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BlueDental PlansBlueDental CareSM

BlueDental ChoiceSM

BlueDental Choice PlusSM

BlueDental ChoiceSM Copayment

Large Group Agent Guide

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The Medical &

Dental C

onnection An undeniable relationship exists between a healthy mouth and overall good health. That means it’s more important than ever for individuals to get regular preventive dental care that will help to maintain or improve good oral and overall health. Infections, nutritional deficiencies and even diseases such as diabetes, heart disease and stroke often appear in the mouth as well as the body. High levels of bacteria in the mouth lead to higher levels of bacteria in the body, which can be a factor in certain diseases.

An undeniable relationship exists between a healthy mouth and good overall health. That means it’s more important than ever for individuals to get regular preventive dental care that will help to maintain or improve good oral and overall health.

Our ability to integrate medical and dental claims information may have a positive impact on members overall health and claims experience. Our Oral Health for Overall Health approach makes financial sense not only for members, but also for employers as they look to increase productivity, lower absenteeism costs, and promote employee overall health and satisfaction.

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• Encouraging members who are not maintaining oral health to make an appointment with their dentist

• Removing financial barriers with enhanced dental benefits: – No copayments, coinsurance, and no

deductible when visiting an in-network provider – Covered outside the annual maximum

The Oral Health for Overall Health program provides enhanced dental benefits and focused attention on additional dental education, including:

• Informing our members about the connection between oral and overall health

• Educating our members about certain medical conditions that may affect their oral and overall health

The Medical &

Dental C

onnection

Covered Medical Conditions and Enhanced Dental Benefits

Automatic Program

Enrollment

Two Additional Cleanings or Periodontal Maintenance

Visits per Year

Oral Cancer Screenings Once Every 6 Months

& Fluoride Treatments Once Every 3 Months

Periodontal Scaling* Covered

100% with No Out-of-Pocket

Expense

Diabetes 3 3 3

Coronary Artery Disease 3 3 3

Stroke 3 3 3

Pregnancy 3 3

Oral Cancer 3 3 3

Head & Neck Cancers (As of January 1, 2020) 3 3 3

Sjögren’s Syndrome 3 3 3*A member’s plan must include periodontal coverage to receive this benefit.

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PPO D

ental Product Overview

With two of the strongest PPO dental networks in Florida, members can choose a dentist who participates in the network for greater savings or choose any licensed dentist. Members also have access to a national network of general dentists and specialists when traveling outside of Florida. Choose between BlueDental Choice, BlueDental Choice Plus, or BlueDental Choice Copayment. All plans offer a variety of deductible and cost-sharing options to create the ideal benefit package for your client.

BlueDental Choice – A PPO that allows members to choose from thousands of in-network providers or an out-of-network provider with no authorizations or referrals needed

BlueDental Choice Plus – A premium PPO for groups of 51 employees or more that comes with a provider network of thousands of dentists, yet still pays usual-and-customary fees for out-of-network care

BlueDental Choice Copayment – A lower-cost option with PPO flexibility, predictable copayments, and an emphasis on preventive care

Plan Selling Features

• Two of the strongest PPO networks in Florida

• National network of 100,000+ general dentists and specialists

• In and out-of-network benefits – members can choose any dentist

• Optional maximum rollover benefits

• Optional orthodontic benefits

• Implants and composite resin fillings are covered benefits

• Value-added benefits

• Enhanced dental benefits – condition specific benefits for members who have oral cancer, diabetes, coronary artery disease, Sjögren’s syndrome, stroke or who are pregnant

Employer Contribution % Number of Lives RequiredMinimum 50% - 100% employer contribution Greater of 10 lives enrolled or 50% of all eligible employees

0 - 49% employer contribution Greater of 10 lives enrolled or 35% of all eligible employees

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Prepaid Dental Product O

verview

Prepaid Dental (PDP) BlueDental Care Services

• Coverage for implants (available on select plans)• Oral cancer screening• Adult fluoride• Teeth whitening

Compare Plans

FD310 FD305 FS305 FS295

Orthodontia coverage Optional Included

Dental implants N/A Optional Included

Specialist coverage 25% discount for covered services when visiting a participating specialist Includes specialists

