6.) Does my group’s dental plan need to include EHB-compliant pediatric dental benefits?
The answer depends on the size of the group and whether the group is fully insured or self-funded.
Self-funded dental plans
No. An employer with a self-funded dental plan does not need to cover EHBs. Under the ACA, only policies in the small group and individual insurance markets are required to cover EHBs.
Fully insured dental plans in the large group market
No. An employer with a fully insured dental plan in the large group market does not need to cover EHBs. Under the ACA, only policies in the small group and individual insurance markets are required to cover EHBs. In most states, the small group market is currently defined as groups that have 50 or fewer employees.
Fully insured dental plans in the small group market
Technically, an employer with a fully insured dental plan in the small group market is not required to offer its employees health or dental coverage under the ACA. However, if the group elects to purchase coverage off the exchange, the group will only be able to purchase coverage that contains all 10 EHBs, including pediatric dental coverage. The group does not need to buy all 10 EHBs from its medical carrier but instead may purchase medical benefits from a medical carrier and an EHB-compliant dental policy from a stand-alone dental carrier. In most states, the small group market is currently defined as groups that have 50 or fewer employees.