Affordable Care Act

Facts & FAQs

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Find out how the Affordable Care Act affects dental and vision benefits.

Q. What impact does health care reform have on dental and vision policies sold separately from medical policies?
A. Stand-alone dental and vision policies, which are sold separately from medical policies, are considered excepted benefits and are not subject to market reforms under federal legislation. Ameritas dental and vision policies are always excepted benefits. Employers who have dental and vision Administrative Services Only (ASO) plans must prove the plans are not integral to their medical plan for the benefits to be considered excepted. If the dental and vision plans are not excepted, certain health care reform provisions may apply.

Q. What is an exchange?
A. Under the Affordable Care Act, individuals and small employers can purchase benefits and have access to premium subsidies and cost reductions through online public marketplaces known as exchanges. States can run their own exchanges or let the federal department of Health and Human Services provide exchange services for their state.

Private exchanges are typically organized by brokers, private enterprise or insurance companies and are not run by the state or federal government. They are intended to give large and small employers the opportunity to select from a variety of benefits to help manage benefit costs and simplify plan administration.

Q. What are pediatric oral and vision Essential Health Benefits?
A. Under the Affordable Care Act, there are 10 categories of Essential Health Benefits that medical carriers must offer to most individuals and small employer groups both inside and outside the public exchanges. One of these categories includes dental and vision benefits for those up to age 19. This does not include adult dental or vision benefits.

Q. How are dental and vision benefits impacted by the public exchange?
A. Insurers who offer stand-alone dental plans must apply for and receive state certification for pediatric dental plans to offer them within or outside a public exchange.

Insurers who offer stand-alone vision plans currently are not allowed to offer pediatric vision Essential Health Benefits within or outside a public exchange.

Q. How are dental and vision benefits affected for dependents age 19 and over?
A. Under the Affordable Care Act, individuals age 22 to 26 can remain covered under their parents’ employer-sponsored or individually purchased medical benefits. Extending coverage to age 26 does not apply to excepted benefits like dental and vision under the law. However, Ameritas will accommodate customers who would like the dependent age for their dental and/or vision plans to match that of their medical plan.

Q. Does changing carriers affect a plan’s grandfathered status?
A. A grandfathered health insurance policy is one that was in effect when the Affordable Care Act was enacted. A change in plan or policy carrier will not trigger a loss in grandfathered status.

Q. Do Ameritas dental and vision plans have to comply with Medical Loss Ratio requirements?
A. Although dental and vision plans are excluded from the federal MLR requirement, individual states could require dental and vision plans to meet the requirements.

Additional Information

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