Capped lab fees Lab fees are not capped Not to exceed $200 Not to exceed $200

Adult/child cleanings 2 cleaning limit in any 12 calendar months 2 cleaning limit in any 12 calendar months

Additional 2 cleanings per year

Minimum eligibility 4 eligible employees with 4 enrolled

4 eligible employees with 4 enrolled

without implants;10 eligible employeeswith 10 enrolled with

implants

100 eligible employees with

10 enrolled

Limited service areas (no restricted SIC codes)

Alachua, Brevard, Broward, Charlotte, Collier, Duval, Hernando, Hillsborough, Lake, Lee,

Manatee, Marion, Martin, Miami-Dade, Orange, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, and Volusia

Alachua, Brevard, Broward, Collier, Duval, Hillsborough, Lee, Martin, Miami-Dade,

Orange, Palm Beach, Pinellas, Polk, Sarasota, Seminole, St. Lucie, and Volusia

Plan Selling Features

• No deductibles

• No waiting period for coverage

• No annual maximum

• No claim forms

• No restricted SIC codes

• No employer contribution requirements

BlueDental Care – A prepaid plan that works like a DHMO – no deductible, no annual maximum benefit, no claim forms, and little or no cost for office visits and cleanings. Out-of-pocket costs for in-network care are always known up front.

The BlueDental Care plan is simple to quote and offers a variety of plan design options. Some plans are available with orthodontics and implants.

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BlueD

ental Group Product M

atrix

Plan Benefit

BlueDental Choice & BlueDental Choice PlusPPO Plans

BlueDental Choice CopaymentPPO Plans

BlueDental CarePrepaid Plans

In-Network1 Out-of-Network In-Network1 Out-of-Network In-Network Only

Provider Selection Any participating Any licensed Any participating Any licensed Any participating

Plan-Year Maximum $500 to $5,000 $750, $1,000, or $1,500 Unlimited

Individual Deductible(Basic and Major)

$25 to $150 $0 or $50 $50 No deductible

Family Deductible 2X-3X or no limit 3X No deductible

Cleaning Copay N/A $0 or $10 $0

Benefit Reimbursement Fee schedule

Choice - allowable chargeChoice Plus - Usual and customary or 60th, 70th, 80th, 90th percentile2

Fee schedule Allowable charge N/A

Diagnostic and Preventive Services

40% to 100% coinsurance paid by BlueDental

Copayment schedule

100%, 80%, or 70% coinsurance paid by

BlueDental

No or low copay on most services

Basic Services 40% to 100% coinsurance paid by BlueDental

Copayment schedule

80%, 60%, or 50% coinsurance paid by

BlueDental

Fixed copayment amounts for

covered services

Major Services 0% to 100% coinsurance paid by BlueDental

Copayment schedule

50%, 40%, or 35% coinsurance paid by

BlueDental

Fixed copayment amounts for

covered services

Flexibility of Services

Bitewing X-rays can move from Preventive to Basic services

Sealants, Full Mouth Panoramic X-rays can move from Basic to Preventive Services

Endodontics & Non-Surgical Periodontics can move from Basic to Major Services

Flexibility of services are not available with Copayment plans N/A

OrthodontiaRider

Minimum 5 child/family units enrolled (optional)

Minimum 5 child/family units enrolled (optional)

Fixed copayment on plans that offer

orthodontia coverage

Rollover Rider Optional Optional N/A

Waiting Periodon Major and Orthodontia Services3

May apply on TG virgin or voluntary groups May apply on TG virgin or voluntary groups No waiting period

