Pediatric Dental and Vision in the ACA

One of the 10 essential health benefits that must be included in all small group and individual health plans for 2014 is pediatric services for children ages 0-18. While many plans in the past did include pediatric services, what's new is the requirement to include pediatric dental services and vision coverage. The dental benefit has an extra twist. How these benefits are purchased depends on whether someone purchases a plan inside or outside of our state's online exchange marketplace, Washington Healthplanfinder. Here's the information that's important to share with your clients:

• If a plan is purchased outside the exchange, pediatric dental coverage will be included in the plan, and the coverage cannot be waived whether or not the purchaser has a dependent age 0-18.
• If a medical plan is purchased through the exchange—Washington Healthplanfinder—it will not include pediatric dental coverage. However, a pediatric dental purchase is required when members have dependents age 0-18. Pediatric dental coverage must be purchased from a stand-alone dental provider with Washington Healthplanfinder. The requirement is waived if the member has no age 0-18 dependents.

Pediatric vision coverage is also a requirement, but it is included in all plans, whether purchased in our out of the exchange.

I am registered to sell medical insurance inside and outside the exchange, or HIX as it is called.