2020 Dental And Vision OVERVIEW Insurance Coverage
2020OVERVIEWIndividual and FamilyDental and VisionInsurance CoverageOCTOBER 23, 2019 5:42 PM
Horizon Dental PlansWe have affordable dental plans for you and your family.Adding a dental plan to your medical coverage makes great sense, because keeping your medical and dental recordstogether gives doctors and other health professionals better insight to treat you. With these plans, you have access toV i }à À iÝ Ã] 8 À ÞÃ Ã Û }à v À ÃiÀÛ Vià ÃÕV à VÀ Ü Ã] w }Ã] À Ì V à Ài Covering a child under the age of 19?Horizon Young GrinsThe Horizon Young Grins Plan emphasizes prevention and early intervention throughroutine oral screenings, evaluations and cosmetic orthodontia, all to help keep thoseyoung grins healthy and looking their best.Horizon BCBSNJ also offers these individual and family dental options:OCTOBER 23, 2019 5:42 PMHorizon Family Grinsand Horizon FamilyGrins PlusThe Horizon Family Grins Plan offers the same quality pediatric coverage as HorizonYoung Grins, along with dental coverage for parents or guardians. Horizon FamilyGrins Plus adds out-of-network coverage for members over the age of 19. Each planoffers coverage for cosmetic orthodontia as well.Horizon Healthy Smilesand Horizon HealthySmiles PlusThe Horizon Healthy Smiles Plans offer comprehensive coverage. No out-of-networkLi iwÌà Ài V Õ i i Ì Þ - ià * Õà «À Û ià VViÃÃ Ì Ì i ÃÌ iÝ« à Ûi Horizon dental network available.Horizon IndividualHorizon Individual Plan provides 100% coverage for preventive, diagnostic and mostbasic services with no deductible, copayments or maximums. Coverage for majorservices is available at a specified coinsurance amount. Your selected primary caredentist will coordinate all your dental care, including referrals to specialists if necessary.Horizon CenturionHorizon Centurion Plan provides on average a 30% discount on all services with nodeductible or maximums, no referrals or claim forms, no exclusions and no waiting.HORIZON DENTAL PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
Dental Plan Guide2020 PLAN DETAILSHorizon Young GrinsHorizon Family GrinsCoverage forUnder Age 19ACA CompliantYesYesNoNoi iwÌ 7 Ì } *iÀ à Ƃ«« Þ* ÀÌ V « Ì } "vwVi V Ì Ã ]äää É Ónä]äää nationwideAnnual MaximumNoneDeductiblefÓxÉf ääÉfÓää3Under Age 19Age 19 and Over ]äää É Ónä]äää nationwideÈ]xää É ÓÎä]äää nationwideNonefÓxÉf ääÉfÓää3Horizon Family Grins PlusUnder Age 19Age 19 and Over INN1Age 19 and Over OON2YesNo ]äää É Ónä]äää nationwideÈ]xää É ÓÎä]äää nationwideNoneNonefÓxÉf ääÉfÓää3 É 1,000fxäÉf xä BENEFIT PERIOD MAXIMUM OUT-OF-POCKET (BASIC, MAJOR & MEDICALLY NECESSARY ORTHODONTIA)Individual 350 350 É 350 É É FamilyfÇää fÇää É fÇää É É Prophylaxis – CleaningÎ Ì iÃÉÞi À 100% after deductibleÎ Ì iÃÉÞi À 100% after deductibleÎ Ì iÃÉÞi À 100%Î Ì iÃÉÞi À 100% after deductibleÎ Ì iÃÉÞi À 100%Î Ì iÃÉÞi À 100%Sealant100% after deductible100% after deductibleNot covered100% after deductibleNot coveredNot coveredFluoride100% after deductible100% after deductibleNot covered100% after deductibleNot coveredNot coveredOral Exam100% after deductible100% after deductible100%100% after deductible100%100%X-Rays100% after deductible100% after