Health Care Marketplace Plans

We're committed to keeping you informed about the Affordable Care Act (ACA). In a nutshell, here are the three types of coverage arrangements and how each might affect your reimbursement for services.

What are the three types of pediatric dental coverage?

1. Embedded

With this type of coverage, pediatric dental benefits are included (embedded) in a patient’s medical policy. The dental coverage provisions may be different from what you are used to seeing. For example, a single high deductible may apply to both the dental and medical benefits together. Some medical plan carriers might waive this deductible for all dental services, may only waive it just for diagnostic and preventive services or may establish a separate smaller deductible for dental; others may not.

2. Bundled

Bundled dental and medical coverages means the policies are sold together, but are still separate policies. The dental coverage could be administered by the medical insurance carrier or by a separate, stand-alone dental carrier like us. Bundled dental coverage has separate deductibles and out-of-pocket maximums that are not tied to the medical coverage. Typically, this is a better value for the patient than embedded plans.

3. Stand-alone

Stand-alone dental coverage includes most of the same advantages as bundled coverage by offering separate, limited deductibles and out-of-pocket maximums. Stand-alone dental coverage can be coupled with a medical policy that does or does not include pediatric dental.

Please note: Children with dental coverage through a family member's employer are not required to have dental coverage through the ACA.