Under the essential health benefits rules for individual and small-group plans, adult dental and vision coverage is:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The essential health benefits (EHBs) require limited pediatric dental and vision coverage for children, but adult dental and vision services are not part of the mandated EHB package. Plans may offer adult dental or vision as an optional rider or separate policy, but they are not required to do so. This is a specific exam point: the mandate attaches to pediatric dental and vision, while the same services for adults remain an elective market choice for the plan sponsor. When advising clients, agents should note that pediatric dental and vision are bundled into the EHB package, while the same services for adults are typically sold as separate riders or stand-alone policies.
Why the other options are wrong
- B) No EHB mandate requires adult dental and vision coverage for people under 65; the mandatory coverage is limited to pediatric services.
- C) There is no age-based mandate for adult dental or vision, whether over or under 65.
- D) Adult dental and vision are not prohibited; they are simply optional and may be offered or omitted.
Memory hook
Adults' teeth and eyes are a la carte. Only children's limited dental and vision are on the required menu.