Pine belt employee booklet 2014 2015

Pine Belt Auto Group

Medical Dental Plan August 2014 – July 2015

Presented by

Voice 856-810-0700

Fax 856-810-8484

www.nationalhr.com

Contents

Pages 2-6 Memo overview of medical plans

Page 7 Medical Plan Spreadsheet

Page 8 Medical Plan claim reimbursement examples

Page 9 Prescription Cost Estimator

Pages 10-11 Key information to know about medical plans

Pages 12-19 Horizon Blue Cross Medical and Rx plan detail

Pages 20-26 Dental

http://www.nationalhr.com/

Pine Belt Auto Group

Memo

To: Our Employees

From: Mike Trebino and Joe Hill

Date: July 1, 2014

Re: Medical Insurance Renewal

August is the renewal of our Health Insurance. As always, we are getting a rate increase from Horizon Blue Cross. After a complete study, we have determined that staying with Horizon and making no changes, will be best for both Pine Belt and employees. Our corporate goals continue to be: Control our cost Help control your cost Provide an outstanding benefit level which protects you from financial hardship

in the face of serious illness We are getting a sizeable rate increase, and we must pass some of the cost to employees.

This year’s plans will be identical to last year. We will continue to buy the most cost effective plans we can and fill in any gaps they may have so we can deliver a great medical plan to you and control our cost and your cost at the same time. Our medical plans continue to be among the best offered by any employer in New Jersey. This comes at a time when so many employers are significantly reducing medical benefits in an effort to control cost. New employees are eligible on the first day of the month following 60 days of full time employment. Jon Nistad, owner of National HR, will be conducting meetings on July 8. He will also be available at his cell phone (609-790-9084) in the evening and over weekends. Do not be bashful. Call or e-mail with questions. The purpose of this memo is to give you advance notice and enable you to compile a list of the prescriptions you use. You will be able to send this list to Jon at

Pine Belt Auto 2014-2015 Page 2

[email protected], and he will get right back to you with a spreadsheet which will show two things: What you would spend at the pharmacy under each prescription option Your share of the premium for each option

With this information, you will be able to make the best plan choice. If you are not taking any prescriptions on a maintenance basis (those you must take all the time, like blood pressure medicine), the lower priced plan may be attractive to you.

MEDICAL Blue Cross has attached the name EPO, for Exclusive Provider Organization, to our plans. An EPO is a hybrid between a PPO and a POS plan. The main provisions of both plans are: No referrals to see specialists A lower co-pay for primary physicians than for specialists Blue Card benefits, which means that you can access Blue Cross network

providers all over the country. No non-network care.

We continue with EPO Options 3 and 4 this year. The details of Option 3 are: $20 co-pay for primary physician and $40 co-pay for specialists 100% lab benefit as long as you use Labcorp 100% X-ray, MRI, CT scan, and other radiology as long as you use a private

radiology office, not the hospital out-patient department $1500 Deductible and 30% co-insurance for hospital in-patient, surgery,

certain hospital out-patient services, diabetic supplies, ambulance, home health, skilled nursing facility and hospice, up to the out of pocket maximum of $4000 ($8000 family maximum per family, even if there are more than 2 people with claims) for any individual in a calendar year.

Pine Belt will be reimbursing you for most of these deductible and co-insurance expenses you may incur. Therefore, you will have a benefit of 100% for these expenses.

The details of EPO 4 are: $30 co-pay for primary physician and $50 co-pay for specialists. This is slightly

higher than Option 3. 100% lab benefit as long as you use Labcorp 100% X-ray, MRI, CT scan, and other radiology as long as you use a private

radiology office, not the hospital out-patient department $2500 Deductible and 50% co-insurance for hospital in-patient, surgery,

certain hospital out-patient services, diabetic supplies, ambulance, home health, skilled nursing facility and hospice, up to the out of pocket maximum of $5000 ($10,000 family maximum per family, even if there are more than 2 people with claims) for any individual in a calendar year.


mailto:[email protected]

Pine Belt will be reimbursing you for most of these deductible and co-insurance expenses you may incur. Therefore, you will have a benefit of 100% for these expenses.

Except for a small difference in the physician co-pay, the medical portion of the plans are virtually identical. EPO 4 has a lower premium for you because the prescription benefit is different.

The only deductible and co-insurance expenses we will not reimburse are those which you could have obtained from a non hospital provider for just a co-pay. Examples of these expenses are:

Use of a physical therapist like Nova Care, which is now owned by a hospital system, but still has its own offices.

Getting care in the hospital out-patient department when a free standing provider could be used. For example, scheduled radiology tests like X-rays, CT Scans and MRIs. Go to the radiology facility, not the hospital.

Also, please note the obvious. The only expenses we reimburse are those considered eligible by Horizon, but not 'paid' because of the deductible or co-insurance. Any expense rejected by Horizon is not paid by us.

Once we add the Pine Belt supplement to what Horizon pays, both plans will have 100% benefits for hospital, surgery, and the other items shown above. But it gets even better. The plans’ out-of- pocket limits can benefit you. EPO 3 is $4000 and EPO 4 is $5000 in a calendar year. These limits include your medical co-pays (but not prescription co-pays), deductibles and co-insurance. If Pine Belt were to pay up to the maximum out of pocket for a hospital stay, you will then be reimbursed by Horizon for all the co-pays you would normally have from that point on until the end of the year. This means that your maximum out-of-pocket cost could be very low even in the face of a serious and expensive illness.

PRESCRIPTION The other main difference between the plans is the prescription co-pay. One has dollar amount co-pays. The other is a hybrid with both dollar and percentage co-pays. The plan attached to EPO 3 has a $50 calendar year deductible and co-pays

of $20 Generic, $40 Brand, and $60 Non Formulary. You can obtain a 90 day supply at the pharmacy or mail order for two co-pays. The prescription must specify 90 days.

The hybrid plan attached to EPO 4 is lower priced, but may be better at the same time. It depends on the drugs you take.

This plan also has a $50 annual deductible. After the deductible, Generic drugs have a $10 co-pay for a 30 day supply and $25 for a 90 day supply.

You pay 20% instead of a dollar amount co-pay for Brand drugs, and 30% for Non Formulary drugs. For Brand drugs, the minimum you must pay is $35


($90 for a 90 day supply) if the drug costs that much. If the total cost of the drug is less than the minimum co-pay, you only pay the actual wholesale cost. Your 20% share is limited to $150 for any one 30 day prescription ($300 for a 90 day prescription).

