ID| The Idaho Department of Insurance Bulletin No. 26-15 reissues Bulletin 14-02 and clarifies how pediatric dental coverage and the ACA “reasonable assurance” standard apply to all EHB-compliant individual and small group health benefit policies, whether sold on or off Your Health Idaho (YHI). While ACA Section 1302 requires coverage of all ten EHB categories including pediatric oral care, Section 1302(b)(4)(F) permits qualified health plans (QHPs) to exclude that benefit when at least one exchange-certified stand-alone dental plan (SADP) is available — an exception the Department stresses is limited to QHPs only, not non-QHPs.
Key Points:
- Non-QHPs: Plans sold exclusively off-exchange cannot obtain QHP certification, get no pediatric dental exclusion, and are ineligible for the reasonable assurance allowance — they must cover all ten EHB categories.
- QHPs sold through YHI: No additional reasonable assurance requirement, since a SADP is available in the rating area. Consumers cannot be required to buy separate pediatric dental coverage, and carriers must not delay enrollment for lack of it.
- QHPs sold outside YHI: Carriers may exclude pediatric dental EHB only if reasonably assured of exchange-certified SADP coverage; clear disclosure language on enrollment forms/applications (model wording provided) satisfies this. Carriers may not ask consumers to report other dental coverage or require its purchase — without the disclosure, the plan fails the ten-EHB requirement.