The Affordable Care Act and Voluntary Benefits

It’s important to understand that the health insurance exchanges created by the Affordable Care Act offer only major medical insurance. When it comes to other benefits, however, voluntary benefits can fill the gaps.

Dental and Vision Benefits

The Affordable Care Act (ACA) requires health plans to cover pediatric dental and vision care services to be considered “qualifying coverage” under the law. This includes non-grandfathered small group (fewer than 50 people) and individual health insurance policies sold both inside and outside of the health insurance exchanges. However, it does not require health plans to cover dental or vision care services for adults.

If your employees will be obtaining health coverage through the exchanges, this means their young dependents will have vision and dental coverage. (The law requires health plans to allow children under age 26 to remain on their parent’s health plan; however, “pediatric” benefits typically end at age 19.)

Dental and vision coverage under exchange plans is likely to be more expensive than under private health plans. U.S. Department of Health and Human Services final rules implementing the exchanges prohibit plans from placing annual or lifetime dollar limits on pediatric dental and vision benefits. Most private plans have both annual and lifetime limits on benefits.

The majority of people with vision benefits get their dental and vision coverage through a separate, standalone vision insurance plan. The health insurance exchanges will not permit the sale of standalone dental and vision plans, so few employees buying coverage through the exchanges will have vision insurance for themselves unless their employers offer separate coverage. To ensure your employees get the dental and vision coverage they need, you can offer these programs on a voluntary, worksite basis. Employees will select the plan they need and pay premiums through payroll deduction.

Critical Illness or Cancer Benefits

Although plans offered on the exchanges will have no annual or lifetime maximums on the treatment of “critical illnesses,” including cancer, they will still have copayments and deductibles your employees must pay out of pocket. Critical illness and cancer insurance can help your employees meet these expenses at a low monthly rate.

Long-Term Care

Misconceptions abound on coverage for long-term care needs. Even if an individual needs long-term care due to illness, medical insurance (including Medicare) typically limits coverage to no more than 100 days and pays for long-term care only if you require skilled nursing services or rehabilitative care in a nursing home. In fact, most long-term care is not medical care, but rather assistance with the basic personal tasks of everyday life, sometimes called activities of daily living (ADLs), such as bathing, dressing, using the toilet, transferring to/from bed or chair, caring for incontinence and eating. Long-term care insurance will provide the coverage your employees need to cover this costly type of care.

Disability Income

Workers’ compensation will pay your employees’ medical bills and replace a portion of their income when they lose work time due to occupational illness or injury. But when a non-work illness or injury causes them to lose work time that exceeds their sick leave benefits, disability income insurance can help. It will replace a portion of income lost when an insured individual cannot work due to a non-occupational illness or injury. A voluntary disability income insurance program can help your employees supplement existing employer-paid sick leave and/or disability income coverage.

Life Insurance

Voluntary life insurance gives your less-healthy employees an opportunity to get the life insurance coverage they might not qualify for on the individual market. Most insurers will offer a minimum level of coverage on a voluntary basis without requiring a medical exam. Policies available on the voluntary market typically offer portability features, which allow your employees to keep their policy if they change jobs. Many also offer accelerated death benefits, which allow policyholders to access a portion of the death benefit if they are diagnosed with a terminal illness or serious condition requiring major medical intervention, such as an organ transplant.