3.) How do I determine if my self-funded dental plan is “integral” to my medical benefits?
On October 1, 2014, the U.S. departments of Health and Human Services, Labor and the Treasury issued a final rule that changes the analysis used to determine when dental benefits are not considered an integral part of a self-funded health plan. Prior to the final rule, dental benefits were not considered an integral part of a health plan so long as 1) participants had the opportunity to opt out of the dental coverage and 2) to the extent the participants elected dental coverage, they paid at least a nominal contribution toward that coverage. Under the final rule, so long as participants are either given the opportunity to opt out of the dental coverage or the dental coverage is being administered pursuant to an agreement that is separate from the claims administration for any other benefits covered under the plan, the dental coverage will not be considered integral to the health plan. Accordingly, if your dental plan is being administered by Delta Dental, your plan is an excepted benefit and is not subject to the ACA’s market reform requirements.