Insurance is difficult to navigate. For example, did you know that many small group medical insurance plans in California include pediatric dental coverage for children through the age of 18? This is because “Pediatric Dental” is one the Essential Health Benefits. The Affordable Care Act (“ACA,” Obama Care”) requires small businesses to include this dental benefit on medical insurance plans.
Many people think that their employer-sponsored health insurance only covers medical services and sign up their children on a separate dental plan that they might not need. Below are some Frequently Asked Questions (FAQs) we think may help guide you when you enroll your child or newborn in your insurance. Hopefully these tips provide some insight and help you save some money.
- Is my child old enough to need a dental policy?
If you recently had a baby, you may be anxious to add them to all your insurance policies to ensure they are taken care of if anything were to happen. However, babies aren’t born with teeth and normally don’t see a dentist for a while after they are born. It is important to consider the age of your child and when you will take them for their first dental visit.
There are multiple opinions on the perfect age to take a child to their first dental appointment. The American Dental Association (ADA) has a great article called Your Baby’s First Dental Visit that you may want to review. If you know you won’t take your baby to their first dental appointment until at least a year after they are born, then you may want to wait until your company’s open enrollment next year to enroll the child. This way you will save the premium you would have paid for your newborn child.
- Is my child enrolled in a California Small Group Medical Plan that Includes Pediatric Dental?
If you are enrolled in a California Small Group plan, chances are it does. Of course, there are some exceptions. For example, some plans that were set up before the Affordable Care Act might not have pediatric dental coverage. The best thing to do is to reach out to your HR person, or broker (like Benefits Cafe (800) 746-0045) to verify whether this is a covered benefit and the maximum age for the child to be enrolled.
- How is Pediatric Dental different than a direct Dental plan?
Pediatric Dental has some limitations, including:
- Your child must be enrolled in the medical plan to have pediatric dental benefits. There is no way to decline medical coverage and enroll only in the pediatric dental that is part of the medical plan.
- Orthodontia is not covered unless it is deemed medically necessary. Conditions such as teeth that impair breathing; or, repair of clef palette, are examples of medically necessary orthodontics.
- Unlike separate dental plans, the dental benefits that are included in a medical plans only cover children through age 18. So, if your child has celebrated their 19th birthday, the pediatric dental coverage that is included in the medical plan won’t cover them.
For more information, you should contact your insurance broker. Benefits Cafe would love to be the insurance broker for your group medical insurance plan. If we aren’t, give us a call at (800)746-0045.
- Can I enroll my child in a separate dental plan any time?
When children lose other dental coverage, such as the pediatric dental coverage in a medical plan, then they should be able to enroll in a separate employer sponsored plan. While this may vary by insurance company, the loss of coverage should be a “qualifying event” that will enable them to enroll in the employer sponsored dental plan that your company offers.
- Will adding my child to the pediatric dental coverage that is included in the medical plan increase my cost?
No. The cost (premium) of the group medical insurance plan includes coverage for dental coverage for kids under age 19 and there is no additional cost.
- What happens when my child outgrows the Pediatric Dental plan?
Children lose the dental benefits included in the medical insurance plan when they turn age 19. They would need to enroll in a separate dental plan at that time.
- Are there any Small Group FAQ’s from the Insurance companies that have more information?
Yes, some insurance companies have their own Pediatric Dental FAQs. Following are links to some California Small Group Pediatric Dental FAQs as offered from each health insurance company (PDFs). It is important to note that to ensure you have the correct FAQ you should reach out to your Broker.
If you need assistance with setting up or managing your group medical, dental, vision or other employer-sponsored insurance plan, please give us a call (800)746-0045.