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News & Press: Advocacy

State Health Benefits Exchange

Tuesday, March 8, 2016   (0 Comments)
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State Health Benefits Exchange
2015 marked the second year that the provisions of the Affordable Care Act regarding mandatory health coverage for most Americans ---- or pay a penalty --- were in effect.
Pediatric dental services for children are one of the ten Essential Health Benefits covered under the Act and California’s Health Benefits Exchange ----- Covered California ---- elected to provide these benefits exclusively in 2014 by the separate purchase of a stand-alone pediatric dental plan. As a result of the manner in which it was offered (as a voluntary add-on item after the purchase of the health plan was completed), the disappointing take-up rate was less than 30 percent. This year, the stand-alone pediatric dental plans were eliminated from the Exchange and, instead, all medical plans include embedded pediatric dental benefits. Medical plans partnered with dental plans to provide these embedded benefits, which have a separate deductible and a separate out-of pocket maximum from those of the medical benefits. State regulators are required
to separately monitor the adequacy of dental plan provider networks and timely access to dental care. It is anticipated that stand-alone family dental plans will be offered in the state exchange and SHOP (Small Business Health Options Program) to adults wishing to obtain dental coverage in 2016. These plans will include dependent coverage and, when purchased, the child’s dental benefits under the plan will be secondary to the benefits of the embedded dental plan.

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