deductible100%100% after deductible100%100%Amalgam Fillings80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductibleComposite Fillings80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductible50% after deductible50% after deductibleDiscount50% after deductible50% after deductible50% after deductible80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductiblePeriodontal Scaling & Root Planing80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductiblePeriodontal Maintenance80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductibleBridges50% after deductible50% after deductibleDiscount50% after deductible50% after deductible50% after deductibleDentures50% after deductible50% after deductibleDiscount50% after deductible50% after deductible50% after deductible80% after deductible80% after deductibleDiscount80% after deductible80% after deductible80% after deductibleOrthodontic Medical NecessityCovered 50%Covered 50%Not coveredCovered 50%Not coveredNot coveredCosmetic OrthodontiaCovered 50%Covered 50%Not coveredCovered 50%Not coveredNot coveredOrthodontic Lifetime Maximum (Cosmetic) 2,000 2,000Not covered 2,000Not coveredNot covered*, 6/ 6 É Ƃ "-/ Ƃ-- BASIC (CLASS II) AND MAJOR (CLASS III)RestorativeÀ Ü ÃÉ ÞÃÉ" Þà EndodonticsRoot CanalsPeriodonticsProsthodonticsOral SurgeryNonsurgical & Surgical Extraction of TeethOrthodontics1. In-network.2. Out-of-network.OCTOBER 23, 2019 5:42 PM3. 25/ 100/ 200 - 25 per person applies to Preventive/Diagnostic (Class I). 100 individual/ 200 family applies to Basic (Class II) and Major (Class III) services.HORIZON DENTAL PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
Dental Plan Guide2020 PLAN DETAILSHorizon Healthy SmilesHorizon Healthy Smiles PlusCoverage forChildren and AdultsChildren and AdultsACA CompliantNoYes1* ÀÌ V « Ì } "vwVi V Ì ÃHorizon Centurion*QTK\QP PFKXKFWCNChildren and AdultsChildren and AdultsNoNoNoYes1NoNoÈ]xää É ÓÎä]äää Ì Ü i ]äää É Ónä]äää Ì Ü i6,500 in NJ1,100 in NJAnnual Maximum 1,000 1,000NoneNoneDeductiblefxäÉf xäfxäÉf xä*, 6Option 1Option 2Option 1Option 21 every 6 months 100%1 every 6 months 80%1 every 6 months 100%1 every 6 months 80%1 every 6 monthsDiscount1 every 6 months 100%i iwÌ 7 Ì } *iÀ à Ƃ«« Þ/ 6 É Ƃ "-/ Ƃ-- Prophylaxis – 00%80%100%80%Discount100%Oral Discount100%Amalgam Fillings80% afterdeductible50% afterdeductible80% afterdeductible50% afterdeductibleDiscount100%Composite Fillings80% afterdeductible50% afterdeductible80% afterdeductible50% afterdeductibleDiscount100%50% afterdeductible50% afterdeductible50% afterdeductible50% afterdeductibleDiscountÎä É{ä Éxä 2BASIC (CLASS II) AND MAJOR (CLASS III)RestorativeÀ Ü ÃÉ ÞÃÉ" Þà EndodonticsRoot Canals50% after deductible50% after deductibleDiscountÎä É{ä Éxä 2Periodontal Scaling & Root Planing50% after deductible50% after deductibleDiscountÎä É{ä Éxä 2Periodontal Maintenance50% after deductible50% after deductibleDiscountÎä É{ä Éxä 2Bridges50% after deductible50% after deductibleDiscountÎä É{ä Éxä 2Dentures50% after deductible50% after deductibleDiscountÎä É{ä Éxä 250% after deductible50% after deductibleDiscountÎä É{ä Éxä 2Orthodontic Medical NecessityNot coveredNot coveredNot coveredNot coveredCosmetic OrthodontiaCovered