State Dental Plan Insurance Education Part #3

Features Self-insured plan Free to choose dentist - no network No pre-existing condition BlueCross BlueShield of SC administers claims State Dental Plan

BlueCross BlueShield of SC administers claims State Dental Plan (cont.) Enrollment  Within 31 days for new hires or  Special eligibility situation  Otherwise, every two years at open enrollment $1,000 annual maximum benefit

BlueCross BlueShield of SC administers claims State Dental Plan (cont.) State Dental Plan ID cards (not personalized)  Benefits administrators order from BCBS  Subscribers request cards from benefits administrator

* $25 deductible for Classes 2 and 3 Class 1 Preventive services 100 % of fee schedule Class 2 * Basic services 80 % of fee schedule Class 4 Orthodontics (only children under age 19; $1,000 lifetime maximum) Classes of Coverage Class 3 * Prosthedontics 50% of fee schedule State Dental Plan

Employee only Employee/spouse Employee/children Full family $ 0.00 $ 7.64 $13.72 $21.34 Monthly Premiums BlueCross BlueShield of SC administers claims State Dental Plan

Dental Plu$ Insurance Education Part #3

Features Must be enrolled in State Dental Plan (SDP) Must have same level of coverage as in SDP May enroll in or cancel coverage only during the open enrollment period (every two years) BlueCross BlueShield of SC administers claims Dental Plus

No additional deductibles, coinsurance or claims to file Higher allowance for same services covered under SDP, except orthodontics Combined annual maximum benefit for SDP and Dental Plus for services in Class 1, 2 and 3  $2,000 per covered person (cont.) BlueCross BlueShield of SC administers claims Dental Plus

Subscribers/providers file claims to Blue Cross Blue Shield of SC BCBS processes claim under SDP first, then under Dental Plus Personalized ID cards for Dental Plus subscribers are in employee’s name (cont.) BlueCross BlueShield of SC administers claims Dental Plus

Order Dental Plus ID cards by visiting:   Go to “My Insurance Manager”  Register to place order (cont.) BlueCross BlueShield of SC administers claims Dental Plus

Employees pay entire premium Pay premiums with pretax money under MoneyPlu$ Participating dentists list on BCBS Web site: (cont.) BlueCross BlueShield of SC administers claims Dental Plus

Pay Dental Plus premiums in addition to State Dental Plan premiums Employee only$20.60 Employee/spouse$39.00 Employee/children$42.56 Full family$60.96 Monthly Premiums Insurance Education Part #3 Dental Plus