2.) How do I determine if my dental plan is structured in a way that exempts it from most ACA requirements, such as the market reforms?*
The answer depends on whether your plan is fully insured or self-funded.
Fully insured dental plans administered by a stand-alone dental carrier like Delta Dental are “excepted benefits” and therefore exempt from ACA requirements. However, if your group is part of the small group insurance market, you will only be able to purchase health coverage off the exchange that includes all 10 Essential Health Benefits, including pediatric dental services. See Question 6. In most states, an employer is considered part of the small group market if the employer has 50 or fewer employees.
Self-funded dental plans are “excepted benefits” if the dental benefits are not “integral” to the medical benefits. See Question 3 for an explanation of what constitutes “integral” medical and dental benefits.