at 50% for those under age 19Covered at 50% for those under age 19Not coveredNot coveredOrthodontic Lifetime Maximum (Cosmetic) 1,000 1,000Not coveredNot coveredPeriodonticsProsthodonticsOral SurgeryNonsurgical & Surgical Extraction of TeethOrthodontics1. Without proof of prior creditable coverage, a benefit waiting period of 6 months for Class II and 12 months for Class III and ortho applies.2. For the first three years. The percentage the plan pays goes up each year you stay with the same primary care dentist.OCTOBER 23, 2019 5:42 PMHORIZON DENTAL PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
Dental Plan RatesHorizon Family Grins PlusHorizon Family GrinsAgeRateAgeRate0-141516 Ç 6364 26.36fÓÇ ÈÇfÓÇ È fÓÇ ä{ 24.88 31.26 28.34 35.31fÎÇ änfÎÇ nÎfÎ ÇÎ 42.52 48.25 52.09fxÇ { fx Ç0-141516 Ç 1819 26.36fÓÇ ÈÇ fÓÇ È fÓÇ ä{ 24.88 9.42Horizon Young GrinsAgeRate0-141516 Ç18 26.36fÓÇ ÈÇfÓÇ ÈfÓÇ ä{ 24.88For Horizon Family Grins Plus, Horizon Family Grins and Horizon Young Grins, you pay for the three oldest children and the remaining children are free.Horizon Healthy SmilesAgeOption 1Option 2Option 1*Option 2*22 and 65 fÓä ÇÈ 20.12 22.86 23.20 24.24 26.34 29.19 31.49fÎÓ Çn 34.24 33.84 16.59f È äÇ 18.26 18.52 19.36 21.06 23.32 25.16 26.19fÓÇ ÎxfÓÇ ä{ f Ç äÎ 16.50f n Ç{ 19.01f nÇ 21.61 23.94 25.82 26.88 28.08fÓÇ Çx 14.02 13.58 15.42 15.65 16.36f Ç Ç 19.69 21.26 22.12 23.10 22.85Horizon Healthy Smiles PlusAgeOption 1Option 2Option 1*Option 2*22 and 65 fÓx Ç 24.39fÓÇ Çä 28.10 29.35 31.94fÎx ÎÇ 38.18fÎ Ç{ 41.49 41.02f ÇÈ 19.14fÓ ÇÎ 22.05 23.04 25.08fÓÇ Çn 29.95 31.19fÎÓ xÇ 32.20fÓä ÓÇ 19.65 22.31 22.64 23.66fÓx ÇÓ 28.50fÎä ÇÈ 32.00 33.42 33.02f È Çä 16.16 18.35 18.63f {Ç 21.19 23.45 25.31 26.34fÓÇ x fÓÇ It’s easy to enroll:Horizon CenturionCall 1-888-425-5611Visit HorizonBlue.com1 Individual1 FamilyOr visit one of ourHorizon ConnectSM locations 60 per year 84 per year*QTK\QP PFKXKFWCNAdult RateChild Rate 180 per year 68.40 per year*Without proof of prior creditable coverage, a benefit waiting period of 6 months for Class II and 12 months for Class III and ortho applies.Products are provided by Horizon Healthcare Dental, Inc. and Horizon Blue Cross Blue Shield of New Jersey.This document is for informational purposes only and does not constitute a binding agreement. Please note that rates are subject tochange. Contact Horizon Blue Cross Blue Shield of New Jersey for the most current rates.OCTOBER 23, 2019 5:42 PMHORIZON DENTAL PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
Horizon Vision PlansWe can help you pay less for vision care nationwide.Adding a Horizon Vision Plan can protect your health and dollars. Regular eye exams can help detect potentialhealth issues such as hypertension and diabetes. We can help you save on vision exams, services and more.About our Vision Plans6 à i iwÌÃLocationsBenefits include an annual eye exam with dilation, coverage for eyeglasses andcontact lenses, a higher frame allowance when purchased through Visionworks ,a one-year breakage warranty and mail-order contact lenses.Horizon Vision plans are administered through Davis Vision, with over 93,000independent vision professionals and retailers in New Jersey and nationwide,including