Enhanced Dental Benefits Included4 Included4 N/A

Value-Added

BenefitsOrthodontic and cosmetic discount5 Orthodontic and cosmetic discount5

25% reduction from UCR for specialists’ services listed as

covered in the member certificate when provided by a

participating general dentist or specialist

Minimum Participation Requirement

Greater of 10 employees or 50% of eligibles for true group

Greater of 10 employees or 35% of eligibles for voluntary

Greater of 10 employees or 50% of eligibles for true group

Greater of 10 employees or 35% of eligibles for voluntary

4 enrolled employees for FD310,

FD305, and FS305 plans; 10 enrolled

employees for FS295 (groups 100+) or FS305 with implant coverage

Employer Contribution

True Group Minimum 50% – 100% employer contribution

Voluntary 0 – 49% employer contribution

True Group Minimum 50% – 100% employer contribution

Voluntary 0 – 49% employer contribution

See participating requirements

1National network available.2The default percentile for BlueDental Choice Plus out-of-network benefits is Usual and Customary. Groups can buy up to the 60th, 70th, 80th, or 90th percentile.3Waiting period may be waived for an additional premium for groups 51+.4Members who have oral cancer, diabetes, coronary artery disease, Sjögren’s syndrome, stroke or are pregnant may be qualified for enhanced dental benefits. These condition-specific benefits are paid at 100% and are not subject to deductibles, coinsurance, or calendar-year maximums when performed by a participating dental provider.5Discounts for value-added orthodontic and cosmetic benefits are only available to insured members in Florida. Certain dentists have voluntarily agreed to offer a 20% discount off their usual charge for non-covered cosmetic or orthodontic services. These dentists are identified by an affiliation to either the Cosmetic Dental Discount Program or Orthodontic Discount Program. Because these dentists are neither contractually nor legally bound to offer these discounts, we recommend that you contact the provider to inquire about the continued availability of any discount prior to scheduling an appointment.

NOTE: This chart highlights available BlueDental plans. A variety of specific plan combinations are available. BlueDental Choice Plus plans must be sold to groups with a minimum of 51 employees. Benefit plan designs may be limited to specific combinations. BlueDental Care prepaid plans are available in limited service areas in Florida.

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Value-Added Benefits Depending on the dental plan selected, members may be eligible for value-added orthodontic and cosmetic dentistry discounts.

Orthodontic Discount* Program Members that choose an orthodontist in our orthodontist provider network will receive 20 percent off their total case fee. This discount is available to members who do not have orthodontic coverage as part of their plan.

Cosmetic Dentistry Discount* Program Members can experience significant savings on cosmetic dentistry procedures by visiting a dentist who participates in our cosmetic dentistry network. Members receive a 20 percent savings on the following procedures:

• Cosmetic Contouring• Laminate Veneer (porcelain or composite)• Whitening (in office or at-home system)

Optional Benefits Maximum Rollover Depending on the dental plan selected, members may be eligible for Maximum Rollover. Maximum Rollover is a BlueDental Choice benefit that rewards members just for visiting the dentist. There is no paperwork to complete. Each year when members visit the dentist and use less than the yearly claim payment threshold, they receive rollover dollars to help cover future unexpected visits or higher out-of-pocket costs for complex procedures. It’s that easy. Maximum Rollover is applied automatically as long as:

• Members receive at least one covered service during their plan year

• They are active members of their plan on the last day of the plan year

• They don’t exceed the claim payment threshold in their plan year

Orthodontia Rider A separate Orthodontia Rider is available for children up to age 19 or for all insureds on many plans.

Value-Added B

enefits/Optional B

enefits

*Certain dentists have voluntarily agreed to offer a 20% discount off their usual charge for non-covered cosmetic or orthodontic services. These dentists are identified by an affiliation to either the Cosmetic Dental Discount Program or Orthodontic Discount Program. Because these dentists are neither contractually nor legally bound to offer these discounts, we recommend that you contact the provider to inquire about the continued availability of any discount prior to scheduling an appointment.

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Provider Directory

Navigating the Provider Directory

Here’s how to help your clients find the dentist that best meets their needs:

1. Go to FloridaBlueDental.com and click Find a Dentist at the top of the page.

2. In Step 1, Dentists Information, select the Type of Dentist.

3. Next, go to Step 2, Insurance Plan Information, and choose Plan type from the drop-down menu. Be sure to select the full plan name of the dental plan being offered. Selecting the proper plan ensures that members search within their plan’s network.

4. Next, go to Step 3, Location, and narrow the selection by Zip Code/Distance, Street/City, or County and click Search.

Note: BlueDental Care members must select a general dentist for themselves and for each of their covered dependents.

Find a Dentist

National Network

From preventive services to specialist procedures, BlueDental Choice plans have your clients covered with a choice of two dental networks – an extensive local network and a coast-to-coast national network that’s available when traveling outside of Florida. They’ll enjoy the freedom of selecting a quality provider from more than 100,000 dentists nationally while still enjoying the benefit of using an in-network provider.

