5 Myths About Health Care Reform and Dental Benefits

Myth 1: “Only medical benefits are impacted by health care reform.”

 Fact: Dental benefits are also impacted. Small groups ( <50 employees in most states) are required to
include pediatric oral services as one of the 10 Essential Health Benefits (EHBs) in 2014.

Myth 2: “As a small business, I won’t be impacted by the changes.”

Fact: Groups with under 50 lives will not face penalties for not offering coverage; however those that do need to be compliant with the EHB regulations — which includes providing pediatric dental care — beginning in 2014.

Myth 3 : “I don’t expect a significant premium increase since I’m a small company.”

Fact: Experts expect that most groups, small and large, will face significant premium increases. According to one report, medical increases for small groups could range from 25–130%, causing many employers to reexamine their benefit strategies — and possibly off er more voluntary options. I expect Defined Contribution Health  Plans (DCHP's, 105's) to take over a major piece of the business in 2015.  Companies will want to remain competitive for the best employees.  To do so, offering a strong benefits package gives a clear advantage. 

Myth 4 :“The pediatric care EHB will need to be provided by the medical carrier.”

Fact: In most states, the pediatric dental EHB can be purchased from a dental carrier — on or o ff exchange — as a stand-alone benefit or as a part of their dental plan.

Myth 5 :“Benefits purchased on the exchange are lower cost and low quality.”

Fact: Many medical carriers are expected to off er a smaller network to save on costs, but the benefit options off ered by dental carriers through the exchange will be largely comparable to what is available today, and
similar to what is available off -exchange.

Written By: Guardian®
The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10

Can't Shop When You Want To Shop - Special Enrollment Periods

Special Enrollment Period – how it’s changing the game . A special enrollment period is a window which allows an individual to enroll in an individual health insurance plan outside the annual open enrollment period. Each special enrollment period is “triggered” by certain qualifying events that are required by law. In most cases, special enrollment periods last 60 days from the date of the qualifying event. There are many qualifying events that can trigger the special enrollment period. Here are some key events to remember: ■Losing minimum essential health coverage ■Getting married ■Divorce ■Relocating ■New child ■Change in income ■Medicaid or CHIP ■Cobra expiration ■Health plan decertified