You pay 30% for Non Formulary drugs. The minimum co-pay is $70 ($175 for a 90 day supply) if the drug costs that much. If not, you only pay the actual wholesale cost. Your 30% share is limited to $300 for any one prescription ($450 for a 90 day prescription).

This plan is not for everyone. However, the cost of this plan is lower than the other plan. Your prescription cost may be slightly better at the pharmacy even though the premium is lower. It depends on the wholesale cost of the drug. If your drug use is low or non existent, or if you are taking generic drugs, you can save. Send your drug list to NationalHR so they can help you select the plan which best meets your needs. They need your family status on the plan (Single, Parent-Child, Husband-Wife, or Family), the exact name of each drug, the exact dosage and the frequency you take it. A form has been created for your use. Each employee must complete a benefit election form. It will specify if you want to participate in our medical plan, and if so, record your family status and plan choice. We need these forms back by July 9.

HOW TO OBTAIN YOUR REIMBURSEMENT

NationalHR will process reimbursements for us. The work will be confidential between you and NationalHR. When you incur a hospital, surgery or other expense, Horizon will send you and your provider an Explanation of Benefits Form (EOB). See below. This form shows both the retail charge and the discounted network price between the provider and Horizon, the amount of any deductible charged, your share of co-insurance, and finally, your responsibility. NationalHR needs the EOB to process your claim. Fax to 856-810-

8484 or scan and e-mail to [email protected]

Attach the EOB to the NationalHR cover sheet which is in each office.

NationalHR will pay you and you will pay the provider when you receive a subsequent bill for the balance due.


Notice the "PATIENT RESPONSIBILITY" on the right of the EOB. This is the amount which is your potential cost after Horizon applies its provider discounts and pays the claim, and is the amount that the employer reimbursement is based

on. It is critical that NationalHR gets this form in order to reimburse you.


Pine Belt Auto Group Medical Choices 2014-2015

Horizon HorizonEPO Option 3 EPO Option 4

Benefits are shown with Benefits are shown with

NETWORK BENEFITS ONLY Deductible and Co-ins Deductible and Co-ins

MEDICAL paid by Pine Belt paid by Pine Belt

National Blue Card PPO Network Yes YesPreventive Care Covered in full; no co-pay Covered in full; no co-payPhysicians

Primary Dr. Required? No No Referrals Required? No No Office Visits - Primary $20 co-pay $30 co-payOffice Visits - Specialists $40 co-pay $50 co-pay

RX $50 Annual Deductible $50 Annual DeductibleGeneric Formulary $20 co-pay $10 co-payName-Brand Formulary $40 co-pay 20% co-pay, $35 min, $150 max

Non-Formulary $60 co-pay 30% co-pay, $70 min, $300 maxMail Order 90 days 2 co-pays Generic $25, 20%, 30%

see memo for min, maxLaboratory @ Lab Corp 100% 100%X-Ray @ free standing facility 100% 100%

Scheduled x-ray @ hospital $1500 ded, 70% $2500 ded, 50%

Deductible and Co-insurance

$1500 per person, 2X per family $2500 per person, 2X per family

70% to $4000 ($8000 family) out of

pocket, then 100%

50% to $5000 ($10,000 family) out of

pocket, then 100%

Hospital

In-Patient 100%* 100%*Physician In Hospital Visits 100%* 100%*Surg & Anesth (hosp) 100%* 100%*Emergency Room $100 co-pay* $100 co-pay*Hospital per Day Co-Pay None NoneSame Day Surgery 100%* 100%*

Mental/Substance

In-Patient 100%* 100%*Out-Patient $40 co-pay $50 co-pay

Out of pocket max in Horizon policy

Single $4,000 $5,000Family $8,000 $10,000

Diabetic Supply 100%* 100%*Durable Medical Equipment 100%* 100%*Plan Maximum

In-Network Unlimited UnlimitedOut of Network N/A N/AChiropractic and Therapy # of visit limits # of visit limits

Note: Asterisk * indicates total level of benefit including Pine Belt reimbursement. In Horizon policy, these

items are subject to deductible and co-insurance

Applies to Hospital, ER, Surgery, Ambulance, Diabetic Supply, Home

Health Care, Hospice

Paid by Pine Belt for eligible services*

The above figures are the policy maximums. Your out of pocket cost will be lower, depending on how much Pine Belt has paid toward deductible and co-insurance.


HRA pays deductible and co-insurance for Hospital, Surgery, ER (no deductible charged), Ambulance, Diabetic Supplies, Skilled Nursing Facility, Home Health Care and HospiceHRA does NOT pay for scheduled x-rays at hospital, hospital out-patient expenses when patient

could have obtained care from private physician office.

EPO Option 3 EPO Option 4Example 1: Out patient surgeryTotal Hospital, Surgery etc. cost $3,000.00 $3,000.00

Plan Deductible $1,500.00 $2,500.00Plan Co-insurance by patient 30% 50%Plan Co-insurance patient cost $450.00 $250.00Total patient cost $1,950.00 $2,750.00

Max 'Out of Pocket' in policy $4,000.00 $5,000.00HRA payment $1,950.00 $2,750.00

Your net cost $0.00 $0.00Insurer payment $1,050.00 $250.00

Example 2: Short In patient hospital stay, surgeryTotal Hospital, Surgery etc. cost $8,000.00 $8,000.00

Plan Deductible $1,500.00 $2,500.00Plan Co-insurance by patient 30% 50%Plan Co-insurance patient cost $1,950.00 $2,500.00Total patient cost $3,450.00 $5,000.00


Your net cost $0.00 $0.00Insurer payment $4,550.00 $3,000.00

Example 3: Catastrophic illness, ambulance, hospital, surgery, skilled nursing home, home healthTotal Hospital, Surgery etc. cost $250,000.00 $250,000.00

Plan Deductible $1,500.00 $2,500.00Plan Co-insurance by patient 30% 50%Plan Co-insurance patient cost $2,500.00 $2,500.00Total patient cost $4,000.00 $5,000.00


Your net cost $0.00 $0.00Insurer payment $246,000.00 $245,000.00

Please note that the HRA will not pay for certain services obtained at a hospital when you could have used another provider without cost or for a co-payment. Examples include a Physical Therapist owned and billed by a hospital or getting a planned x-ray at the hospital when you could have gone to a private radiology office.

Health Reimbursement Arrangement (HRA) Claim ExamplesExpense estimate combining the HRA and Horizon EPO medical plans


Name:

Employer: Pine Belt Auto Group 2014-15Co-pays 30 days 90 days

20.00$ Generic Formulary 40.00$

40.00$ Brand Formulary 80.00$

60.00$ Non Formulary 120.00$

Name and DosageAnnual

Cost

Wholesale

Cost 30 day

Wholesale

Cost 90

day

Annual

Cost

Your Cost

at 50%

Additional

Cost for

50% Plan30 day 90 day

-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Plus $50 annual deductible 50.00$ Your Total Annual Cost 50.00$ -$ Total Additional Annual Cost With Percentage Rx Plan (50.00)$ Reduced annual premium for Percentage Rx plan -$

Your RateSingle 48.00$ Parent Child 82.00$ Husband Wife 108.00$ Family 145.00$

Net (Cost) or Net Saving 50.00$

NationalHR Prescription Drug Cost Estimator

Cost with $10, 20% brand, 30% non-formulary Cost with Rx Card

Monthly Rate Reduction

Your Selected

Co-pay

Cost of Generic in same family of drug. Always rely on the advice of your physician.

The prices obtained are from one of the major suppliers of prescription cards. Your cost may vary slightly. You can check with your pharmacist for the exact cost of your current prescription and any generic or formulary equivalents.

NationalHR 6/23/2014Pine Belt Auto 2014-2015 Page 9

Pine Belt Auto Group GET THE MOST OUT OF YOUR

EMPLOYEE BENEFITS

NationalHR dedicated service NationalHR has a dedicated team to help us with any service issues which may cone up. We encourage you to call NationalHR instead of the insurance company. You will get prompt courteous and professional service. Whether you have a question about a benefit, need materials, have a claim which is not yet paid properly, or need advocacy with respect to the benefits, you can call on a NationalHR team member. Leann D'Amico, 856-810-0700, [email protected] Jon Nistad, 856-810-0700, cell 609-790-9084, [email protected] Don’t call the insurance company only to wait on hold. Our friendly staff will do it for you and get back to you promptly. Think ahead and give yourself lead time whenever possible. Problems are easier to prevent than to solve. Know your responsibilities. You can prevent many problems by knowing what you have to do. Here are the areas in which most difficulties arise.

Pre-certification. Know which services need it. Give yourself lead time. Referrals: The Horizon Blue Cross EPO plans do not require referrals. Network: Your plans use the Horizon Managed Care Network in New Jersey, and

the National Blue Card PPO Network in the rest of the country. Laboratory: You must use Labcorp. Prescriptions: Know which drugs require pre-certification or can only be obtained

from the insurance company’s special pharmacy. Think ahead. Pre-existing Condition Restrictions: If you have been continuously covered, by

law there can be no restriction as you switch plans. Make sure you always have coverage.

New Dependents: Make sure you actively enroll new dependents within 30 days. College Students: Student verification has become a thing of the past as a result

of the new Age 26 dependent eligibility under the new insurance law. Dependent Children Eligibility: Know ahead of time if they are eligible.


mailto:[email protected]

Here are some of the particulars about your plans: You are eligible on the 1st of the month following 60 days of full time service. You have the choice of two medical plans and two dental plans. You must

choose as of August 1, and your choice remains until the following August 1. Late entrants can be subject to additional waiting periods and pre-existing

condition limitations. Ask NationalHR for more information if this applies to you. Medical and FSA dependents are covered to age 26. In New Jersey, coverage

can also be extended to age 30. The dependent gets a separate bill. See www.state.nj.us/dobi/division_consumers/du31.html for clarification.

Pine Belt reimburses you for certain deductible and co-insurance expenses, but not those incurred when you could have obtained care at a location other than a hospital and avoided the deductible completely.

Do not pay the balance due on ambulance charges without checking with NationalHR. We have seen many instances of incorrect billing.

You can download forms at www.nationalhr.com

o Enrollment forms which can be completed on your computer screen

o FSA calculator which can help you select the right FSA contribution

o Rx Estimator input form. Send to us so we can help you pick the right plan.

The Affordable Care Act (Obama Care) has mandated the following:

o Preventive care services are covered 100%.

o Lifetime limits on medical plans are eliminated. Benefit maximums are unlimited.

You can elect COBRA continuation of medical and dental coverage.

If you cannot afford coverage, you may be able to get assistance from the government. Go to www.dol.gov/ebsa for more information.

If you are over 65 or have a dependent who is disabled and on Medicare, you must have ‘creditable’ drug coverage in order to avoid paying a premium surcharge at some point in the future if you purchase a Part D Medicare Drug Plan. Our plans are currently all ‘creditable’. Anyone in this position will receive a special notice each year from us.

Web Sites

NationalHR www.nationalhr.com

Horizon Blue Cross www.horizonbcbs.com

Department of Labor www.dol.com

Download IRC Publication 502 to see what is eligible in an FSA


http://www.state.nj.us/dobi/division_consumers/du31.html


http://www.dol.gov/ebsa


http://www.horizonbcbs.com/

http://www.dol.com/

Benefit In-Network Benefits Only (Includes Bluecard network)

Benefit Period Calendar year

Deductible

Individual $1,500

Family Two deductibles per family

Coinsurance 100/70%

Maximum Out of Pocket

Individual $4,000

Family $8,000

Benefit Period Maximum Unlimited

Lifetime Maximum Unlimited

Primary Care Physician Selection Not Required

Doctor’s Office Visits

100% after $20 copay

A primary care physician is a general or family practitioner, internist or pediatrician


A referral is not required to visit a specialist.


Copay applies to 1st visit only

Dependent children are ineligible for Maternity/Obstetrical Benefits.

Allergy Testing and Treatment

100%

Note: A copay will only apply when an office visit is billed.

