ACA Update – Small Businesses & Pediatric Dental

By Phil Castell

Attention Employers:

The ACA has required a form letter be given to all employees by October 1st 2013.  They have postponed the penalty employers faced for non-compliance, but it’s still a good idea to find out what your obligations are under the ACA as an employer.

If you send an email to info@castellinsurance.com, we will provide you with a PowerPoint presentation on how the ACA affects business as well as a PDF of a sample form letter.

 

In the next 8 days, the last few questions should be answered.  On October 1, we will go live in the assistance and enrollment process of the much anticipated Affordable Care Act (ACA) open enrollment period for coverage starting in January 2014.

In this blog, I will cover a few things we’ve learned in the past week.

We have always been told the plans offered by Premera and Lifewise were identical, but we have found an important difference.  If a person travels in the U.S. or even abroad, the Premera Blue Card would have greater acceptance than the similar card of Lifewise.  If you don’t travel, this is not a big difference.  If you do, we will be suggesting the Premera Blue Cross for this reason.

We mentioned that Pediatric Dental must now be included in all programs as one of the 10 Essential Health Benefits.  This is a benefit for children under the age of 19.  We now have a greater understanding of how this is handled.

Outside the Exchange, the pediatric dental is an included benefit (no additional cost). Inside the Exchange, it is an additional cost of $26.50 per month per child.  So, if outside the Exchange it is covered and inside it costs $26.50… What is the difference???

Inside the Exchange, there is only a $65 annual dental deductible prior to accessing dental benefits.  Outside the Exchange, the medical deductible must be satisfied before obtaining any dental benefits.  For example, if you had a $2,000 medical deductible, that would have to be satisfied prior to receiving any benefit of the dental rider.

I consider this next item the most important plan detail to emerge so far.  It is called Prior Authorization.  Prior Authorization means that the insurance company wants to review all planned procedures to ensure they are medically appropriate and necessary.  Now, before you get all excited…  If your treatment is an emergency or life threatening situation, Prior Authorization is not required.

For example, if you are going for repeated cat-scans or MRI’s, the insurance company will want to ensure it is in yours and their best interest for that testing.

At this point, we believe it will likely fall upon the provider to contact the insurance company to request the procedure. This is our educated opinion since the provider will have all the details, reasons and procedure codes.

At Castell Insurance, we are busy creating documents and charts to ensure we fully explain plans and benefits in a clear and concise manner.  We will have four full time agents available (Phil Castell, John Coulson, James Castell and Stephany Shackelford), all fully licensed and trained in all plans both inside and outside the exchange.

When you apply for coverage inside the exchange, it will be necessary to enter the initial premium via credit card, debit card or your checking account.  Please do not worry, they will not withdraw the funds for January until a date you specify.  The latest date for a January start will be December 23.

NOW would be a great time to pick up the phone or send us an email to request your appointment to review options and enroll for 2014.  Stephany is the dedicated contact person for making appointments and can be reached at 683-9284 or stephany@castellinsurance.com