With the new HIPAA regs, can self-funded plans still exclude dental care for congenital anomalies except in children who were covered under the plan from either birth or the date of placement for adoption? Or is the exclusion period limited to only six months? Your advise is greatly appreciated.

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Judy

I think the first step is to determine whether the dental plan is subject to HIPAA. (Most dental plans aren't.) If the dental plan is subject to HIPAA, I think that sort of exclusion is a form of pre-existing condition limitation and would have to be modified or eliminated.

Also, would the treatment be considered dental treatment or medical treatment?

The application of HIPAA depends on whether the dental benefits are offered under a medical plan or a separate dental plan. If the benefit is under a medical plan, HIPAA will apply. If the benefit is under a dental plan, HIPAA probably won't apply (because most dental plans meet the definition of excepted benefits). If HIPAA applies, a permanent exclusion based on a condition arising before coverage took effect sounds like a pre-ex to me. I think some insurers disagree. I'd like to hear support for the contrary position.