All off-exchange Kaiser Foundation Health Plan HMO and Kaiser Permanente Insurance Company, Inc. (KPIC)1 PPO metal plans cover the ACA-defined essential health benefits, which include child dental services.
Grandfathered (nonmetal) HMO plans2 don’t include child dental coverage, but supplemental child dental coverage may be purchased and paired with a grandfathered (nonmetal) HMO plan. In this case, child dental coverage is available up to age 26. Supplemental coverage can only be added to a grandfathered (nonmetal) HMO plan during the health plan renewal period.
Use these summaries to see detailed benefit information for each child dental plan.
Here are answers to some frequently asked questions about off-exchange child dental coverage, as well as coordination of benefits when your clients offer a family dental plan paired with an off-exchange Kaiser Permanente metal plan.
Use these questions and answers when selling off-exchange supplemental family dental plans or share them with your customers. They include instructions on how to register online and receive services from Delta Dental.
We offer 3 types of family dental plans to meet your clients’ needs — KPIC Premier fee-for-service, KPIC PPO, and DeltaCare HMO. Please note that the DeltaCare HMO family dental plan can’t be offered with any PPO health insurance plans.
Note: Family dental plans are not a substitute for the child dental coverage required by the ACA for members under 19. That coverage is included in the Kaiser Permanente health plan. The family dental plan is in addition to that coverage.
Here’s an overview of our plan types through Delta Dental:
Benefit | KPIC fee-for-service plan3 | KPIC PPO plan3 | DeltaCare® USA plan |
---|---|---|---|
Flexibility and choice | Members can see any licensed dentist, including any Delta Dental PPO provider, for the same cost share. | Members can see any licensed dentist. However, their health insurance plan benefits are richer if they see a Delta Dental PPO provider. | Members must visit assigned DeltaCare® USA dentists |
Network access | Delta Dental PPO and Delta Dental PremierSM ® | Delta Dental PPO and Delta Dental PremierSM ® | DeltaCare® USA only |
Premium cost | Highest | Moderate | Lowest |
Cleanings and exams | Covered | Covered | Covered |
Claim forms | Not with network providers | Not with network providers | Not with network providers |
Deductible | Yes (except Plan C) |
Yes | No |
Plan limits | Yes | Yes | No |
You can share this value-of-dental-care flyer with their employees to demonstrate the benefits of having dental services included in their coverage.
For more dental plan and benefit information, contact your account manager or call our Account Management Support Team at 1-800-790-4661, option 3.
Use these summaries to compare the benefits and rates for all 3 dental plan options in each service area.
Use these summaries to see detailed benefit information for each dental plan.
1Kaiser Permanente Insurance Company (KPIC), a subsidiary of Kaiser Foundation Health Plan, Inc., underwrites the Kaiser Permanente Preferred Provider Organization (PPO) Plan.
2Kaiser Permanente Insurance Company (KPIC) PPO plans for small business are limited to non-grandfathered PPO metal plans only.
3This dental insurance plan is underwritten by Kaiser Permanente Insurance Company a subsidiary of Kaiser Foundation Health Plan, and administered by Delta Dental of California.