Preventive Care

Routine Adult Physicals, GYN Exams,

PAP, Mammograms, Prostate Cancer

Screening, Colorectal Screening,

Immunizations

100%

Well Child Exams 100%

Well Child Immunizations and Lead

Screening 100%

Diagnostic Procedures

100% in office setting or Labcorp

70% after deductible in outpatient facility

100% in office setting


Hospital Care

Inpatient Admission (including maternity) 70% after deductible

Room and Board 70% after deductible

Pre-admission Testing 70% after deductible

Surgery in Hospital 70% after deductible

Inpatient Physician Services 70% after deductible

Outpatient Dept. Services 70% after deductible

Emergency Care

Emergency Room 70% after $100 facility copay

Ambulance 70% after deductible

Outpatient X-ray/Radiology Services

CT/CTA Scans, Pet Scans, MRIs/MRAs, Nuclear Medicine studies (including Nuclear Cardiology) require prior authorization. The ordering physician should request

the prior authorization by calling CareCore National, LLC (CCN) at 1-866-496-6200 and providing the necessary clinical information. Once the authorization number is

received, the member may call CCN at 1-866-969-1234 to schedule an appointment.

Note: Managed Care members can call 1-866-969-1234 to obtain a confirmation number for non-Advanced Imaging diagnostic procedures. Confirmation numbers

from CCN replace the need for a paper referral.

Advantage EPO DESIGN 3

Pine Belt Automotive, Grp# 85593-62

Maternity Visits

Primary Care Office Visit

Specialist Office Visit

Maximum Out of Pocket is Calendar year. The deductible, coinsurance and copayments apply to the Maximum Out of Pocket.

Laboratory

Page 1 of 3Pine Belt Auto 2014-2015 Page 12



Outpatient Surgery

Hospital Outpatient Surgery 70% after deductible

Surgery in an Ambulatory SurgiCenter 70% after deductible

Mental Health Services

Inpatient 70% after deductible

Outpatient department 70% after deductible

Office setting 100% after $40 copay

Substance Abuse Services




Alcohol Abuse Services




Inpatient and Outpatient Mental Health/Substance Abuse/Alcoholism Services must be coordinated through Magellan

Behavioral Health at 1-800-626-2212.

Other ServicesAcupuncture Not covered

Bariatric Surgery Not covered

Diabetic Education 100% after office copayment

Diabetic Supplies 70% after deductible

Durable Medical Equipment 70% after deductible

Orthotics and Prosthetics (Per NJ mandate) 100% after $20 copay

Home Health Care 70% after deductible

Hospice Care 70% after deductible

100% after copayment in office setting


Limited to 4 egg retrievals per lifetime

70% after deductible

Limited to 60 days per benefit period


Limited to 30 visits per benefit period (8-hour shifts)


30 visit maximum per therapy, per benefit period




25 visit maximum per benefit period

Vision - Routine Eye Exam 100% after $40 copay

Vision Hardware $100 every two years

Prescription Drugs Covered under a freestanding prescription program

Eligibility Dependent children, including full-time students, are covered until the end of the calendar year in which they

reach the age of 26. Handicapped dependents are covered beyond the child removal age, if the handicap

occurred prior to the age of 26. Under certain conditions, coverage may be extended for qualified dependents

up to age 31.

Physical Rehabilitation Facility

Inpatient Services

Therapeutic Manipulation (Chiropractic Care)

Short-term Therapies:

Physical, Occupational, Speech,

Respiratory

Private Duty Nursing

Skilled Nursing Facility/Extended Care

Center

Infertility (including in-vitro fertilization)




Pre-Existing Conditions The plan includes a “pre-existing conditions” limitation. A “pre-existing condition” is an illness or injury for

which medical advice, diagnosis, care or treatment was received during the six month period immediately prior

to a covered person’s enrollment date. If this limitation applies, no benefits will be paid for charges incurred

for the covered person’s pre-existing condition until 12 months after the enrollment date. But this limitation

does not apply to: pregnancy; any individual or enrollee age 19 and under; genetic information, in the absence

of a diagnosis of the condition related to that information; or a newborn child’s birth defect. Other exceptions

may also apply. Even if the limitation applies, the 12 month period may be reduced by the time during which

a person was covered under certain other healthcare coverage (Creditable Coverage) that was continuously in

force up to a date not more than 63 days prior to the enrollment date.

Prior Authorization Some services/procedures require prior authorization. For a complete list, contact our customer service

number at 1-800-355-BLUE (2583) or refer to our website at www.HorizonBlue.com.

24/7 Nurse Line Not applicable

Services and products provided by Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association.

® Registered marks of the Blue Cross and Blue Shield Association.

® ́and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey. © 2008 Horizon Blue Cross Blue Shield of New Jersey

Three Penn Plaza East, Newark, New Jersey 07105

The Advantage EPO plans cover eligible expenses rendered by providers in Horizon's Managed Care network. When you utilize participating providers, you generally

only pay your copayment and any applicable in-network coinsurance or deductible. No benefits are available out-of-network, except in emergency situations.

This summary highlights the major features of your health benefit program. It is not a contract and some limitations and exclusions may apply. Payment of benefits is

subject solely to the terms of the contract. Please refer to your benefit booklet for more information.


http://www.HorizonBlue.com

Preferred Preferred Brand Non-Preferred

Generic Drugs Name Drugs Drugs

Three Tier Copayment Plan:

Retail: Up to a 90 day supply

(1 retail copay applies per 30-day suppy)

Mail Order: Up to 90 day supply

(1 mail order copay applies for the 90-day supply)

Front End Deductible:

Benefit Period Maximum

Plan includes: Contraceptive drugs & devices obtained at a pharmacy

Fertility Drugs

Self-Administered Contraceptives & Injectible Contraceptives

Mandatory Generic:

Specialty Pharmacy Program:

iNOTE: Specialty pharmacies are considered "retail" pharmacies and are always subject to the

Exclusions: Anti-Obesity Drugs

Over The Counter Vitamins & Minerals

Growth Hormones (unless prior authorized)

Drugs for Cosmetic Purposes

Immunization Agents and Allergy Serum

Services and products provided through Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association.


®' and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey.

© 2006 Horizon Blue Cross Blue Shield of New Jersey


Amount excluding copayments/co-insurance, which must be incurred

per member in a benefit period before benefits are paid.

Certain specialty pharmaceuticals must be obtained from one of the

contracted pharmacies. Specialty pharmaceuticals are typically used to

treat conditions such as: Adenosine Deaminase Deficiency, Allergic

Asthma, Alpha-1 Proteinase Inhibitor Deficiency, Anemia, Crohn's

Disease, Cytomegalovirus, Fabry's Disease, Gaucher Disease,

Hypercalcemia of Malignancy, Neutropenia, Prostate Cancer,

Psoriasis, Pulmonary Hypertension, Respiratory Synctial Virus, and

Rheumatoid Arthritis.

iConfidential and convenient delivery to the location of choice (i.e., home, physician's office.)

iHelpful follow-up care calls to remind when it's time to refill a prescription, check on therapy

progress and answer any questions.

retail copayment levels, even if the specialty pharmaceutical is obtained through the mail.