Visionworks retail locations. Find your vision professional by visitingHorizonBlue.com/DoctorFinder and clicking “Horizon Vision” in the QuickLinks box.Horizon BCBSNJ offers these Vision Plans:Horizon VistaPlan V: Horizon PanoramaPlan V: OCTOBER 23, 2019 5:42 PM Annual eye exam for 10 100 frame allowance and clear plastic single vision, lined bifocal or trifocal lensincluded OR 100 allowance for contact lensesU - } wV Ì Ã Û }à «À }ÀiÃà ÛiÃ] } iÝ i Ãià Ài Annual eye exam for 10 130 frame allowance and clear plastic single vision, lined bifocal or trifocal lensincluded OR 130 allowance for contact lensesU - } wV Ì Ã Û }à «À }ÀiÃà ÛiÃ] } iÝ i Ãià ÀiHORIZON VISION PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
Vision Plan Guide & Rates*QTK\QP 8KUVC 8%QXGTGF 5GTXKEGU*QTK\QP 2CPQTCOC 8*QTK\QP &CXKU 8KUKQP 8KGY 0GVYQTM P 0GVYQTM GPGƂVUVista VPanorama VMonthly PremiumMonthly PremiumEye examination inclusive of dilation (when professionally indicated)Once every 12 monthsSingle 12.52- } if Î Çn-«iVÌ V i i ÃiÃÉvÀ iÃ Ó Ì ÃÉ Ó Ì ÃTwo Adults 25.04/Ü Ƃ Õ ÌÃfÓÇ xÈCopaymentsÞi iÝ Ì ÉëiVÌ V i i Ãià f äÉf ä'[GINCUU GPGƂV s (TCOGMember ChargesUp to 100 or 150 Ài fÓÈ Ó Ƃ Õ ÌÉ Ài fÓn {Family 36.68Family 40.38Up to 130 or 1801Non-collection frame allowance (retail)Ƃ Õ ÌÉ1Plus 20% discount on any overage2Davis Vision Frame Collection3 iÕ v Ü Vi \ Ã É ià } iÀÉ*Ài iÀ V Õ i Éf xÉf{ä V Õ i É V Õ i ÉfÓx'[GINCUU GPGƂV s 5RGEVCENG .GPUGUIncludedClear plastic single vision, lined bifocal, trifocal or lenticular lenses (any size or Rx)/ Ì } v « ÃÌ V i ÃiÃÉÃVÀ ÌV Àià ÃÌ Ì V Ì }f xÉ V Õ i V Õ i É V Õ i Polycarbonate lenses (children4É Õ Ì fäÉfÎxfäÉfÎäUltraviolet coating 15 12fÎxÉf{nÉfÈäƂ Ì ÀiyiVÌ Ûi Ƃ, V Ì } ÃÌ À É«Ài Õ ÉÕ ÌÀ f{äÉfxxÉfÈ *À }ÀiÃà Ûi i Ãià ÃÌ À É«Ài Õ ÉÕ ÌÀ fÈxÉf äxÉf {äfxäÉf äÉf {ä } iÝ i ÃiÃÉ« ÃÌ V « Ì V À V i ÃiÃÉ« À âi i ÃiÃfÈäÉfÇäÉfÇxfxxÉfÈxÉfÇx-VÀ ÌV *À ÌiVÌ * \ à } i Û Ã É Õ Ì v V i ÃiÃfÓäÉf{ä%QPVCEV .GPU GPGƂV P .KGW QH '[GINCUUGUNon-collection contact lenses: materials allowanceUp to 100Up to 130Plus 15% discount on any overage2 Û Õ Ì ] wÌÌ } v Ü Õ« V Ài q ÃÌ À ëiV ÌÞ i à ÌÞ«iÃ15% discount2Collection Contact Lenses (in lieu of allowance): ë à L iÉ« i Ài« Vi i Ì É 1« Ì { L ÝiÃÉ Õ Ì « V ÃÉ1« Ì Ó L ÝiÃÉ Õ Ì « V Ã Û Õ Ì wÌÌ } v Ü Õ« V Ài É Included3Visually required contact lenses (with prior approval): ÌiÀ Ã] iÛ Õ Ì ] wÌÌ } v Ü Õ« V ÀiIncludedCall 1-888-425-5611Visit HorizonBlue.com1WV QH 0GVYQTM 4GKODWTUGOGPV 5EJGFWNG s 7R VQEye examination: 40Frame: 50Single vision lenses: 40 v V É«À }ÀiÃà Ûi i ÃiÃ\ fÈäIt’s easy to enroll:Trifocal lenses: 80Elective contact lenses:6 ÃÌ \ fnäÉ* À \ f äxLenticular lenses: 100Visually required contactlenses: 225Or visit one of ourHorizon ConnectSM locations1PG [GCT '[GINCUU TGCMCIG 9CTTCPV[ PENWFGF1. Members receive an additional 50 allowance at Visionworks retail locations.2. Additional discounts not applicable at Walmart, Sam’s Club or Costco locations.3. Davis Vision Collection is available at most participating independent provider offices. Collection is subject to change. Contact lens collection (Panorama V) is inclusive of select torics and multifocals.4. Polycarbonate lenses are covered in full for children up to the age of 19, monocular patients and patients with prescriptions /- 6.00 diopter or greater.Seven-day benefit waiting period on both vision plans.This document is for informational purposes only and does not constitute a binding agreement.Please note that rates are subject to change. Contact Horizon Blue Cross Blue Shield of New Jersey for the most current rates.OCTOBER 23, 2019 5:42 PMHORIZON VISION PLANS2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE
That’s health insurance you can count on.6JCVoU JQY NWG YQTMU HQT [QW Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google LLC.There is no charge to download the Horizon Blue app but rates from your wireless provider may apply.Horizon Blue Cross Blue Shield of New Jersey is a Qualified Health Plan issuer in the Health Insurance Marketplace.The information provided by this document is not intended to replace or modify the terms, conditions, limitations, and exclusions contained within health, dental or vision benefit plans issued or administered by Horizon BCBSNJ. In the event of a conflict between the information contained in this document and yourplan documents, your plan documents shall control.Davis Vision Inc. supports Horizon Blue Cross Blue Shield of New Jersey in the administration of vision benefits. Davis Vision Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association. Products and policies provided by Horizon InsuranceCompany and services provided by Horizon Blue Cross Blue Shield of New Jersey, both of which are independent licensees of the Blue Cross Blue Shield Association. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations forall its companies.WebMD is an independent company that supports Horizon BCBSNJ by connecting individuals to health care information. WebMD is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross and Blue Shield Association. WebMD is a registered mark of WebMD, Inc.Sanitas Medical Centers are independently owned and operated by Sanitas of New Jersey LLC. Sanitas is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey. Sanitas Medical Centers serve people insured by Horizon Blue Cross Blue Shield of New Jersey. OriginalMedicare and those self-paying for medical treatment.*LifeSecure is an independent company that operates separately from Horizon BCBSNJ. Life Secure does not sell or service Horizon BCBSNJ products and is soley responsible for the personal accident products referenced herein.**GeoBlue is a trademark of Worldwide Insurance Services, LLC, an independent licensee of the Blue Cross and Blue Shield Association.***Pet Insurance is not a Horizon Blue Cross Blue Shield of New Jersey product. Horizon BCBSNJ members enjoy a discount. The ASPCA is not an insurer and is not engaged in the business of insurance. Products are underwritten by the United States Fire Insurance Company, produced andadministered by C&F Insurance Agency, Inc. (NPN # 3974227), a Crum & Forster company. Through a licensing agreement, the ASPCA receives a royalty fee that is in exchange for use of the ASPCA’s marks and is not a charitable contribution. C&F and Crum & Forster are registered trademarks of UnitedStates Fire Insurance Company. Pre-existing conditions are not covered. Coverage for prescription food does not include prevention or general health maintenance (including weight loss). Waiting periods, annual deductible, co-insurance, benefit limits and exclusions may apply. For all terms andconditions visit aspcapetinsurance.com/terms. Customers enrolled on product Levels 1-4 should visit the Member Center for their policy benefits. Products, rates and discounts may vary and are subject to change.Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols, and Blue365 are registered marks of the Blue Cross and Blue Shield Association. The Horizon name and symbols are registered marks,and OMNIASM, HorizonbFitSM and Horizon ConnectSM are service marks of Horizon Blue Cross Blue Shield of New Jersey. 2020 Horizon Blue Cross Blue Shield of New Jersey, Three Penn Plaza East, Newark, New Jersey 07105.Horizon Blue Cross Blue Shield of New Jersey complies with applicable Federal civil rights laws and does not discriminate against nor does it exclude people or treat them differently on the basis of race, color, gender, national origin, age, disability, pregnancy, gender identity, sex, sexual orientation or health statusin the administration of the plan, including enrollment and benefit determinations.Spanish (Español): Para ayuda en español, llame al 1-866-660-6528. ChineseECA004818 (0919) 1-866-660-6528.
Notice of NondiscriminationHorizon Blue Cross Blue Shield of New Jersey complies with applicable Federal civil rights laws and does not discriminate against nor does it exclude people or treat them differently on the basis of race, color, gender,QDWLRQDO RULJLQ DJH GLVDELOLW\ SUHJQDQF\ JHQGHU LGHQWLW\ VH[ VH[XDO RULHQWDWLRQ RU KHDOWK VWDWXV LQ WKH DGPLQLVWUDWLRQ RI WKH SODQ LQFOXGLQJ HQUROOPHQW DQG EHQH¿W GHWHUPLQDWLRQV RUL]RQ %&%61- SURYLGHV IUHH DLGV DQG VHUYLFHV WR SHRSOH ZLWK GLVDELOLWLHV H J TXDOL¿HG VLJQ ODQJXDJH LQWHUSUHWHUV DQG LQIRUPDWLRQ LQ RWKHU IRUPDWV DQG WR WKRVH ZKRVH SULPDU\ ODQJXDJH LV QRW (QJOLVK H J LQIRUPDWLRQ LQ RWKHU ODQJXDJHV WR FRPPXQLFDWH HIIHFWLYHO\ ZLWK XV Contacting Member ServicesPlease call Member Services at 1-800-355-BLUE (2583) (TTY 711) or the phone number on the back of your member ID card, if you need the free aids and services noted above and for all other Member Servicesissues.Filing a Section 1557 Grievance,I \RX EHOLHYH WKDW RUL]RQ %&%61- KDV IDLOHG WR SURYLGH WKH IUHH FRPPXQLFDWLRQ DLGV DQG VHUYLFHV RU GLVFULPLQDWHG DJDLQVW \RX IRU RQH RI WKH UHDVRQV GHVFULEHG DERYH \RX FDQ ¿OH D GLVFULPLQDWLRQ FRPSODLQW DOVR NQRZQ DV D 6HFWLRQ *ULHYDQFH Horizon BCBSNJ’s Civil Rights Coordinator FDQ EH UHDFKHG E\ FDOOLQJ WKH 0HPEHU 6HUYLFHV QXPEHU RQ WKH EDFN RI \RXU PHPEHU ,' FDUG RU E\ ZULWLQJ WR WKH IROORZLQJ DGGUHVVHorizon BCBSNJCivil Rights CoordinatorPO Box 820, Newark, NJ 07101. RX FDQ DOVR ¿OH D FLYLO ULJKWV FRPSODLQW ZLWK WKH 8 6 'HSDUWPHQW RI HDOWK DQG XPDQ 6HUYLFHV 2I¿FH IRU &LYLO 5LJKWV WKURXJK WKH 2I¿FH IRU &LYLO 5LJKWV &RPSODLQW 3RUWDO RQOLQH DW https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail at U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201 or by phone at1-800-368-1019 or 1-800-537-7697 7'' 2&5 &RPSODLQW IRUPV DUH DYDLODEOH DW ZZZ KKV JRY RFU RI¿FH ¿OH LQGH[ KWPO Language assistance6L KDEOD XQ LGLRPD GLIHUHQWH DO LQJOpV KD\ D\XGD GLVSRQLEOH JUDWLV /ODPH DO Q PHUR TXH DSDUHFH DO UHYHUVR GH VX WDUMHWD GH LGHQWL¿FDFLyQ Ⱁ㨫 幁喀幼ⅴ 䤓幼岏 噆 忈ソ ᇭ庆㕷㓢 䤓愺 幐卛槱䤓 䪐ᇭ꾶꽩 넩뀭넍 꽭꽩ꌱ ꩡ끞뼍鱉 陲끥 ꓩꊁ 덵낅 ꟹ걙ꌱ ꗐ냹 ꯍ 넽걪鱽鲙 ,' 렩麑 鹬ꐩ꾅 넽鱉 뿭ꈑ 놹쀉뼍겢겑꿙 6H YRFr IDOD XP LGLRPD GLIHUHQWH GR LQJOrV D DMXGD HVWi GLVSRQtYHO JUDWXLWDPHQWH /LJXH SDUD R Q PHUR QR YHUVR GR VHX ELOKHWH GH LGHQWLGDGH ڇ ڱښ ڂٱٳ ڬ ژڏ گڇ ڛ ڔٴ ڜچڤڔ ڦړڌڌڤڀ ڦڌٵٴ ڤښڤژڏ ڬ چ ڒڱ ږڛڔٷ ڑڑژ ٱڤڤژڏڕژ گڏ ڝگڡ ڤڏڛگږ ڤڟڤڗ ڦړڙڤڝڥڠ ڦ ڬ ڛڮڀ ښڔ ښ ٱڤږړ ڤ ڬ -HĝOL PµZLV] Z MÛ]\NX LQQ\P QLľ DQJLHOVNL SRPRF XG]LHODQD MHVW EH]SĄDWQLH DG]ZRĆ SRG QXPHU SRGDQ\ QD RGZURFLH GRZRGX RVRELVWHJR 6H SDUOL XQD OLQJXD GLYHUVD GDOOಬLQJOHVH ª GLVSRQLELOH XQ VHUYL]LR GL DVVLVWHQ]D JUDWXLWR &KLDPD LO QXPHUR VXO UHWUR GHOOD WXD FDUWD G¶LGHQWL¿FD] LRQH .XQJ QDJVDVDOLWD ND QJ LVDQJ ZLND PDOLEDQ VD ,QJOHV PDJDJDPLW DQJ WXORQJ QDQJ ZDODQJ ED\DG 7XPDZDJ VD QXPHURQJ QDVD OLNRG QJ L\RQJ ,' FDUG ȿɫɥɢ ɜɵ ɧɟ ɝɨɜɨɪɢɬɟ ɩɨ ɚɧɝɥɢɣɫɤɢ ɜɚɦ ɩɨɦɨɝɭɬ ɛɟɫɩɥɚɬɧɨ ɉɨɡɜɨɧɢɬɟ ɩɨ ɬɟɥɟɮɨɧɭ ɭɤɚɡɚɧɧɨɦɭ ɧɚ ɨɛɪɚɬɧɨɣ ɫɬɨɪɨɧɟ ɜɚɲɟɣ ,' ɤɚɪɬɵ 6L RX SDOH RQ OzW ODQJ NH QJOq JHQ qG NL GLVSRQLE JUDWLV 5HOH QDQ QLPHZR NL HNUL QDQ GR NDW LGDQWLI\DQ Z ODQ ֑ֈ֟ ը է չե ֭֒ վ֧ ֜֠ ֚ ֧ ֟ ֊ ֭֊ շ֫ժ է֊ ֑֭ ֟ ֞֙֞ ֫֔ֆ ֧ ֛ ֨ ե ֆ֫ ֊֊֟ զ֘ ֔֡ ֭շ ֛֑֚֞ֆ֞ ի ֔ ։֭ ֛ ֿ֨ է ֊ ֧ ըժփ ֜֠ շ֞փփ շ ֧ ֜֠ս ֧ ֈ֟ ձ չձ ֊ ե ֒ ֒ 1ӃX EҥQ QyL QJ{Q QJӳ NKiF QJRjL WLӃQJ QK WKu FK QJ W{L Fy WKӇ JL S EҥQ PLӉQ SKt m\ JӑL Vӕ ӣ PһW VDX WKҿ ,' FӫD EҥQ 6L YRXV SDUOH] XQH ODQJXH DXWUH TXH O¶DQJODLV O¶DLGH HVW JUDWXLWH SSHOH] OH QXPpUR DX GRV GH YRWUH FDUWH G¶LGHQWLWp ҩҴҫ ӂӅҮ ҮҮұҳү ӃҾҭ ҧҲ ҵӈ ҾӉҵ ҫӃҩӅҰӃӉҶӉҭҢ ӅӇӀҵ Ӄӂ ҫӃӄҷҫҽҳҭ ӄҰҫӅӊ ҫ ӉӎӄӂӅӂ ҫӃҫҮҹҫӃ ҬҫӃҵӁӄ ҫӃӄӇҰ Ӈҳ ҽӃӈ Ҽӆҵ ҬһҫӁҭ ҫӃӆӇӉҭҫԟҵ ҦӮ ҫӅԟҵӉҶԹ ԙԾ ҽӃҫӇԮ ԙӇҪԹ ҳӇҷҵԹ ҶҬҫӅ ҬӇӃ ҷԙҮԾ ԮӉԨ ҮӇ ӄӀҮ ӄҳҳ ҳҷҮӉҫҬ ԮԾՀ ҬҵҫԮ ӄԮҵҬҫӅԹ ҸӅҫҲҮԹ ԙҫҵӸ ԙԹ ӮӶӆӃԹ һҵӀ ҳҵҰ ҸҳԮ ӅӄҬҵ Ӯҵ ԙҫӃ ԙҵӉԨՀCMC0008179 A (0619)An Independent Licensee of the Blue Cross and Blue Shield Association
Three Penn Plaza EastiÜ À ] äÇ äx ÓÓää HorizonBlue.comQuestions and Answers: RZ RUL]RQ %&%61- &ROOHFWV DQG 0DLQWDLQV RXU 3HUVRQDOO\ ,GHQWL¿DEOH ,QIRUPDWLRQ 3ULYDF\ 1RWLFH 6WDWHPHQW 5HTXLUHG E\ & ) 5 3OHDVH UHDG WKHVH TXHVWLRQV DQG DQVZHUV WR OHDUQ KRZ RUL]RQ %OXH &URVV %OXH 6KLHOG RI 1HZ -HUVH\ ZLOO FROOHFW DQG PDLQWDLQ DQ\ 3HUVRQDOO\ ,GHQWL¿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website, HorizonBlue.com Q1:What is PII? 3,, RU 3HUVRQDOO\ ,GHQWL¿DEOH ,QIRUPDWLRQ LV DQ\ LQIRUPDWLRQ WKDW FDQ EH XVHG WR GLVWLQJXLVK RU WUDFH \RXU LGHQWLW\ DORQH RU ZKHQ FRPELQHG ZLWK RWKHU SHUVRQDO RU LGHQWLI\LQJ LQIRUPDWLRQ WKDW LV OLQNHG RU OLQNDEOH WR \RX 6RPH H[DPSOHV RI 3,, LQFOXGHNameSocial Security NumberBiometric recordsBB 'DWH DQG SODFH RI ELUWKBB 0RWKHU¶V PDLGHQ QDPHBB 0HGLFDO HGXFDWLRQDO ¿QDQFLDO DQG RU HPSOR\PHQW LQIRUPDWLRQPhone numberHome addressBB 'ULYHU¶V OLFHQVH QXPEHUBB (PDLO DGGUHVVQ2:Is Horizon BCBSNJ legally allowed to collect PII? HV RUL]RQ %&%61- LV DXWKRUL]HG WR FROOHFW \RXU 3,, SXUVXDQW WR WKH IIRUGDEOH &DUH FW & DQG LWV LPSOHPHQWLQJ UXOHV DQG UHJXODWLRQV SXEOLVKHG E\ WKH 'HSDUWPHQW RI HDOWK DQG XPDQ 6HUYLFHV 6 Q3:Will Horizon BCBSNJ representatives collect my PII? RUL]RQ %&%61- UHSUHVHQWDWLYHV ZLOO FROOHFW FHUWDLQ 3,, LQ FRQQHFWLRQ ZLWK \RXU LQWHUHVW LQ RUL]RQ %&%61- KHDOWK FRYHUDJH RSWLRQV RUL]RQ %&%61- VKDOO PDLQWDLQ DQG RU VWRUH \RXU 3,, DQG RU WKH 3,, RI \RXU DXWKRUL]HG UHSUHVHQWDWLYH LQ DFFRUGDQFH ZLWK LWV SULYDF\ SROLFLHV DQG SURFHGXUHV (Continues)2430 (W1112)Î Ç{äL ä n An Independent Licensee of the Blue Cross and Blue Shield Association.
