The Affordable Care Act (ACA), also known as Health Care Reform (HCR), has the most impact on companies with fewer than 50 employees (or fewer than 100 employees in some states).
Some health plans have "grandfathered" status, which allows them to be exempted from many of the changes required by the ACA legislation. However, some consumer protections must be added to plans even if they've been grandfathered. All health plans:
Are prohibited from applying lifetime dollar limits to key health benefits.
Are not permitted to cancel insurance coverage solely because of an honest mistake the participant or employer made on an insurance application.
Must extend dependent coverage to adult children until they turn 26 years old, unless they have access to affordable coverage through their own employer.
With these updates, you can continue to offer your existing plans to current and new employees the way you offer them now. Your plans will remain grandfathered until you make changes to your plan.
Non-grandfathered plans and plans that lose their grandfathered status must comply with all ACA requirements.
The ACA requires small business employers to offer a medical plan that includes 10 essential health benefits (EHBs), including pediatric dental benefits.
Pediatric dental benefits don't have to be embedded with the other essential health benefits in a medical plan. In fact, we believe it's better if dental benefits are not embedded in a medical plan.
If you provide fully insured dental benefits through a stand-alone dental carrier, like MetLife, your dental plan can be an excepted benefit plan. Dental plans are largely exempt from the requirements of the ACA if the dental plan qualifies as an excepted benefit.
MetLife has put a lot of thought into designing ACA-compliant plans that work for our customers and their employees.
To help our small-business customers comply with HCR, we added the pediatric dental benefit to many of our dental benefit plans. So, many of you are able to continue offering MetLife dental benefits just like you have always done.
Public Health Insurance Marketplaces
To help small businesses provide plans that comply with the ACA, the legislation also required each state to establish a health insurance marketplace or participate in the federal health insurance marketplace, where small businesses can find ACA-compliant plans.
While ACA-compliant dental plans can be purchased in a variety of ways, we know some of our small business customers have chosen, and will continue to choose, to purchase their dental benefits through public marketplaces. That’s why we sell group dental products through some public marketplaces.
You can choose to participate in the marketplaces or offer ACA-compliant insurance on your own.
Your company and employees may be able to find a broader selection of plan designs, including ACA-compliant benefits, outside the marketplaces, or exchanges.