The Affordable Care Act’s individual mandate requires that all individuals carry pediatric dental coverage for their children or face a tax penalty. The problem is that New York State’s exchange website (NY State of Health) offers limited, stand-alone dental plans for individuals. This means that health insurance companies in NY are not required to offer built in pediatric dental coverage in their health plans. Many individual health insurance customers are not aware of this, and could be faced with a tax penalty next year due to (unknowingly) uninsuring their dependent children. For those that do have pediatric dental coverage built into their health plans, these benefits are very basic, and do not cover the adults.

Healthplex has responded to this gap in coverage need by providing robust, individual dental insurance products for downstate New York residents. In fact, as of last month, they have introduced a second fully ACA-compliant dental plan, which provides even better benefits over their existing plan. These two affordable individual dental plans are not subject to an open enrollment period like the individual health insurance market is structured…anyone can enroll on the 1st of every month, all year long. Additionally, both of these plans have a built in vision discount plan at no additional cost.

Here is the breakdown for both individual Healthplex dental plans:

“CapDent” Plan

-No waiting periods for benefits
-No claim forms, no deductibles, and no annual maximum coverage limits
-In network only coverage (no referral forms necessary)
–Select a primary “CapDent” dentist from a panel of 5000 providers in downstate NY
-Members pay only a fixed copayment for covered services
-If referred to a specialist within the CapDent network, members receive a 25% discount off any participating specialists’ usual fees
-Discount vision benefits are included for free, and are provided through Davis Vision Centers
-Annual premiums: Single – $177, Two person – $300, Family (3 or more) – $408
-You can find the CapDent plan brochure here: Healthplex – CapDent NY Brochure

“Select” Plan

-No waiting periods for benefits
-No claim forms, no deductibles, and no annual maximum coverage limits
-In network only coverage (no referral forms necessary)
–Select a primary “Select” dentist from a panel of 5500 providers in downstate NY
-Members pay only a fixed copayment for covered services
-If referred to a specialist within the Select network, members pay the same fixed copay structure for covered services
-Discount vision benefits are included for free, and are provided through Davis Vision Centers
-Annual premiums: Single – $264, Two person – $432, Family (3 or more) – $612
-You can find the Select plan brochure here: Healthplex – Select NY Brochure

Vision benefits (included at no additional charge) can be found here: Davis Vision Discount Benefits

To request an application for enrollment, or if you have questions, contact us today.