Pediatric Dental Compliance Under the Affordable Care Act (ACA)

2014 was the first year that small employer groups had to comply with Pediatric Dental coverage requirements under the Affordable Care Act (ACA). Although the basis of the law has not materially changed for 2015 for groups with under 51 employees, it is important to note that each state has adjusted their deductible levels. Pediatric Dental is still considered an Essential Health Benefit (EHB) under the ACA, and any group with a Qualified Health Plan (QHP) must have the coverage in place for all members under 19 years of age.

What has changed for 2015 for Small Group and Individual plans?

Many of the carriers have changed their interpretation of the law and are now requiring groups to prove that they have obtained coverage for Pediatric Dental under another policy or have enrolled in their medical insurer’s Pediatric Dental program. Policy numbers and/or actual policies are now required at the time of implementation or renewal. Furthermore, some carriers are requiring groups that waived the Pediatric Dental policy in 2014 to waive coverage under the plan again in 2015 with the required proof of coverage.

The good news is that many ancillary carriers have created new solutions for groups looking for alternatives to their medical carriers’ Pediatric Dental solutions. Listed below are just a few Stand-alone options available in the Ancillary Products market:

  • Ameritas offers a rider for groups to add, which allows groups to be compliant with the regulations.
  • Delta Dental offers add-ons to their traditional dental programs in New York, Pennsylvania, and Delaware.
  • Guardian offers a complete line of solutions for Stand-alone Pediatric Dental and “Wrap” plans that can be added to groups with Pediatric Dental embedded in the medical benefit.
  • Horizon BCBSNJ’s “Young Grins” program can be sold on a Stand-alone basis for individuals and groups without a Horizon medical plan in place.
  • Lincoln will have a Pediatric Dental solution for groups enrolled in their traditional dental plans starting 2/1/15
  • MetLife is offering competitively priced traditional dental plans with embedded Pediatric Dental benefits.
  • Principal has the ability to embed Pediatric Dental benefits in their traditional dental programs.
  • Solstice has extended their partnership program with Health Republic Insurance of New York by offering their Stand-alone Pediatric Dental plan for groups in New York.
  • The Standard now offers Pediatric Dental as part of their traditional dental programs for groups with over 10 employees.

Employers with <51 employees with questions regarding Pediatric Dental or requests to review their options for compliance, should contact Lisa Keith at: 866-750-7477 or by email: