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Does your Health Plan Include Pediatric Dental Benefits?

Understand the basics.

About the Pediatric dental Essential Health Benefit

A child with good dental health has an easier time eating, speaking, playing, going to school and paying attention in class. Unfortunately, tooth decay is the most common chronic early childhood disease in the United States, and dental problems cause America’s children to miss 51 million school hours a year. Part of the solution to protecting the dental health of your children is a solid dental insurance plan that is the right fit for your family. Therefor the Affordable Care Act (ACA) has included Pediatric Dental Coverage as an Essential Health Benefit (EHB) that must be covered by all health plans.

What's covered and how?

What pediatric oral care services are covered as an Essential Health Benefit?

  • Exams, cleanings, fluoride, sealants, E-rays

  • Minor restorative services, such as fillings

  • Major restorative services, such as crowns

  • Medically necessary orthodontia

Plan designs may vary by state and health plan selected. Its is important to note that what is considered "medically necessary orthodontia" is very different than traditional dental orthodontic services. Medically necessary orthodontia coverage is limited to those with sever bite impairment or congenital concerns, such as cleft palate and requires pre-authorization. Consult your Health insurance carrier for more information on the medical plan you are considering.

How do I get more benefit details?

Are you covered with an Emblem Small Group Plan?

Emblem Health offers an integrated family dental plan for no extra cost. Please reach out to Glucks Insurance Agency or to Emblem Health to get full details.

Are you covered with Aetna, Empire, MVP, or Oxford?

Please click on your carrier link below to access more information on your pediatric dental benefits.

All other members please reach out to your carrier by calling member services.

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