order to avoid the Individual Shared Responsibility Payment (i.e. individual penalty).

IRS Notice 2013-42, issued Wednesday 6/26/2013, addresses these questions and provides an employee, or an individual with a relationship to the employee, who is eligible to enroll in a non-calendar year employer-sponsored plan with a plan year beginning in 2013 and ending in 2014 will not be liable for the individual penalty until the end of the 2013-2014 plan year. Thus, employees and dependents that choose to wait until the 2014-2015 plan year to enroll in coverage will not be subject to the individual penalty for the months in 2014 that are part of the 2013-2014 plan year.

For your easy access, we posted IRS Notice 2013-42 on our blog; where you also will find an abundance of helpful resources like our ACA Calculators http://bit.ly/19uAC9s

Employer ACA Calculators


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Public Opinion Stays Static on Affordable Care Act

ImagePublic Opinion Stays Static on
Affordable Care Act

March 21, 2013:

In the three years since the Affordable Care Act became law, it has become fodder for campaign ads and the subject of a high-profile Supreme Court challenge, while news analysts have endlessly debated and dissected it. None of that has had any effect on public opinion.

The Kaiser Health Tracking Poll, which has asked the question nearly every month since 2009, has found that the public’s views of the law, overall, have remained nearly static. About 40 percent of people don’t like the law. About 40 percent do. The remainder are unsure. Other polls show the same trend.

“Nothing has changed,” said Tresa Undem of PerryUndem Research and Communication, who has conducted polls and focus groups on the ACA.

All the advocacy and rhetoric hasn’t nudged approval higher. It also hasn’t had any major effect on public knowledge about what the law actually does and says. Recent surveys from Enroll America, an umbrella group for advocacy organizations and health providers, found that huge majorities of the populations that will benefit most from the law did not know it affected them. More than 80 percent of people who will be eligible for free health insurance through the Medicaid expansion, for example, had no idea they could get coverage.

The latest Kaiser poll, published Wednesday, said that awareness of individual provisions in the law has actually declined over time, not improved. Compared with April 2010, just after the law passed, fewer people know it will mean anyone can get insurance, regardless of their health history; that small businesses are eligible for tax credits; that the Medicaid program will expand; or that uninsured Americans will be able to get financial help buying health plans.

While politicians may be frustrated that their messages are not penetrating, pollsters say the trends in public opinion are not a huge surprise to them. For most members of the public, the law has registered as something big, abstract, and linked to government intervention in the health care system. Absent concrete experience, most people have decided what they think about the idea of health reform, and their opinions have remained entrenched. Think about the deep-blue state of Massachusetts, which enacted a similar health reform law in 2006. About two-thirds of people there approve of the state law, while only about half like the ACA.

That may start to change as next year rolls around and the law’s largest provisions begin to take effect. The minority of the U.S. population that lacks health insurance will start to see new options. Others may be overwhelmed by complex bureaucracies. Some people with cheap insurance may see their rates increase. People whose policies included limited benefits may suddenly become eligible for much more robust coverage. Those personal experiences are likely to shake up public perception rapidly.

“It goes from a hypothetical discussion of what may be to an actual experience of what they see,” said Robert Blendon, a professor at the Harvard School of Public Health.

Boosters of the law tend to think that implementation will lead to increased popularity. Blendon says that really will depend on the smoothness of the rollout. “I’m not sure what they see is going to make the bill more popular,” he said.

By:  Margot Sanger-katz – National Journal