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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2013

Pediatric Dental and Vision Coverage


Harvard Pilgrim is introducing a new pediatric dental product and expanding our dental and vision coverage for children under age 19 for small employer groups (with 50 or fewer employers) or individuals who purchase their plans directly from Harvard Pilgrim. These changes ensure that Harvard Pilgrim meets the requirements of the Affordable Care Act, which mandates that health plans offered in the individual and small group markets cover 10 essential health benefits, including pediatric dental and vision care.

Pediatric Dental Coverage
Beginning on January 1, 2014*, Harvard Pilgrim is partnering with UnitedHealthcare (Dental Benefit Providers, Inc.) to offer a pediatric dental plan to small groups in Massachusetts, Maine, and New Hampshire. Benefits are comprehensive and include cleanings, fillings, major and minor restorative work, and medically necessary orthodontics. Members of our pediatric dental product receive care through UnitedHealthcare’s (Dental Benefit Providers, Inc.) national network of dentists.

Because this only applies to small group members, not all Harvard Pilgrim members will have this dental coverage. To aid your office staff in determining whether a member under age 19 is covered under this benefit, we are issuing separate pediatric dental ID cards to these members. Prior to providing services, please check with the member to see if they have the card (image below).

       

If you have questions about eligibility or claims, please call 800-822-5353 (you'll also find this phone number on the back of the member’s pediatric dental ID card). You may also call this phone number if you are a dental provider who is not currently part of the UnitedHealthcare dental network, but would like to provide services to Harvard Pilgrim’s small group members.

Members who have not been issued a pediatric dental ID card should call the phone number on the back of their Harvard Pilgrim medical ID card with any questions about eligibility for dental coverage. This new benefit will not impact any coverage provided under the member’s medical benefit (such as emergency care) or the limited pediatric preventive coverage that is offered under some large-group medical plans.

For more information, please see the Pediatric Dental plan page in the Provider Manual.

Pediatric Vision Coverage
For small groups in New Hampshire and Maine, members under the age of 19 are also eligible for coverage of prescription eyeglass frames or prescription contact lenses every 24 months, effective January 1, 2014. Reimbursement varies by state:

  • In Maine, Harvard Pilgrim pays the first $50 toward covered prescription eyeglass frames and lenses or the first order of covered prescription contact lenses and 50% of the remaining cost of that pair of the eyeglasses or first order of contacts
  • In New Hampshire, Harvard Pilgrim pays the first $100 toward covered prescription eyeglass frames and lenses or the first order of covered prescription contact lenses and 50% of the remaining cost of that pair eyeglasses or first order of contacts.

Providers should bill members directly for prescription eyeglasses and contact lenses. Harvard Pilgrim is informing members about this benefit and the process for obtaining reimbursement from the health plan.

* Pending regulatory approval in the state of Rhode Island.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

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Editor

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Production Coordinator