HHS Issues Final Exchange Rule: Implications for Dental Coverage

The Children's Dental Health Project applauds the US Department of Health and Human Services (HHS) for issuing a clear directive to states on the importance of ensuring access and affordability for families purchasing pediatric dental coverage under the Affordable Care Act (ACA). The final rule on the Establishment of Exchanges and Qualified Health Plans which was released Monday directs states in establishing and implementing the new Affordable Insurance Exchanges, through which millions of families will be able to purchase essential health benefits, including pediatric dental coverage.

In response to comments from advocates related to parity in pediatric dental benefits, the final HHS rule clarifies that families will have the same level of consumer protections, affordability standards, and access to pediatric dental coverage whether they purchase that coverage from a stand-alone dental plan or a qualified health plan.

Specifically, this rule will:

  • apply the same cost-sharing limits and restrictions on annual and lifetime limits to stand-alone dental plans as are applied to qualified health plans;
  • require stand-alone dental plans to offer child-only plans in the Exchanges;
  • require the Exchange to ensure that participating dental plans have the provider network capacity to offer sufficient access to all eligible children;
  • require that stand-alone dental plans comply with all certification standards for qualified health plans except for those related to services other than pediatric oral health care;
  • and direct the Exchanges to collect rate information on pediatric dental benefits for the purposes of determining advance payments of the premium tax credit.

If implemented as outlined in the rule, these provisions stand to greatly improve dental coverage in terms of access, affordability and quality for families in the Exchanges, regardless of how they get their coverage. Click here for the full text of the rule.

Look for more information and analysis from the Children's Dental Health Project on the Exchange rule and its impact on the implementation of the pediatric dental benefit in the coming weeks.

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Did you know?

44% }
of U.S. children will have at least one cavity by kindergarten.
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