WASHINGTON – U.S. Senator Ben Cardin (D-MD) today lauded the forceful consumer protections for stand-alone dental plans that will be offered in health insurance exchanges, which will be available for individuals and small businesses as part of the Affordable Care Act (ACA) starting January 1, 2014.  The ACA requires states to include pediatric oral health care as part of the Essential Benefits package, and permits that coverage to be made available through either comprehensive health plans or stand-alone dental plans.    

In October, Senator Cardin and 11 other Senators wrote to Secretary Sebelius urging her to ensure strong protections for dental plan in the health exchanges. In addition to Senator Cardin, the letter to the Secretary was signed by the following Senators: Jeff Bingaman (D-NM), Richard Blumenthal (D-CT), Sherrod Brown (D-OH), Robert Casey, Jr. (D-PA), Al Franken (D-MN), Robert Menendez (D-NJ), Barbara A. Mikulski (D-MD),  John Rockefeller (D-WVA), Bernard Sanders (I-VT), and Tom Udall (D-NM).

“Tooth decay is the most prevalent chronic condition affecting our nation’s children, and that’s why guaranteeing oral health care coverage in the Affordable Care Act is essential,” said Senator Cardin.  “The final rule ensures that patients in stand-alone dental plans will benefit from the same consumer protections that apply to other health plans in the exchange, whenever applicable.”

The Department of Health and Human Services this week issued its “Rule on the Establishment of Exchanges and Qualified Health Plans.” It requires plans in exchanges to provide:  

• protections against high out-of-pocket costs;
• families the option of selecting a child-only dental plan;
• solvency standards equivalent to those in medical plans;
• adequate provider networks, and;
• vigorous certification standards.

“Moving forward, states have a critical role to play in ensuring that the ACA’s pediatric oral health benefit is designed to provide incentives to encourage prevention, recognize that some children are at greater risk for dental disease than others, and deliver care based on that risk.  These rules provide a great start as states begin to prepare for enrollment through the health insurance exchanges in 2014,” said Senator Cardin.