18.) Must all employees covered by an employer that needs an EHB-compliant plan enroll in an exchange-certified pediatric dental plan, even if they’re currently waiving the group dental plan? What if the member doesn’t have a spouse or dependent under age 19? What if the member is waiving the group dental plan currently and their dependents under age 19 are covered under a spouse’s exchange-certified pediatric dental plan?
Under the ACA, a medical carrier may only issue coverage that does not contain pediatric dental to an individual or small group employee if that carrier is “reasonably assured” that the individual or small group employee obtained certified pediatric dental coverage from a stand-alone dental carrier. However, because it is the medical carrier who is ultimately responsible for ensuring that appropriate coverage has been issued to an individual or small group employee, consulting with your medical carrier is the best way to determine how it is answering the specific questions above.
Each medical carrier may handle these situations slightly differently. Regardless of how your medical carrier chooses to address the above scenarios, rest assured that Delta Dental is ready and able to assist by providing you and your employees with the dental coverage you need.