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OCTOBER 23, 2019 5:42 PM HORIZON DENTAL PLANS 2020 OVERVIEW INDIVIDUAL & FAMILY INSURANCE COVERAGE Dental Plan Guide 2020 PLAN DETAILS Horizon Young Grins Horizon Family Grins Horizon Family Grins Plus Coverage for Under Age 19 Under Age 19 Age 19 and Over Under Age 19 Age 19 and
DENTAL SCIENCES 1 Chapter 1 I Dental Assisting— The Profession 3 The Career of Dental Assisting 4 Employment for the Dental Assistant 4 The Dental Team 6 Dental Jurisprudence and Ethics 12 Dental Practice Act 12 State Board of Dentistry 12 The Dentist, the Dental Assistant, and the Law 13 Standard of Care 13 Dental Records 14 Ethics 14
Cigna Dental Care DMO Patient Charge Schedules 887394 09/15 CDT 2016 Covered under Procedure Code1 Dental Description and Nomenclature Cigna Dental 01 and 02 PCS Cigna Dental 03 PCS Cigna Dental 04 PCS Cigna Dental 05 PCS Cigna Dental 06 PCS Cigna Dental 07 PCS Cigna Dental 08 PCS Chair Time Per Y/N Minutes Code # (if different) Y/N Code # (if .
Mid-level dental providers, variously referred to as dental therapists, dental health aide therapists and registered or licensed dental practitioners, work as part of the dental team to provide preventive and routine dental services, such as cleanings and fillings. Similar to how nurse practitioners work alongside physicians, mid-level dental .
is a detailed list of dental services provided by a dental office and given to Delta Dental for payment. Delta Dental means Delta Dental Plan of Michigan, Inc., a service provider for dental benefits under the Michigan Dental Program. Delta Dental ID Card is a permanent (not monthly) card. We send
Dental Blue for Individuals. SM - a consumer-driven dental plan for individuals and their eligible dependents . Dental Blue for Seniors. SM - a consumer dental product for individuals and their spouse age 65 and older . Dental Blue For Federal Employee Program - offers federal employees a dental supplemental plan to
Jun 14, 2016 · active duty Soldiers treated at any of five dental clinics on Fort Bragg. These clinics included Davis Dental Clinic, Joel Dental Clinic, LaFlamme Dental Clinic, Pope Dental Clinic, and Smoke Bomb Hill Dental Clinic. For each appointment the appointment type, date, and dental wellness class
1. The General Dental Council (GDC) issues ethical guidance that all registrants (dentists, dental nurses, dental technicians, clinical dental technicians, dental hygienists, dental therapists and orthodontic therapists) are expected to follow. At present, this ethical guidance is called Standards for Dental Professionals. To
DEN 131 Dental Hygiene Clinic 1 3 credits . Summer 2022. DEN 125 Dental Office Emergencies 1 credit DEN 140 Dental Hygiene Theory 2 1 credit DEN 141 Dental Hygiene Clinic 2 2 credits DEN 222 General and Oral Pathology 2 credits . Fall 2022. DEN 123 Nutrition/Dental Health 2 credits DEN 220 Dental Hygiene Theory 3 2 credits DEN 221 Dental .