For more information about your prescription drug plan, please refer to our website at www.horizon-bcbsnj.com under Member Information. Should you have any additional

questions, please feel free to contact Member Services at the phone number listed on your identification card.

Dependent children, including full-time students, are covered until their 26th birthday. Handicapped dependents are covered beyond the child removal age, if the handicap occurred

prior to the age of 26. Under certain conditions, coverage may be extended for qualified dependents up to age 31.

Not Applicable

iClaims assistance to help determine individual coverage and file the necessary paperwork.

iEasy access to pharmacists and other health experts 24 hours a day, seven days a week.

iSingle, reliable source for specialty medication needs.

Prescription Drug Program

The Prescription Drug Program covers FDA approved legend drugs. A prescription order from a physician is required for drugs to be eligible. Prescriptions may be refilled within

one year of the original prescription date, when authorized by the physician and permitted by law. Any limitations that apply to an original prescription also apply to the refills.

The Horizon Prescription Formulary is a list of prescription medications developed by an independent Pharmacy and Therapeutics (P&T) Committee comprised of practicing

physicians and pharmacists in New Jersey. The Horizon P&T Committee determines which drugs will be placed into preferred and non-preferred status within our open formulary.

The priority consideration is clinical efficacy and safety, followed by other considerations such as second line therapies, and availability of commonly used and safe generics. At

least two drugs from each therapeutic class are placed in the preferred status on the formulary. Once a quality review has determined that two or more drugs are equal to other

therapeutic alternatives, the P&T Committee may place the most cost effective drug(s) into preferred status.

Unlimited

Type of Program

$20 $40

$50 per individual

$120

$60

iEasy ordering with a dedicated toll-free number.

iPersonal attention from a pharmacist-led team that provides condition-specific education,

administration instruction and expert advice to help manage therapy.

Diabetic Supplies

Erectile Dysfunction drugs - limit of 4 per month

$40 $80


Benefit In-Network Benefits Only (Includes Bluecard network)

Benefit Period Calendar year

Deductible

Individual $2,500

Family Two deductibles per family

Coinsurance 100/50%

Maximum Out of Pocket

Individual $5,000

Family $10,000

Benefit Period Maximum Unlimited

Lifetime Maximum Unlimited

Primary Care Physician Selection Not Required

Doctor’s Office Visits


A primary care physician is a general or family practitioner, internist or pediatrician


A referral is not required to visit a specialist.


Copay applies to 1st visit only

Dependent children are ineligible for Maternity/Obstetrical Benefits.

Allergy Testing and Treatment

100%

Note: A copay will only apply when an office visit is billed.

Preventive Care

Routine Adult Physicals, GYN Exams,

PAP, Mammograms, Prostate Cancer

Screening, Colorectal Screening,

Immunizations

100%

Well Child Exams 100%

Well Child Immunizations and Lead

Screening 100%

Diagnostic Procedures

100% in office setting or Labcorp


100% in office setting


Hospital Care

Inpatient Admission (including maternity) 50% after deductible

Room and Board 50% after deductible

Pre-admission Testing 50% after deductible

Surgery in Hospital 50% after deductible

Inpatient Physician Services 50% after deductible

Outpatient Dept. Services 50% after deductible

Emergency Care

Emergency Room 50% after $100 facility copay

Ambulance 50% after deductible

Maximum Out of Pocket is Calendar year. The deductible, coinsurance and copayments apply to the Maximum Out of Pocket.

Laboratory

Outpatient X-ray/Radiology Services

CT/CTA Scans, Pet Scans, MRIs/MRAs, Nuclear Medicine studies (including Nuclear Cardiology) require prior authorization. The ordering physician should request

the prior authorization by calling CareCore National, LLC (CCN) at 1-866-496-6200 and providing the necessary clinical information. Once the authorization number is

received, the member may call CCN at 1-866-969-1234 to schedule an appointment.

Note: Managed Care members can call 1-866-969-1234 to obtain a confirmation number for non-Advanced Imaging diagnostic procedures. Confirmation numbers

from CCN replace the need for a paper referral.


Maternity Visits

Primary Care Office Visit

Specialist Office Visit



Outpatient Surgery

Hospital Outpatient Surgery 50% after deductible

Surgery in an Ambulatory SurgiCenter 50% after deductible

Mental Health Services




Substance Abuse Services




Alcohol Abuse Services




Inpatient and Outpatient Mental Health/Substance Abuse/Alcoholism Services must be coordinated through Magellan

Behavioral Health at 1-800-626-2212.

Other ServicesAcupuncture Not covered

Bariatric Surgery Not covered

Diabetic Education 100% after office copayment

Diabetic Supplies 50% after deductible

Durable Medical Equipment 50% after deductible

Orthotics and Prosthetics (Per NJ mandate) 100% after $30 copay

Home Health Care 50% after deductible

Hospice Care 50% after deductible

100% after copayment in office setting


Limited to 4 egg retrievals per lifetime




Limited to 30 visits per benefit period (8-hour shifts)


30 visit maximum per therapy, per benefit period




25 visit maximum per benefit period

Vision - Routine Eye Exam 100% after $50 copay

Vision Hardware $100 every two years

Prescription Drugs Covered under a freestanding prescription program

Eligibility Dependent children, including full-time students, are covered until the end of the calendar year in which they

reach the age of 26. Handicapped dependents are covered beyond the child removal age, if the handicap

occurred prior to the age of 26. Under certain conditions, coverage may be extended for qualified dependents

up to age 31.

Infertility (including in-vitro fertilization)

Physical Rehabilitation Facility

Inpatient Services

Therapeutic Manipulation (Chiropractic Care)

Short-term Therapies:

Physical, Occupational, Speech,

Respiratory

Private Duty Nursing

Skilled Nursing Facility/Extended Care

Center



Pre-Existing Conditions The plan includes a “pre-existing conditions” limitation. A “pre-existing condition” is an illness or injury for

which medical advice, diagnosis, care or treatment was received during the six month period immediately prior

to a covered person’s enrollment date. If this limitation applies, no benefits will be paid for charges incurred

for the covered person’s pre-existing condition until 12 months after the enrollment date. But this limitation

does not apply to: pregnancy; any individual or enrollee age 18 and under; genetic information, in the absence

of a diagnosis of the condition related to that information; or a newborn child’s birth defect. Other exceptions

may also apply. Even if the limitation applies, the 12 month period may be reduced by the time during which

a person was covered under certain other healthcare coverage (Creditable Coverage) that was continuously in

force up to a date not more than 63 days prior to the enrollment date.

