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Off-exchange dental plan shopping is available in the HealthSherpa account and allows agents to submit a stand-alone dental enrollment.
In this article we’ll cover:
Off-Exchange dental plans are not available within HealthSherpa Enrollee Assistance Full-Service account types.
Off-exchange dental plans at a glance
The term exchange refers to the Marketplace, either the Federally Facilitated Marketplace (FFM) or a State-based Exchange (SBM). Dental coverage works different depending on whether it's purchased on-exchange or off-exchange.
Dental plans off-exchange
Dental plans off-exchange
Off-exchange dental plans do not go through the Marketplace, and are not subsidy eligible. Off-exchange dental plans are stand-alone policies, meaning a consumer does not need a Marketplace health plan enrollment submission in order to enroll in off-exchange dental.
Off-exchange dental plans can be sold year-round and do not require the consumer to be within an enrollment period to enroll.
Off-exchange dental plans are not required to meet Marketplace pediatric dental essential health benefit standards, and coverage details can vary by plan. These plans are also known as non-qualified dental (NQD).
Dental plans on-exchange
Dental plans on-exchange
On-exchange dental plans are purchased through the Marketplace. In most states, on-exchange dental plans can only be purchased if the consumer is also buying a Marketplace health plan at the same time.
Because on-exchange dental is tied to Marketplace enrollment rules, consumers must be within an enrollment period to enroll in on-exchange dental coverage.
On-exchange dental plans follow Marketplace rules for pediatric dental essential health benefits. Pediatric dental coverage is an essential health benefit and must be available for children age 18 and under. If a consumer has leftover advance premium tax credit (APTC) dollars after selecting the Marketplace health plan, remaining APTC may be applied to the portion of the on-exchange dental premium that covers pediatric dental essential health benefits.
On-exchange dental plans and on-exchange health plans are separate policies and are billed separately.
An off-exchange dental enrollment submission takes place once the plan selection is finalized and the off-exchange application is completed.
Enrollment submission for off-marketplace plans begins with plan shopping. Use the quoter to review available plans with the consumer, then use discovery questions to narrow options and identify a plan that fits the consumer’s needs.
After a plan is selected, complete the consumer’s off-marketplace application to submit the stand-alone dental enrollment.
Available carriers
Off-exchange dental plans are currently available in HealthSherpa for select carriers and states.
Available off-exchange dental carriers in HealthSherpa
Available off-exchange dental carriers in HealthSherpa
Blue Cross Blue Shield of Arizona: AZ
UnitedHealthcare Golden Rule: AK, AL, AR, AZ, DE, FL, GA, HI, IA, IL, IN, KS, LA, MI, MO, MS, NC, ND, NE, NH, OH, OK, OR, SC, SD, TN, TX, UT, VA, WI, WV, WY
Agents must be appointed with the carrier to sell off-exchange dental plans on the carrier's behalf.
Appointment information
Appointment information
Blue Cross Blue Shield of Arizona: Agents who are already appointed to sell Off-Ex Medical plans can also sell off-exchange dental plans. Agents/Brokers interested in getting appointed with BCBS of AZ can start here: AZBlue - Brokers: How to become contracted with BCBSAZ.
UnitedHealthcare Golden Rule: UHC has a single application for all UHC ancillary products. Agents and Brokers can apply at Broker Contracting & Appointment | UnitedHealthOne. Contracted/Appointed Agents and Brokers can call the UHC Broker Service Line at 800-474-4467.
Getting a quote
Agents can start plan shopping at any time by clicking the drop-down menu on the Quote button, and selecting Quote Off-Ex Dental.
Enter the consumer’s ZIP code, age, and gender into the quoter.
Add additional people to the quote
Add additional people to the quote
If additional people in the household are applying for coverage, add them in the Applicants section.
Review available plans with the consumer and narrow options based on the consumer’s needs.
Viewing available plans
Plan results display below the quoter after the consumer’s information is entered.
