Individual Marketplace Pediatric Dental Benefit Decisions for 2014
This chart highlights marketplace policy decisions related to pediatric dental coverage for the 2014 plan year. It tracks the kinds of pediatric dental products that marketplaces solicited and offered on the marketplace in 2014, particularly whether dental benefits were offered through stand-alone dental products (SADP), as “bundled” products that paired a specific SADP and a qualified health plan (QHP), or “embedded” as part of a QHP. Don’t see your state listed on the chart? Your state is a state running a federally-facilitated or partnership marketplace and is shown in the first row. If you’d like to learn more about dental coverage and Essential Health Benefits, check out the Oral Health and Essential Health Benefits discussions. For an in-depth analysis of a wide variety of issues relating to marketplace dental coverage, check out an April 2014 NASHP report.
Like all State Refor(u)m research, this chart is a collaborative effort with you, the user. State Refor(u)m captures the health reform comments, documents, and links submitted by health policy thinkers and doers all over the country. And our team periodically supplements, analyzes, and compiles this key content.
Know of something we should add to this compilation? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email a NASHP staff member with your suggestion.
| State | Marketplace Type | Stand-Alone Dental Policy (SADP) (Separately offered pediatric dental benefits) | Embedded (QHP includes pediatric dental benefits) | Bundled (QHP contracts with a dental issuer) | Requirement to Purchase Pediatric Dental (inside the marketplace) | 2014 Annual Out-Of-Pocket Maximum for SADP | Pediatric Dental Benchmark Selection |
|---|---|---|---|---|---|---|---|
| Federally-Facilitated & Partnership States [1] | FFM or Partnership | Yes | Yes | No | $700 for one child enrollee or $1,400 for two or more child enrollees | Varies by state: 12 CHIP, 22 FEDVIP, 1 Included | |
| CA | State-Based Marketplace (SBM) | Yes | No | $1,000 for one child, $2,000 for two or more children | CHIP | ||
| CO | SBM | Yes | Yes | S | No | $700 for one child, $1,400 for two or more children | CHIP |
| CT | SBM | Yes | N/A | N/A | CHIP | ||
| DC | SBM | S | Yes | S | No | $1,000 for one child, $2,000 for two or more children | FEDVIP |
| HI | SBM | Yes | Yes | No | $700 for one child, $1,400 for two or more children [2] | CHIP | |
| ID | SBM | Yes | Yes | No | $1,000 per person | FEDVIP | |
| KY | SBM | Yes | Yes | Yes | $1,000 for one child, $2,000 for two or more children | CHIP | |
| MA | SBM | Yes | Yes | No | $1,000 for one child, $2,000 for two or more children [2] | CHIP | |
| MD | SBM | Yes | Yes | S | No | $1,000 for one child, $2,000 for two or more children | CHIP |
| MN | SBM | Yes | Yes | S | No | $700 for one child, $1,400 for two or more children [2] | FEDVIP |
| NY | SBM | Yes | Yes | No | $700 for one child, $1,400 for two or more children | CHIP | |
| NV | SBM | Yes | S | S | Yes | $700 for one child, $1,400 for two or more children | CHIP |
| OR | SBM | Yes | Yes | No | $1,000 per person | CHIP | |
| RI | SBM | Yes | Yes (individual market only) | No | $700 for one child, $1,400 for two or more children [2] | FEDVIP | |
| VT | SBM | Yes | Yes | S | No | N/A | CHIP |
| WA | SBM | Yes (individual market only) | Yes | No imposed dollar amount – OOP deemed ‘reasonable’ if EHB is covered and actuarial value is met [3] | CHIP | ||
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Notes:
S=State solicited for this type of dental offering but did not receive any submissions and is not offering this type of product in plan year 2014
[1]AK, AL, AR, AZ, DE, FL, GA, IA, IL, IN, KS, LA, ME, MI, MO, MT, NC, ND, NE, NH, NJ, NM, OH, OK, PA, SC, SD, TN, TX, UT, VA, WA, WV, and WY are either federally-faciliated marketplace (FFM) or partnership marketplace states. This row includes information for these 34 states set by the federal government.
[2] Information obtained through correspondence with the National Association of Dental Plans
[3] Information obtained through correspondence with Washington marketplace officials.
[1]AK, AL, AR, AZ, DE, FL, GA, IA, IL, IN, KS, LA, ME, MI, MO, MT, NC, ND, NE, NH, NJ, NM, OH, OK, PA, SC, SD, TN, TX, UT, VA, WA, WV, and WY are either federally-faciliated marketplace (FFM) or partnership marketplace states. This row includes information for these 34 states set by the federal government.
[2] Information obtained through correspondence with the National Association of Dental Plans
[3] Information obtained through correspondence with Washington marketplace officials.
The development of this chart was made possible with support from the DentaQuest Foundation.
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