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Affordable Care Act Includes Dental Care

The Affordable Care Act (ACA) requires that plans offered to small businesses (1 to 50 employees) and individuals include the 10 essential health benefits (EHBs). In Iowa, large group employers (51 or more employees) generally cover the 10 EHBs and are not required by the ACA to offer their employees this coverage.

Transparency in Coverage - Delta Dental of Iowa policies and practices for ACA individual plans.

Delta Dental Pediatric Essential Health Benefit for Small Groups and Individuals 

  • Age Limits: The pediatric dental EHB mandates coverage up to age 19, but Delta Dental of Iowa plans expand this benefit up to age 21.
  • Lifetime Maximums: There are no annual or lifetime maximums.
  • Cost Sharing: The annual out-of-pocket limit for pediatric dental services is $350 per child or $700 for all children on the policy for services performed by an in-network provider.
  • Orthodontia: Medically necessary orthodontia is included and is defined by each carrier. Delta Dental members eligible for medically necessary orthodontia have a need for orthognathic survey, which is defined by certain designated syndromes or genetic disorders such as cleft palate. Delta Dental requires prior approval before treatment begins. 

Coverage for Children up to Age 26 

Children up to age 26 are eligible for coverage under their parents/guardians’ health care plans, regardless of marital status, dependent status, student status or residency. Although this provision does not apply to stand-alone dental or vision insurance, Delta Dental of Iowa applies this coverage to all small group plans and lets large groups choose whether to include coverage for eligible children up to the age of 26.

The content provided is for informational purposes only, and is not intended as legal or tax advice or opinion relative to any specific issue. Additional changes may be made to the Federal or State regulations described in this message. You should consider consulting with your lawyer or tax advisor before acting based on this information.