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Group Dental/Vision

Aside from protecting your smile, dental care ensures good oral and overall health. Several studies suggest that oral diseases, such as periodontitis (gum disease), can affect other areas of your body—including your heart. Understanding and choosing dental coverage will help protect you and your family from the high cost of dental disease and surgery.

What Is Dental Coverage?

Dental coverage is similar to regular medical insurance and is one of the voluntary benefit options commonly offered through employers. When you have dental insurance, you pay a premium and then your insurance will cover part or all of the cost for many dental services.

How Has Health Care Reform Affected Dental Coverage?

Under the Affordable Care Act (ACA), dental services are an essential health benefit for children under the age of 19, although individual states can choose to extend the age limit beyond this baseline. Declaring pediatric dental care an essential health benefit means that, beginning in 2014, all non-grandfathered medical health plans must offer dental benefits for children unless certified stand-alone coverage is available. Non-medically necessary orthodontia is not included in the essential health benefits definition.

The essential health benefit status for dental coverage does not apply to adults. In addition, unlike medical insurance, you do not have to obtain dental coverage to avoid penalties.

 

 

Vision Insurance

Driving to work, reading a news article and watching television are likely activities you perform every day. Your ability to do all of these, however, depends on your vision and eye health. Routine eye exams will help maintain your vision as well as detect various eye problems and concerns about your overall health. Obtaining vision insurance is a way to make sure you can continue enjoying good health as well as the sights around you.

What Is Vision Insurance?

Vision coverage is similar to regular medical insurance and is one of the voluntary benefit options commonly offered through employers.  Vision insurance generally provides coverage for basic care and eyewear. Most vision plans will cover the following services:

•     Annual or biannual eye exams, including dilation

•     Eyeglass frames

•     Eyeglass lenses

•     Contact lenses

How Has Health Care Reform Affected Vision Insurance?

The Affordable Care Act (ACA) does affect some vision benefit plans. If your vision coverage falls under the new ACA rules, then the vision plan will have to cover adult children up to age 26, and lifetime and annual limits on coverage will be eliminated. If the vision plan is of limited scope, then it is considered an excepted benefit and does not have to follow the new rules. Limited-scope plans include vision benefits provided under a policy separate from regular medical benefits, or vision benefits that are not an “integral part” of the group health plan.

In addition, under the ACA, pediatric vision care is considered an essential health benefit. This means that vision coverage must be available for children under the age of 19. The ACA does not consider vision care an essential health benefit for adults, so vision care is not mandatory for individuals 19 years and older. Unlike medical insurance, there will be no penalty for not purchasing vision insurance. For further information on the ACA and vision insurance, visit www.dol.gov/ebsa/faqs/faq-aca2.html.

  
 
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Texas Associates Insurors - Home Office
1120 Capital of Texas Hwy
Bldg 3-300
Austin, TX 78746

Ph: 800.765.4154
Ph: 512.328.7676
Fax: 512.327.8337

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