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

1. 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

2. 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

3. 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

4. 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

5. 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."

6. 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

7. 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

8. Broker Education Series: Individual and Small Group Dental