Review plans
Review plans
Each plan card shows key details to review, such as:
Network
Monthly premium
Deductible
Benefit maximum
Use the sort option in the top right corner to change how plans are sorted.
The plan results page may look different depending on the HealthSherpa account type.
To review a plan in more detail, click Plan details on the plan card. When available, the Plan details page also includes official carrier documents, such as the dentist directory.
Refining plan results
Plan results can be filtered to narrow options based on the consumer’s needs. Start by identifying the consumer’s priorities and how they expect to use coverage.
Ask questions
Ask questions
Common questions to understand needs include:
Do you have any preferred dentists?
Do you have any upcoming procedures?
Is there anything you’d like to prioritize when looking for a plan?
Available filters can vary by HealthSherpa account type. When available, the Plan details page also includes official carrier documents, such as the dentist directory.
Use filters & official carrier document to align plan results to the consumer’s needs.
Reminder on budget tradeoffs
Reminder on budget tradeoffs
Lowest monthly premium does not always mean lowest total cost.
When reviewing plan options, consider total possible costs the consumer may pay over the full plan year, including:
Monthly premium x 12 months: The amount the consumer will pay each month to have coverage, multiplied by 12 months.
Deductible: How much the consumer could pay for certain covered services before the plan pays anything.
Coinsurance: A set percentage of charges consumer could pay each time they get care.
Benefit maximum: The most the plan will pay for services in a policy year. After this amount is reached, the consumer pays 100% for covered services.
Sharing plans
From plan results, agents can save a quote or share plan options with a consumer.
Save a quote as a lead
Save a quote as a lead
To create a lead from a quote, select Save Lead.
Enter the consumer’s basic information in the Save lead window, and the consumer will display on the Leads page.
Share plan option
Share plan option
Agents can share plan options at any time by selecting Share.
Agents can share the quote directly from the pop-up window or copy the link to share from an alternate email.
Consumers must create a HealthSherpa login to view personalized quotes.
Complete stand-alone dental application
Plan shopping and the off-marketplace application are distinct parts of the flow that culminate in an enrollment submission.
Select Enroll or Enroll now on a plan card to continue with the enrollment submission flow.
Off-exchange dental plans can be sold year-round and do not require the consumer to be within an enrollment period to enroll.
Consumers who start plan shopping or start an off-marketplace application but have not submitted an enrollment display on the Leads page. After an enrollment is successfully submitted, the consumer moves to the Clients page.
Frequently asked questions
What do the terms off-exchange and on-exchange mean?
The term exchange refers to the Marketplace, either the Federally Facilitated Marketplace (FFM) or a State-based Exchange (SBM).
Off-exchange plans are not subsidy eligible. An enrollment submission takes place once the plan selection is finalized.
On-exchange plans are subsidy eligible. An enrollment submission takes place once the subsidy application is submitted and the plan selection is finalized.
Plan availability can vary when shopping on-exchange vs off-exchange, depending on the state and carriers. Affordable Care Act (ACA) compliant plans cover the same essential health benefits on-exchange and off-exchange.
Do off-exchange dental plans require an enrollment period?
Off-exchange dental plans can be sold year-round and do not require the consumer to be within an enrollment period to enroll.
What if the off-exchange dental plans option does not display?
Off-exchange dental plan quoting is not available for all HealthSherpa account types. If an agent does not see off-exchange dental plans displayed in the Quote drop-down, it typically means the functionality is not available for that account type.
What if the quoter says no results are found?
Off-exchange dental plans are only available for select carriers and states. If the off-exchange option displays but no plans show after switching to off-exchange, HealthSherpa does not yet support off-exchange dental plans with carriers in the selected state.
Can consumers enroll in off-exchange plans when using an agent’s marketing link?
When using an agent’s marketing link, consumers can only complete on-exchange enrollment submissions. Off-exchange plans in HealthSherpa are only available to agents.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.