The MDA Health Plan is a group benefit plan. Federal regulations require a minimum of two eligible employees (dentists count) and one employee electing coverage. In order to protect the group from adverse selection and future rate increases, businesses must meet group participation requirements to be eligible for the MDA Health Plan. If a group is found ineligible or if the application packet is incomplete, coverage could be denied or delayed.
There is a minimum participation requirement of 75% of eligible employees within each dental office. An eligible employee waiving coverage because they are covered through their spouse or parent or if waiving because they are receiving an individual subsidy will be counted as a “participant” for determining the participation percentage.
Eligible participants waiving coverage and not able to prove insurance elsewhere will have a negative impact on your participation percentage.
Note: MDA Health Plan will collect waivers from all eligible employees for record keeping purposes, to calculate participation and to track qualifying events.