Prior Authorization Some services/procedures require prior authorization. For a complete list, contact our customer service

number at 1-800-355-BLUE (2583) or refer to our website at www.HorizonBlue.com.

24/7 Nurse Line Not applicable

Services and products provided by Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association.


® ́and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey. © 2008 Horizon Blue Cross Blue Shield of New Jersey


The Advantage EPO plans cover eligible expenses rendered by providers in Horizon's Managed Care network. When you utilize participating providers, you generally

only pay your copayment and any applicable in-network coinsurance or deductible. No benefits are available out-of-network, except in emergency situations.

This summary highlights the major features of your health benefit program. It is not a contract and some limitations and exclusions may apply. Payment of benefits is

subject solely to the terms of the contract. Please refer to your benefit booklet for more information.


Preferred Preferred Brand Non-Preferred Generic Drugs Name Drugs Drugs

Three Tier Copayment Plan:Retail: Up to a 90 day supply

(1 retail copay applies per 30-day suppy)

Mail Order: Up to 90 day supply(1 mail order copay applies for the 90-day supply)

Front End Deductible (applies to retail and mail):

Benefit Period Maximum:

Plan includes: iContraceptive (self-administered or injectible) drugs & devices obtained at a pharmacy

iFertility Drugs

Specialty Pharmacy Program:

Exclusions: Anti-Obesity DrugsOver The Counter Vitamins & MineralsGrowth Hormones (unless prior authorized)Drugs for Cosmetic PurposesImmunization Agents and Allergy SerumLifestyle Drugs

Services and products provided through Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association.

® Registered marks of the Blue Cross and Blue Shield Association.®' and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey.

© 2006 Horizon Blue Cross Blue Shield of New Jersey


iClaims assistance to help determine individual coverage and file the necessary paperwork.iEasy access to pharmacists and other health experts 24 hours a day, seven days a week.iSingle, reliable source for specialty medication needs.

$50 per individual

iDAW1 Program (Dispense as Written) - If prescriber requests brand drug when generic equivalent is available, prior authorization will be required and the non-preferred copay is charged.

iDAW2 Program - If member requests brand drug when generic equivalent is available, the generic copay PLUS the cost difference between the brand and generic will be assessed.

20%min. $90 - max. $300

iConfidential and convenient delivery to the location of choice (i.e., home, physician's office.)

iHelpful follow-up care calls to remind when it's time to refill a prescription, check on therapy progress and answer any questions.

For more information about your prescription drug plan, please refer to our website at www.horizon-bcbsnj.com under Member Information. Should you have any additional questions, please feel free to contact Member Services at the phone number listed on your identification card.

iNOTE: Specialty pharmacies are considered "retail" pharmacies and are always subject to the retail copayment levels, even if the specialty pharmaceutical is obtained through the mail.

Dependent children, including full-time students, are covered until the end of the Calendar Year in which they reach the age 26. Handicapped dependents are covered beyond the child removal age, if the handicap occurred prior to the age of 26. Under certain conditions, coverage may be extended for qualified dependents up to age 31.

Amount excluding copayments/co-insurance, which must be incurred per member in a benefit period before benefits are paid.

Certain specialty pharmaceuticals must be obtained from one of the contracted pharmacies. Specialty pharmaceuticals are typically used to treat conditions such as: Adenosine Deaminase Deficiency, Allergic Asthma, Alpha-1 Proteinase Inhibitor Deficiency, Anemia, Crohn's Disease, Cytomegalovirus, Fabry's Disease, Gaucher Disease, Hypercalcemia of Malignancy, Neutropenia, Prostate Cancer, Psoriasis, Pulmonary Hypertension, Respiratory Synctial Virus, and Rheumatoid Arthritis.

iPersonal attention from a pharmacist-led team that provides condition-specific education, medication administration instruction and expert advice to help manage therapy.

30%min. $175 - max. $450

iDiabetic Supplies

iEasy ordering with a dedicated toll-free number.

iPrior Authorization and Advantage Formulary Program - Certain medications that have medical utility for only a select group of patients require PA before coverage is approved. Specific guidelines, developed and approved by physicians and pharmacists, have to be met for these drugs to be approved and covered under your prescription drug benefits. See Horizon's website for the PA drug list.

Prescription Drug ProgramGroup Name

The Prescription Drug Program covers FDA approved legend drugs. A prescription order from a physician is required for drugs to be eligible. Prescriptions may be refilled within one year of the original prescription date, when authorized by the physician and permitted by law. Any limitations that apply to an original prescription also apply to the refills.

The Horizon Prescription Formulary is a list of prescription medications developed by an independent Pharmacy and Therapeutics (P&T) Committee comprised of practicing physicians and pharmacists in New Jersey. The Horizon P&T Committee determines which drugs will be placed into preferred and non-preferred status within our open formulary. The priority consideration is clinical efficacy and safety, followed by other considerations such as second line therapies, and availability of commonly used and safe generics. At least two drugs from each therapeutic class are placed in the preferred status on the formulary. Once a quality review has determined that two or more drugs are equal to other therapeutic alternatives, the P&T Committee may place the most cost effective drug(s) into preferred status.

Unlimited

Type of Program

$10 20%min. $35 - max. $150

30%min. $70 - max. $300

$25


Dental Carrier(s) and Policy #: 85593 Horizon Blue Cross

Eligibility: 1st of month following 60 days

Plans: Employee choice between Dental Option Plan (PPO) and TotalCare Plan (DMO, Dental HMO) plan. Premium rate is identical. Employees may choose plan each May. Dental Option Plan $50 Calendar Year Deductible Preventive Care: 100% Basic Care: 80%. Includes surgery and periodontics Major Care: 50% Orthodontics: 50%, $1,000 lifetime max, children only Notes: Amalgam only for molars Maximum: $1,000 per calendar year Network: Horizon PPO network. If non network dentist is used, benefits

paid on network schedule. Participants can use any dentist. TotalCare Very small network dentist selection No non network benefit Preventive: 100% Basic: 100% Major: 100% Orthodontia: 100% No annual max or orthodontia max Notes: Employee selects a dental office. Dentist receives a capitation

from Horizon instead of submitting claims. All financial risk is borne by dentist.

