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Important EMBLEM ACA Compliance Update

Re: Pediatric  Dental
Emblem has asked us to reach out to our brokers to follow up on a letter that all Emblem Medical groups should have received in February and again in April regarding the Affordable Care Act and Pediatric Dental Coverage that is required in order to be ACA Compliant.  Emblem did not embed the Pediatric Dental coverage in their group medical plans, so what they have done to address this is partner with Dentcare (us) to offer it to the groups to ensure that they are ACA compliant.  

Please keep in mind that these plans are only for children, not adults.  Companies with employees that have children under the age of 19 must offer this coverage to their employees to become compliant with the Affordable Care Act. They do not need to offer this coverage if the group has an alternate dental plan that is ACA compliant or they have do not have employees with children under the age of 19. Plans can be back dated if necessary.

Below is Emblem’s Off Exchange Group Application(FX-0012DDS) and enrollment form(FX-2364DDS) for Shop Pediatric Off Exchange Dentcare Smiles Kids plan for small businesses.  Also attached are two separate benefit breakdowns.  This plan meets all NY State mandated essential health benefits for pediatric dental coverage.  The coverage is only for the dependent children, the parents will not be covered.

If you would like to enroll your client in this plan, please follow the steps below.

•         The employer should fill out the group application, and each employee with children should fill out an enrollment form for their children.  The employer does not need to pay for the employees coverage however, the premiums are to be paid by the employer, but can be deducted from the employees paycheck if they elect for the coverage.  

•         The company should supply us with a copy of their most recent NYS-45 form. (If Available)

•         The  “Broker Appointment Letter” below should be filled out by the group on their company letterhead so you can get commissions for the group.