On November 26, the U.S. Department of Health and Human Services published guidance on the Affordable Care Act's standard set of benefits that must be offered in the new state health insurance exchanges and small group and individual insurance markets outside the exchanges.
In response, the Children's Dental Health Project (CDHP) has issued a policy checkup that examines dental-specific issues in the proposed rule on Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation.
According to the CDHP, the proposed rule clarifies that any essential health benefits (EHB) benchmark plan that is lacking pediatric dental coverage must supplement with either the set of oral health services outlined in the Federal Employees Dental and Vision Insurance Program or those in the state's separate Children's Health Insurance Program.
The same benefit standard will also apply for states that do not elect an EHB benchmark or establish a state-based exchange and instead allow the federal government to set one up, the CDHP noted.
Also, while the rule proposes a separate cost-sharing limit for standalone dental plans, it only specifies that this limit be reasonable and finally it proposes a separate actuarial value standard for standalone dental plans.