(a) Annual limitation on cost-sharing. For a stand-alone dental plan covering the pediatric dental EHB under § 155.1065 of this subchapter in any Exchange, cost sharing may not exceed $350 for one covered child and $700 for two or more covered children.
- (1) For plan years beginning after 2017, for one covered child - the dollar limit applicable to a stand-alone dental plan for one covered child specified in this paragraph (a) increased by the percent increase of the consumer price index for dental services for the year 2 years prior to the applicable plan year over the consumer price index for dental services for 2016.
- (2) For plan years after 2017, for two or more covered children - twice the dollar limit for one child described in paragraph (a)(1) of this section.
(b) Calculation of AV. A stand-alone dental plan:
- (1) May not use the AV calculator in § 156.135 of this subpart;
(2) Must demonstrate that the stand-alone dental plan offers the pediatric dental essential health benefit at either:
- (i) A low level of coverage with an AV of 70 percent; or
- (ii) A high level of coverage with an AV of 85 percent; and
- (iii) Within a de minimis variation of ±2 percentage points of the level of coverage in paragraphs (b)(2)(i) or (ii) of this section.
- (3) The level of coverage as defined in paragraph (b)(2) of this section must be certified by a member of the American Academy of Actuaries using generally accepted actuarial principles.
- (c) Consumer price index for dental services defined. The consumer price index for dental services is a sub-component of the U.S. Department of Labor's Bureau of Labor Statistics Consumer Price Index specific to dental services.
- (d) Increments of cost sharing increases. Any increase in the annual dollar limits described in paragraph (a)(1) of this section that does not result in a multiple of 25 dollars will be rounded down, to the next lowest multiple of 25 dollars.
[78 FR 12866, Feb. 25, 2013, as amended at 79 FR 13840, Mar. 11, 2014; 81 FR 12349, Mar. 8, 2016]