To see all the out-of-network provider options, go to FloridaBlueDental.com and click Find A Dentist at the top.

Find a Dentist

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EnrollPoint offers your clients the following advantages:

• A user-friendly system that simplifies the benefit administration process and saves time

• Access via a secure site – no need to download software

• Automation that removes guesswork from employee eligibility dates and plan eligibility

• Improved data accuracy by replacing error-prone paper applications

• Benefit changes that can be seen in real time

Have Your Clients Enroll Today! It’s Easy.

Your clients that are interested in using EnrollPoint should complete the Benefit Administrator Authorization Form located under the Employers tab at FloridaBlue.com. Once the form is received, a representative will contact them with details and log-in information.

EnrollPoint Florida Blue and FCL know that finding ways to be more efficient is always a priority. That’s why we offer EnrollPoint. EnrollPoint is an online Florida Blue tool that allows organizations to quickly and efficiently manage their group’s benefits. With EnrollPoint, your groups can make changes from anywhere, eliminating the need to mail paper forms. The site is designed to include your clients’ plan rules and provisions so they can make year-around changes to:

• New-hire benefit elections• New-hire declinations• Terminations• Life-event changes• Address changes• Rehires

BluesEnroll

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Large Group Renew

als/Com

missions &

Rewards

Large Group Renewals

Renewals for large groups of 51 or more eligible employees will be given to groups and agents by Florida Blue sales representatives. Please contact your sales representative when you need assistance or have questions regarding any renewal of FCL products.

Commissions and Rewards

Our compensation and bonus programs continue to reflect our commitment to our valued sales partners. For more information about our various reward and recognition programs, talk to your Florida Blue representative or contact the Agent Service Center at 800-267-3156. Don’t forget that sales of FCL ancillary products – dental, life, and disability – count toward your Florida Blue classification and in-force bonus, helping to maximize your rewards.

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Sales and Service Contacts

Contact Phone/Fax Address

Florida Blue Agent Service Center: (800) 267-3156

BlueDental Choice, Choice Plus, and Choice Copayment Plans

Dental Customer Service(888) 223-4892 - Members(888) 224-4049 - Group Admin. and Agents

N/A

Claims(888) 223-4892 - Members(888) 224-4049 - Group Admin. and Agents

Electronic submissions: Payer ID: 76031Paper submissions: Florida Combined LifeDental Claims DepartmentP.O. Box 1047Elk Grove Village, IL 60009-1047

Enrollment/Membership(Applications for New Hires and Change Forms)

(866) 946-2583 Fax: (904) 997-5471

Florida BlueP.O. Box 44144Jacksonville, FL 32231

Billing Inquiries(Invoices and Payments) (866) 946-2583

Remit all payments to:Florida Combined LifeDept. 1158P.O. Box 121158Dallas, TX 75312-1158

or Overnight:Florida Combined Life 8911581501 North Plano RoadSuite 100Richardson, TX 75081

BlueDental Care Prepaid Plan

Dental Customer Service(877) 325-3979 Press 1 for memberPress 4 for agent

N/A

Billing/Payments (866) 537-0233 X 85702

Florida Combined LifeP.O. Box 211778Kansas City, MO 64121-1778fclbilling@cbbcbsfl.com

New Hires/Change Forms Fax: (904) 376-8425Florida Combined LifeP.O. Box 769569Roswell, GA 30076-8223

Applications for new hires, enrollment additions, terminations, and changes should be included with the group’s invoices. Urgent additions, terminations, changes, or billing questions may be emailed to fclbilling@cbbcbsfl.com. New hire applications not submitted with the invoice may be faxed to the number above. Groups should note group number on the application.

New Business Group Packages (4-50) N/ABCBSFL SGEO4800 Deerwood Campus Parkway, DCC8-6 Jacksonville, FL 32246

Florida Blue, Florida Blue HMO, Florida Blue Preferred HMO (collectively, “Florida Blue”), Florida Combined Life and the Blue Cross and Blue Shield Federal Employee Program® (FEP) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex.

22194R-02.20 19D-FB-0310