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Delta Dental Quoting

Employer contribution entered in Dental Contribution under Group Information affects the Delta Dental plans and rates returned. Please be aware that Delta Dental will require groups with 100% employer contribution to have 100% participation.

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ACA/Healthcare Reform

Who are the exempt from the individual mandate?

  1. Religious conscience. Individuals that are members of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects according to the criteria in the law.
  2. Health care sharing ministry. Individuals that are members of a health care sharing ministry. To qualify for this exemption, the individual must be a member of a health care sharing ministry that 1) has been in existence (and sharing medical expenses) at all times since December 31, 1999, and 2) conducts an annual audit by an independent certified public accountant, available to the public upon request.
  3. Indian tribes.  (1) Members of a federally recognized Indian tribe, or (2) Individuals eligible for services through an Indian care provider.
  4. Income below the income tax return filing requirement. Individuals whose household income is less than the filing threshold for federal income taxes for the applicable tax year. The requirement to file a federal tax return depends on filing status, age, and types and amounts of income.
  5. Short coverage gap. Individuals without coverage for less than three consecutive months during the year. This exemption applies only to the first short coverage gap in a calendar year.
  6. Hardship. Any individual whom the Secretary of Health and Human Services (HHS) determines to have suffered a hardship with respect to the capability to obtain coverage. Individuals who obtain hardship exemptions are eligible for catastrophic coverage.
  7. Affordability. Individuals whose required contribution for self-only coverage exceeds 8% (indexed annually) of household income. Individuals who obtain affordability exemptions are eligible for catastrophic coverage.
  8. Incarceration. Individuals in a jail, prison, or similar penal institution or correctional facility after the disposition of charges against them.
  9. Not lawfully present. Individuals not lawfully present in the U.S. and are not a U.S. citizen, or U.S. national.