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Pediatric Dental as an Essential (PPACA defined) benefit


Guest Ira Hayes
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Guest Ira Hayes

Ladies and Gentlemen, here is the Northern Cali solution by the Blues to a nationwide problem:

The healthcare client whose employees are immediately subject to the individual mandate is offered a choice between a High ($3,000 max per member) Dental PPO (90%/60%) and a Low ($1,500 max per member)Dental PPO (80%/50%). In addition, a choice of Pediatric Dental PPOs is offered to subscribers and dependents under age 19 with the proviso that one of the Pediatric Dental PPO options must be elected by the employer.

Hence, members and subscribers under age 19 have two premiums offered, one of which (the Pediatric Dental PPO) must be selected and paid in order to satisfy the individual (and ultimately employer) mandate.

Does anybody (certainly not the regulators nor Speaker Pelosi) have a simpler solution?

Regards,

Ira

P.S. The same situation applies to the essential vision benefit. Trust me, the Delta Dentals and VSPs of the world won't touch these issues with a 10' pole.

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How can there be a Northern Cali solution by the Blues to a nationwide problem?

What is the nationwide problem?

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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FWIW in the 36 states operating under a Federally Facilitated Marketplace they're requiring pediatric dental and vision must be OFFERED but doesn't have to be PURCHASED.

Outside of the marketplace pediatric dental and vision has to be PURCHASED as a condition of purchasing basic medical coverage in order to meet EHB.

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Guest Ira Hayes

Gentlemen and Ladies, ancillary providers with competitive networks do not have to offer EHB. Hence, individuals and small groups pay twice with respect to subscribers and dependents under age 19 (the cutoff age for pediatric dental) up to the non Pediatric PPO annual maxima.

Do you understand the problem now, George?

Ira

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