Do health reform requirements apply to dental-only plans?
Issue:

You have been asked to review your company’s employee benefit plans to determine what changes must be made to comply with the health care reform laws. You know your group health plan must comply with certain provisions such as the extension of dependent coverage. But what about your company’s dental-only plan? Does the dependent coverage provision apply to such plans?
Answer:    

No. Most of the group market reforms in the Patient Protection and Affordable Care Act (PPACA) do not apply to retiree-only plans or excepted benefits, such as dental care.

The preamble to rules implementing the PPACA states that health reform changes to the Public Health Service Act (PHSA) could be interpreted as requiring retiree-only plans and excepted benefits to comply with the health reform provisions. However, the interim rules clarify that the existing ERISA and Internal Revenue Code exceptions remain in effect, and reforms enacted by the PPACA “do not apply to such [retiree-only] plans or excepted benefits.”

What are excepted benefits? Excepted benefits generally include dental-only and vision-only plans, most health flexible spending arrangements, Medigap policies, and accidental death and dismemberment coverage.

Which provisions don’t apply? Included among the health reform provisions in the PHSA that do not apply to retiree-only plans or excepted benefits are the following:

  • Sec. 2701. Fair health insurance premiums;
  • Sec. 2702. Guaranteed availability of coverage;
  • Sec. 2703. Guaranteed renewability of coverage;
  • Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status;
  • Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status;
  • Sec. 2706. Nondiscrimination in health care;
  • Sec. 2707. Comprehensive health insurance coverage;
  • Sec. 2708. Prohibition on excessive waiting periods;
  • Sec. 2711. No lifetime or annual limits;
  • Sec. 2712. Prohibition on rescissions;
  • Sec. 2713. Coverage of preventive health services;
  • Sec. 2714. Extension of dependent coverage;
  • Sec. 2715. Development and utilization of uniform explanation of coverage documents and standardized definitions;
  • Sec. 2716. Prohibition of discrimination based on salary;
  • Sec. 2717. Ensuring the quality of care;
  • Sec. 2718. Bringing down the cost of health care coverage; and
  • Sec. 2719. Appeals process.

Source:  75 FR 37187, June 28, 2010.
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