Broker Education Series: Individual and Small Group Dental Rev. 4

Overview: Dental Specialties Endodontics Think Root Canal - Maintain teeth through procedures involving the pulp Prosthodontics Think Dentures - Diagnosis, treatment and maintenance of the oral function, comfort, appearance and health of patients with missing teeth Periodontics Think Gums - Prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of the teeth Orthodontics Think Braces - Treatment of the alignment and spacing of teeth using braces and other devices Oral & Maxillofacial Surgery Think Mouth and Jaw - Diagnosis and surgical treatment of the mouth, teeth, jaws, face, head and neck

Overview: Common Dental Procedures Exam/Evaluation Performed to determine changes in dental/medical status DIAGNOSTIC PREVENTIVE PROSTHODONTIC Prophylaxis Cleaning teeth to remove tartar and plaque, and to avoid gum disease Sealant Protective application that is applied to chewing surface teeth that acts as a barrier against decay Bridge Restoration using a false tooth anchored in place by neighboring teeth Dentures Prosthetic device used to replace lost teeth Implant Artificial root used to support false replacement tooth Extraction Removal of a tooth ORAL SURGERY ORTHODONTIC Braces Device to correct teeth alignment and bite-related problems ENDODONTIC Root Canal Therapy Procedure for a diseased tooth in which the root is removed and hole is filled and sealed RESTORATIVE PERIODONTIC Bonding Procedure that uses resin to repair decayed, fractured, chipped, or discolored teeth Filling Lay term used for the restoration of lost tooth structure using a gold, porcelain, silver amalgam, or a composite resin filling Crown (Cap) Restoration using metal or porcelain that sits over the part of the tooth that lies above the gum line Scaling / Root Planing Therapy to remove (deep clean) plaque and calculus

Underwriting Rules Individual Small Group Consumers can enroll or dis-enroll at any time (there is no SEP for dental) Consumers must be a resident of NJ The effective date for consumers applying for: dental coverage only between the 1st and the 14th of the month will be the 15th of the month dental coverage only between the 15th of the month and the end of the month will be the first of the following month pediatric or family pediatric dental coverage at the same time as medical coverage will be the same as for medical Small Group Small Employers that meet the eligibility and underwriting requirements may enroll at any time Small Employers may consist of a group of two eligible employees who are husband and wife (different from medical) Small Employers may request to voluntarily terminate coverage at any time and may re-enroll as follows: For Horizon Dental Companion – may re-enroll at any time For dental plans other than Horizon Dental Companion – must wait at least 12 months from the date they terminated their dental plan before they are eligible to re-enroll For Stand Alone Pediatric Dental (SAPD) plans: Group enrolled in a Horizon SEH plan – must wait until the anniversary date of their Horizon SEH plan to re-enroll in a SAPD plan All other situations – must wait at least 12 months from the date they terminated their SAPD plan before they are eligible to re-enroll in a SAPD plan

Participation Rules For the following plans… The minimum employee participation requirement is as follows… Horizon Dental Option Plan Horizon Dental PPO Horizon Dental PPO Access Horizon Healthy Smiles Plus Horizon Healthy Smiles 2-9 eligible employees: 50% participation including Spousal Waivers 10-50 eligible employees: 75% participation including Spousal Waivers Horizon Dental Companion Must meet the minimum employee participation requirement for the Horizon SEH medical plan Enrollment must match enrollment in the Horizon SEH medical plan, except when an employee declines coverage for dependent(s) due to enrollment in a Horizon SAPD plan Spousal Waiver - when an employee waives coverage because he/she is covered as a dependent under his/her spouse’s/civil union partner’s/domestic partner’s group dental plan

Horizon Individual and Small Group Dental Networks Horizon BCBSNJ dental plan networks include the following: Traditional-Only Network, PPO Network, Managed Care Network, and the National Grid Network. Some of our dental plans allow members to use participating dentists in the contiguous counties of New York, Pennsylvania and Delaware (however, those dentists must use the same type of network as used by the member's dental plan). Finally, some of our dental plans allow the use of a National Grid Network, useful when members are traveling outside of New Jersey (however, those dentists must use the same type of network as used by the member's dental plan). Horizon Dental Networks Managed Care Network (NJ Only) Traditional-Only Network and PPO Network* National Network Contiguous Counties Include NY PA DE Bronx Kings New York Orange Richmond Rockland West Chester Bucks Delaware Monroe Northampton Philadelphia Pike New Castle Grid Grid + PPO Network 183,000 access points Traditional-Only + PPO Network 228,000 access points * The PPO Network also includes Traditional Network dentists who are not in the Traditional-Only Network. You will sometimes see this written as "Traditional + PPO."

Horizon "Legacy" Dental Plans Highlights Plan Name Individual or Small Group Pediatric Only? Network OON Benefits? Product Value Horizon Individual Dental Individual No Managed Care Must choose primary care dentist Low cost No annual maximums, deductibles or claim forms Horizon Centurion PPO Discount Only plan Low cost, if using participating PPO provider "Security blanket" dental plan Horizon Young Grins Individual, Small Group Yes Meets ACA requirement Dental Option Plan (DOP) PPO, Traditional Only Flexibility to see any provider Biggest savings when using participating provider Access to largest network Preferred Provider Organization (PPO) Access to deepest discounts when using par provider Companion Some "covered benefits" Best for those looking for low-cost coverage Only sold with medical PPO Access Best for those looking for low cost coverage

New Horizon Dental Plans Highlights Plan Name Individual or Small Group Pediatric Only? Network OON Benefits? Product Value Horizon Family Grins Individual, Small Group No, both pediatric and adult dental PPO, Grid No (but with some exceptions) Meets ACA requirement Family Coverage Basic dental coverage Low cost coverage Cosmetic orthodontia for those under 19 Horizon Family Grins Plus Yes, only for those > 19 Family coverage Richer benefit Horizon Healthy Smiles Small Group* No Choice of levels of benefits Comprehensive family plan Horizon Healthy Smiles Plus PPO, Traditional-Only, Grid Plus * Small groups have other options

Broker Education Series: Individual and Small Group Dental