Contributions All coverage is contributory


www.HorizonBlue.com

Comparison of Horizon Benefit Options (DOP/TC with ortho)

Dental Option Plan TotalCare

Annual Deductible $50 per person NONE

Out-of-network

Yes

No

Annual Maximum $1,000 NONE

Ortho Maximum $1,000 NONE

COVERED SERVICES OUT-OF-POCKET

COSTS OUT-OF-

POCKET COSTS

Exams and Preventive Services Exams*

All exams Fluoride treatment (child) Sealant application Prophylaxis

0%

0%

X-rays*

Panoramic Full-mouth X-rays

0% 0%

Space maintainers Space maintainers – fixed unilateral/bilateral 20% 0%

Restorations and Repairs

Amalgam restorations Composite restorations (other than for molars)

20%

0%

Endodontics

Pulp cap/Pulpotomy Root canal therapy – anterior, bicuspid, molar Denture adjustments and repairs

20%

0%

Periodontics

Scaling and root planing Gingivectomy Soft tissue grafts Periodontal maintenance Osseous surgery

20%

20%

0%

0%

Oral Surgery

Routine extractions Soft tissue surgical extractions Incision and drainage of abscess Surgical extractions - impacted

20%

20%

0%

0%

COVERED SERVICES

OUT-OF-POCKET COSTS

OUT-OF-POCKET COSTS

Major Restoration

Crowns 50%

0%

Dentures

Complete and partial dentures

50%

0%

Fixed Bridges Retainers and pontics 50% 0%

Orthodontic Procedures (per optional rider) Children only. Limited to one complete

orthodontic treatment per lifetime 50% 0%

Services are for illustrative purposes only. For complete listing of covered services, plan limitations, deductibles and maximums, consult your benefit booklet.


www.HorizonBlue.com

Dental Vocabulary

Visits and Exams

Fluoride Treatment - a prescription strength fluoride product that helps strengthen the tooth surface and prevent cavities.

Sealant Application - a composite material used to seal the decay-prone pits, fissures and grooves of children’s teeth to prevent tooth decay.

Space Maintainer - a dental appliance that fills the space of a lost tooth or teeth and prevents other teeth from moving into the space. Used especially in orthodontic and pediatric treatment.

Prophylaxis - the scaling and polishing procedure performed to remove calculus, plaque and stains from teeth.

Restorations and Repairs

Restoration - any material or device used to replace tooth structure lost because of decay or fracture. Amalgam - an alloy used to restore teeth.

Composite Restoration - a tooth-colored material used to restore teeth.

Endodontics

Endodontics - the dental specialty that deals with injuries to or diseases of the pulp, or nerve, of the tooth.

Pulp Cap - procedure used by which pulp is covered with a dressing or cement.

Pulpotomy - to remove a portion of the tooth’s pulp.

Root Canal Therapy - the process of treating disease or inflammation of the pulp or root canal. This involves removing the pulp and tooth’s nerves and filling the canal(s) with an appropriate material for a permanent seal. Anterior - refers to the teeth and tissues toward the front of the mouth. Molar - the broad, multicusped back teeth used for grinding food. Bicuspid - a two-cusped tooth found between the molar and the cuspid.

Periodontics

Periodontics - the dental specialty that deals with injuries or diseases of the gums and supporting tissues.

Scaling - a procedure used to remove plaque, calculus and stains from the teeth.

Root Planning - the process of scaling and planning root surfaces to remove all calculus, plaque and infected tissue.

Gingivectomy - the surgical removal of gingival (gum) tissue.

Osseous Surgery - surgery performed to correct damage to gingival (gum) tissue and supporting structures as a result of periodontal disease.

Oral Surgery

Surgical Extractions - extraction of an unerupted tooth by making a surgical incision. Incision and Drainage of Abscess - making an incision so the trapped liquids in the infected tissue can escape.

Major Restoration

Crowns - the portion of the tooth that is covered by enamel. Also a dental restoration that covers the area of the tooth and restores it to its original shape.

Dentures

Complete Dentures - a dental prosthesis that replaces all the natural teeth of a single dental arch.

Partial Dentures - a dental prosthesis that replaces one or more, but less than all, of the natural teeth and associated structures in an arch.

Fixed Bridges

Retainers - the part of a fixed bridge that attaches a false tooth to a natural tooth or implant. Pontics - an artificial tooth used in a fixed bridge to replace a missing tooth.

PProducts are provided by Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association. ® Registered marks of the Blue Cross and Blue Shield Association. ®´ and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey. © 2007 Horizon Blue Cross Blue Shield of New Jersey


Answers to frequently asked questions about the Horizon Dental Option Plan

See plan document for a complete description, including limitations, exclusions and waiting periods.

Products are provided by Horizon Blue Cross Blue Shield of New Jersey,an independent licensee of the Blue Cross and Blue Shield Association. ® Registered marks of the Blue Cross and Blue Shield Association. ®´ and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey. © 2007 Horizon Blue Cross Blue Shield of New JerseyThree Penn Plaza East, Newark, New Jersey 07105.

Questions & AnswersAQ&

Can I go to any dentist?Yes. You have the freedom to use any dentist.

How does my plan work?You have the freedom to receive dental servicesfrom any dentist. However, if you use a dentistwho participates with the Horizon Dental PPONetwork, you can maximize your benefits and savemoney. Discounts off participating dentists’charges range between 10 and 30 percent.

With an out-of-network option, if you use a nonparticipating dentist, you will still receive abenefit for eligible services. Nonparticipating dentists have the freedom to charge their normalfees. We pay up to plan allowances. Chargesabove our plan allowance will be your responsibility. You may be required to pay at thetime of service and submit a claim for reimbursement.

How can I take the best advantage of my plan?By using a dentist who participates with theHorizon Dental PPO Network.

Where are participating dentists located?Members have access to an extensive network ofparticipating dentists in our regional service area,including the 21 counties of New Jersey, five boroughs of New York City (Manhattan, Staten Island, the Bronx, Queens and Brooklyn),Nassau, Suffolk, Orange, Westchester and Rockland counties in New York and in Bucks, Montgomery,Philadelphia, Delaware and Chester counties inPennsylvania. Horizon Dental Option Plan members also have access to over 75,000 participating dentists nationwide.

