Orthodontia-over Age 18-group Benefit Help

[yorkriver1]

Gaining group experience. Have some questions for more experienced benefits pros. Thanks in advance.

One person in the group (my one group for the time being, that I took over on AOR) is questioning whether there is orthodontia coverage. There is not.

The questioner is one of the admin folks, with an adult child, age 21, who needs orthodontia re-treatment. This child will be on the dental until age 25. The plan's renewal is 11/30/14.

1. most plans with orthodontia coverage seem to stop at age 18. I see that adult is an option on more rich benefit dental plans.

2. the limit of lifetime coverage is usually something like the total of one year's maximum paid by the dental plan, like $1,000 or $1,500.

What is the average offer of orthodontia for groups 25-50 with dental coverage? This is an ER group of 40, 30 on plan.
How many small groups, on average, offer ortho on their plans? How frequently would they also include adult coverage?

 

[ABC]

It's about the same benefit, up to $2,000 life time.

What the dental carriers are doing is coordinating the benefit. I you use that benefit up with Principal and the plan moves to Met Life, you don't get another $2,000.

You use to be able to game the group dental plans but not anymore.

Now this for groups under 50.

It's all about the definition in the plan contract.

 

[yorkriver1]

Thanks for the info. Adult orthodontia seems like a good option. Attractive to all EE's/dependents, not just those with kids under 18. Cost will be a factor.

Yes, doubling down. Without any plan from us to make this happen, my spouse's employer group insurance changed the plan a couple times. We had at least two, maybe three lifetime max orthodontia benefits when our daughter had braces. Lucky coincidence.

I can see how a small biz owner could have gamed this.