To: Bill who wrote (844665 ) 3/24/2015 1:23:23 PM From: Alighieri Read Replies (2) | Respond to You are wrong, again, and posting a dated article doesn't support your position. Obviously you are covered by somebody else, or else you'd know the Federal EHBs. The regulations require that states define EHBs for policies sitused in the state. To meet this requirement, each state selected an existing health plan as a “benchmark” to establish services and items included in that state’s EHB package. Per Department of Health and Human Services (HHS) guidance, states were required to choose from one of four health insurance plan options as a benchmark: • The largest plan, based on enrollment in any of the three largest small group products in the state • Any of the three largest state employee health plans • Any one of the three largest federal employee health plan options • The largest HMO plan offered in the state’s commercial marketwill typically be based on either the FedVIP plan, or the State CHIP plan , depending on which plan the state selected. In some states, the benchmark plan includes pediatric dental services. Under these plans, pediatric dental services are often broader than screenings, and include dental checkups. Plans offered in the individual and insured small group market must either include pediatric dental benefits, or follow these rules for the provision of pediatric dental benefits as a stand-alone dental plan: Stand-alone Dental: • Inside the Exchanges/Health Insurance Marketplaces • If a stand-alone pediatric dental option is available from any carrier on the Exchange, from any carrier, pediatric dental coverage can be excluded from the EHB package provided by the medical plan. • There is no requirement for an individual or family (with a child or without) to purchase a stand-alone plan if the Exchange medical plan does not cover the pediatric dental. • Outside the Exchanges/Health Insurance Marketplaces • Pediatric dental coverage can be excluded if carriers are reasonably assured that the individual has obtained pediatric dental coverage by an Exchange-certified stand-alone dental plan. It does not have to be purchased through an Exchange. • An individual or family must be offered coverage of all ten categories of EHBs, either through one policy, or through a combination of a medical policy and an Exchange-certified stand-alone dental plan. Self-funded and large group plans do not have to offer the pediatric dental benefit. Only plans that are “excepted benefits” can impose annual or lifetime dollar limits for pediatric dental EHBs for anyone under 19. • By maintaining excepted benefit status, dental benefits are exempt from PPACA and HIPAA requirements that are applicable to medical plans.
