As the Affordable Care Act implementation moves forward at the federal and state levels, Delta Dental of Illinois -- with over 2 million enrollees in Illinois -- remains committed to its mission of improving the oral health of all Illinoisans. We will continue to pursue this mission by providing affordable benefit programs to individuals and groups in Illinois, as well as through the Delta Dental of Illinois Foundation's support of statewide community benefit programs that provide Illinoisans access to oral health care and education.
Are you looking for a plan that complies with the Affordable Care Act’s pediatric dental essential health benefit (EHB)?
We offer plans that meet all the guidelines of the Affordable Care Act’s pediatric dental essential health benefit (EHB). You do not have to purchase pediatric dental coverage from a medical carrier, and the pediatric dental EHB does not have to be embedded in a medical plan, or purchased from an exchange.
Our Kids Dental Wellness Plus plan is offered as a companion/rider to Delta Dental PPO Gold and Silver plans* or on a standalone basis. The Delta Dental PPO Kids Dental Wellness Plus plan uses an Exclusive Provider Feature. With an Exclusive Provider Feature, benefits are paid only when members see a Delta Dental PPO dentist. There are no benefits when a member sees a dentist outside of the Delta Dental PPO network.
Members under age 19 who are enrolled in Delta Dental PPO Gold or Silver with Kids Dental Wellness Plus can use the benefits of both plans but can only receive benefits from Kids Dental Wellness Plus with Delta Dental PPO dentists.
Choosing the best dental plan that fits your needs is very important. Below are the top 5 things to know about buying dental insurance.
1. All plans must offer the same dental benefits for children.
Starting in 2014, all health plans sold to individuals must offer 10 essential health benefits (EHBs), one of which is pediatric dental care, including:
- Coverage for diagnostic and preventive care, as well as medically necessary orthodontia;
- Coverage for children under age 19;
- No annual or lifetime benefit maximum for covered services; and
- Out-of-pocket limit of $700 per child or $1,400 per family.
2. Not all medical plans pay children’s benefits equally, and you do not have to purchase the required pediatric dental care from a medical carrier.
On the Illinois Health Insurance Marketplace, it is possible to purchase the pediatric dental benefit through a medical carrier or a stand-alone dental plan through a dental benefits carrier. Because many medical plans may require the policy’s annual deductible and out-of-pocket maximums be met before paying dental benefits, a stand-alone dental policy may expand benefits and reduce overall expenses.
3. Different dental plan types are available.
All health care and dental plans must be differentiated in a way that helps consumers compare plans from different carriers on the Illinois Health Insurance Marketplace. Dental plans are characterized as either High or Low.
- High plans have slightly higher premiums but offer lower co-pays and annual deductibles.
- Low plans have lower premiums but offer reduced benefits, resulting in higher co-pays and annual deductibles.
All dental plans, whether high or low, will meet the pediatric dental care requirement mandated by health care reform.
4. Adult dental coverage is also an option.
Medical plans are not required to offer any dental benefits for adults, but they can be purchased through a stand-alone dental carrier. Although not required, adult dental coverage should be strongly considered. In addition to its relatively low cost compared to medical coverage, dental coverage encourages regular preventive dental check-ups, which not only helps protect dental health but also can detect as many as 120 different diseases in their earliest stages, when they are most effectively treated.
5. It’s important to evaluate carrier differences.
Even though the coverage may be similar among different companies offering insurance on the Illinois Health Insurance Marketplace, there are still differences consumers should consider. Some questions to ask include:
- Is your dentist part of the network offered by the carrier? This is important to check because not only will you enjoy the convenience of keeping your dentist, you may save money since network dentists have agreed negotiated fees which are lower than their usual fees and they cannot bill consumers over that negotiated fee.
- Customer service is another key area. Consumers should look at service statistics, such as how quickly calls are answered and issues are resolved.
Our Delta Dental of Illinois Health Insurance website can provide you with all the detail you need to choose a plan.