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Tag Archives: HIPAA

By Ian Wasser

Is there really a clear distinction between dental health issues and “traditional” health issues?

The American Dental Association reports that evidence suggests that gum disease and periodontal disease both have negative consequences on heart health.  Heart disease is the leading cause of death in the United States.  Wouldn’t it make sense to consider all of the potential factors that contribute to heart disease, including high cholesterol, high triglycerides, high blood pressure, gum disease, and periodontal disease in the same category?  And, along this same line of reasoning, shouldn’t dental coverage be included in all general health insurance policies?

Typically, employers that offer group health insurance plans also offer separate group dental insurance plans.  While the availability, renewability, and portability of  health insurance plans are all subject to HIPAA regulation, additional “add-on” insurance coverage like dental and vision plans are excluded from HIPAA regulation.  42 U.S.C. § 300gg-21.  This has the effect of denying an employee, who elects add-on insurance coverage, a certificate of creditable coverage should his or her employer change add-on insurance plans.

What this could mean is that, with each successive change in dental insurance plans, an employee is potentially barred from coverage for pre-existing dental issues.  But, dental health deteriorates with age–isn’t every cavity necessarily a pre-existing condition? By failing to include dental benefits as an “integral part of the plan,” employers fail to encourage their employees to seek dental insurance and to see a dentist regularly.  In the long-term, this jeopardizes both the health of the employee and adds costs for the employer–certainly heart disease is more expensive to treat when compared to paying for routine dental check-ups.