How can I find a participating dentist?To find participating dentists, refer to our HorizonDental Option Plan Directory of Dentists or visit ouruser-friendly Web site, www.HorizonBlue.com,and use the Quick Dentist Search. Click on theDENTEMAX box to search for participating dentists nationwide outside New Jersey, New Yorkand Pennsylvania.

What if I use a nonparticipating dentist? Is there an out-of-network benefit?Yes. There is an out-of-network benefit. If you usea nonparticipating dentist, you will still receive abenefit for eligible services. Nonparticipating dentists have the freedom to charge their normalfees. We pay up to plan allowances. Chargesabove our plan allowances will be your responsibility. In addition, you may be required topay at the time of service and submit a claim forreimbursement.

Will I need to submit a claim form every time Igo to the dentist?Most participating dentists will submit a claim foryou. Check with your dentist to confirm this.

Will I need to satisfy a deductible?Please refer to your benefit booklet.

Will I need to pay anything directly to the dentist?If you use a participating dentist, you will only beresponsible for any required copayment anddeductible. Nonparticipating dentists have the freedom to charge their normal fees. We pay up toplan allowances. Charges above our planallowances will be your responsibility. You may berequired to pay at the time of service and submit aclaim for reimbursement.

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Answers to frequently asked questions about the Horizon Dental Option Plan (Cont.)

Questions & AnswersAQ&

How do I see a specialist?You have the freedom to use any specialist. Thereare no referrals. However, if you use a specialistwho participates with the Horizon Dental PPONetwork, you can maximize your benefits and savemoney. Discounts off participating specialists’charges range between 10 and 30 percent.

With an out-of-network option, if you use a nonparticipating specialist, you will still receive abenefit for eligible services. Nonparticipating specialists have the freedom to charge their normal fees. We pay up to plan allowances.Charges above our plan allowance will be your responsibility. You may be required to pay at thetime of service and submit a claim for reimbursement.

If I have dental work in progress, can I enrolland will this plan cover those services?Yes.

Does my plan include orthodontia coverage?Please refer to your benefit booklet.

Is there a waiting period before I’m eligible formajor services?You may be subject to a six-month waiting periodbefore you become eligible for major services.Please refer to your benefit booklet.

What if I’m in pain and require emergency dental care?Always seek appropriate care. Please refer to yourbenefit booklet.

If I do not choose to enroll at this time, whencan I enroll next?If you do not enroll when you first become eligible,you may need to satisfy an 18-month waiting period before you again become eligible to enrollin this plan. Please refer to your benefit booklet.

Who can I call if I have questions?Dedicated representatives are available to speakwith you, Monday through Friday, from 8 a.m. to 6 p.m., at 1-800-4DENTAL.

You can also access our Interactive Voice Response(IVR) system, a user-friendly, self-service toolavailable 24 hours a day, seven days a week, generally including weekends and holidays. Youcan check claims and enrollment status, order ID cards, locate a dentist or specialist and verify general benefit information.

D E N TA L P RO G R A M S


Answers to frequently asked questions about theHorizon TotalCare Dental Plan

See plan document for a complete description, including limitations, exclusions and waiting periods.

Products are provided by Horizon Blue Cross Blue Shield of New Jersey,an independent licensee of the Blue Cross and Blue Shield Association.® Registered marks of the Blue Cross and Blue Shield Association.®´ and SM Registered and service marks of Horizon Blue Cross Blue Shield of New Jersey.© 2009 Horizon Blue Cross Blue Shield of New JerseyThree Penn Plaza East, Newark, New Jersey 07105.

Questions & AnswersAQ&Can I go to any dentist?No. You must choose one of the dental officeslisted in the Horizon TotalCare Dental directory.

How does my plan work?The Horizon TotalCare Dental Plan covers100 percent of all eligible basic, major andspecialty services with no copayments, nomaximums and no deductibles when receivingthose services at your primary Horizon TotalCareoffice. Plus, there is no claim paperwork tosubmit and no waiting to be reimbursed.

How can I take the best advantage of my plan?By receiving services at your primary HorizonTotalCare Dental office.

Do I need to choose a primary care dentist?You must choose a primary care dental office fromthe Horizon TotalCare Dental network.

Can my family members choose differentdentists?No. All family members must use the sameHorizon TotalCare Dental office.

Can I change my primary care dentist?Your choice of primary care dentist may changeeffective on the first day of any month by givingHorizon Blue Cross Blue Shield of New Jersey’sdental programs 15-days’ notice.

How can I find a participating dentist?Refer to our directory of participating dental officesor visit our user-friendly Web site,www.HorizonBlue.com, and use the Quick DentistSearch to find the names and addresses ofparticipating dental offices, detailed door-to-doordirections and a street map.

What do I do if my dentist isn’t in the network?You must choose a primary care dental office fromthe Horizon TotalCare Dental network.

What if I use a nonparticipating dentist? Isthere an out-of-network benefit?No.

Will I need to submit a claim form every time Igo to the dentist?No.

Will I need to satisfy a deductible?No.

Will I need to pay anything directly to thedentist?Not for eligible services.

How do I see a specialist?All services must be performed or referred by yourHorizon TotalCare Dental office.

If I have dental work in progress can I enrolland will Horizon TotalCare Dental cover thoseservices?No. If you have work in progress, you must waituntil the work is completed before you can enrollin Horizon TotalCare Dental.

Does my plan include orthodontia coverage?Please refer to your benefit booklet.

Is there a waiting period before I am eligible formajor services?No.

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Answers to frequently asked questions about theHorizon TotalCare Dental Plan (Cont.)

Questions & AnswersAQ&What if I’m in pain and require emergencydental care?Always seek appropriate care. Please refer to yourbenefit booklet for additional information.

If I do not choose to enroll at this time, whencan I enroll next?If you do not enroll when you first become eligible,you may need to satisfy a 12-month waitingperiod before you again become eligible to enrollin this plan. Please refer to your benefit booklet.

Who can I call if I have questions?Dedicated representatives are available to speakwith you, Monday through Friday, from 8 a.m. to6 p.m., at 1-800-4DENTAL.

You can also access our Interactive Voice Response(IVR) system, a user-friendly, self-service toolavailable 24 hours a day, seven days a week,generally including weekends and holidays. Youcan check claims and enrollment status, orderID cards, locate a dentist or specialist and verifygeneral benefit information.

D E N TA L P RO G R A M S


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