Health Care Exchange (Marketplace) for Brokers and Consultants

When it comes to the Health Care Exchange (Marketplace) and dental coverage, we’ve got your clients covered with valuable dental coverage at affordable rates.

With dental plans that meet and complement the Affordable Care Act’s (ACA) required essential health benefits (EHBs) for pediatric dental care, we are your go-to for offering quality benefits on and off state exchanges.

We can give you the tools to help your clients make confident and responsible decisions about their dental benefits package, whether they want to:

  • Conservar un plan,
  • Comprar un nuevo plan,
  • Vincular planes dentales y médicos independientes
  • Crear otras combinaciones de cobertura.

Lo que debe saber

Your clients have options with Delta Dental. They can choose to:

  • Purchase a stand-alone, ACA-compliant1 Delta Dental pediatric dental plan within most state exchanges, or
  • Keep their traditional Delta Dental plan and add a stand-alone, ACA-compliant pediatric dental plan

Inside most state exchanges, Delta Dental offers several ACA-compliant plan options. Fuera de los mercados estatales, la mayoría de los estados permitirán a las compañías de seguro como Delta Dental ofrecer planes dentales pediátricos independientes que cumplan con los requisitos de la ACA cuando se vinculen con una póliza médica que cumpla con la ACA.

Important Purchasing Factors

  • Supplemental dental benefits plans (like our family plans) cover adults and adult dependents, as well as provide children’s benefits not typically covered by an ACA-compliant pediatric plan.
  • Important purchasing factors for your clients:
    • Elegir solo un plan integrado (un plan médico que incluye los requisitos del cuidado bucal pediátrico) puede ser una manera fácil de cumplir los requisitos de la ACA, sin embargo:
      • The dental portion won’t cover adults or children age 19 and over
      • Dental expenses may not be covered until a combined medical/dental deductible is met, which can be as high as $2,000 per person annually
      • Enrollees may have to change dentists to obtain services
    • Bundled medical/dental plans (separate dental and medical policies sold together to meet ACA requirements sold in some states) offer the same advantages as a separate stand-alone dental plan — a lower deductible and out-of-pocket maximum for dental — but with more meaningful dental coverage for children when compared to embedded dental plans.
    • Many medical insurers embed a pediatric EHB benefit in their policies. However, your clients can usually request that a medical insurer accept reasonable assurance2 to allow them to purchase a stand-alone, ACA-compliant dental plan. Usually, stand alone dental plans will have lower deductibles and out-of-pocket maximums, than embedded plans, allowing dental enrollees to benefit from coverage sooner that with embedded (integrated) coverage.

Helping Your Clients Choose Plans

Marketing our ACA-compliant plans is easy; however, before you help your clients choose a plan, you should consider the following:

  • You must be appointed by Delta Dental before marketing plans on the exchange. You will not receive commission if you market a plan before completing the exchange registration.
  • How to market plans offered on state exchanges:
    • Most states allow brokers to assist their clients in purchasing exchange-certified, stand-alone dental plans. Visite healthcare.gov to find the marketplace for your state.
  • How to market plans offered outside state exchanges:
    • In many states, Delta Dental sells EHB plans through a network of medical partners. To learn more about these plans, contact your Delta Dental Account Executive.
    • Your group clients can purchase plans through our Programa para pequeñas empresas or our medical partners.

We’re Here to Help

We have dental plans that meet and complement the ACA’s defined essential health benefit (EHB) requirement for pediatric dental care.

  • Within most state exchanges (and for small businesses, both in and outside the Small Business Health Options Program (SHOP) exchange3), we offer:
    • Coverage for families with plans that include the pediatric dental EHB requirement, but also provide benefits for adults
    • Coverage for children with plans covering only pediatric dependents

We’re happy to help you market ACA-compliant dental coverage as your dental benefits experts!

Note: If You’re Marketing Plans for Small Businesses, please consider the following:

Starting in 2016, some states will change their definition of small business from 50 employees to include those that employ up to 100 employees. Some things for you and your clients to consider:

  • Many more employers in states that expand their definition to the new size will be required to purchase an ACA-compliant health plan.
  • Most states will keep the definition of up to 50 employees, and not open their SHOP to the larger group size. Esto se debe a la aprobación de la ley PACE en el Congreso, que firmó el Presidente Obama en octubre de 2015.
  1. 1Los planes de salud que cumplen con la ACA incluyen los 10 beneficios esenciales para la salud (EHB, por sus siglas en inglés), uno de los cuales es el cuidado bucal pediátrico hasta los 19 años. Consulte con un representante de ventas de Delta Dental sobre los requisitos de su estado.
  2. 2 La garantía razonable es una declaración de un comprador de póliza de salud a una aseguradora de póliza que verifica que el comprador tiene o va a obtener un plan pediátrico independiente certificado por los mercados de seguros de salud. Puede haber una gran variación en lo que los reguladores estatales aceptarán como garantía razonable. Algunos estados no pueden aceptar una garantía razonable.
  3. 3Plan availability varies by state.