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HomeMy WebLinkAboutAGMT - Private Medical-Care Inc. (PMI) RIVATE MEDICAL-CARE, INC. ? 12898 1 u ne Center Drive, Cerritos, California 9 03 (562) 924 - 8311 • AMENDMENT TO GROUP DENTAL SERVICE CONTRACT (Prepaid) As of the date stated below„ the Group Dental Service Contract ("Contract") issued to you by Private Medical-Care, Inc. (PMI) is amended as follows to comply with changes in state and federal law which apply to this Contract. 1. The following Definitions are added to the list of Definitions in Article 1. DEFINITIONS: "Acute Condition" means a condition requiring Emergency Services while a New Enrollee is within thirty-five (35) miles from the office of the assigned Panel Dentist. "New Enrollee" means an Enrollee who is enrolled less than thirty (30) days from the date he or she is eligible for Benefits. 2. Article 4. BENEFITS, LIMITATIONS AND EXCLUSIONS is modified as follows: • • necessary to avoid placing his or health in serious jeopardy; and b. that treatment for an Acute Condition does not include any services other than Emergency Services; and • c. that PMI will reimburse the Enrollee for the cost of such treatment up to a maximum of $100.00 during any 12- month period; and d. that the Enrollee must submit a claim within ninety (90) days after receiving the treatment; and e. that the Enrollee must visit his or her Panel Dentist.for further treatment. PMI may require a non-Panel Dentist providing treatment to an Enrollee of an Acute Condition to agree in writing to meet the same contractual terms and conditions which are imposed upon Dentists who have signed a contract with PMI. PMI is not liable for actions resulting solely from the negligence, malpractice or other tortious or wrongful acts arising out of the treatment provided by a non-Panel Dentist. C. The following provision is added as Section 4.10: 4.10 A Panel Dentist is compensated by PMI through monthly capitation (an amount based on the number of Enrollees assigned to the Dentist), and by Enrollees through required Copayments for • treatment received. A Specialist is compensated by PMI through an agreed-upon amount for each covered procedure, and by Enrollees through applicable Copayments. In no event does PMI pay a Dentist or a Specialist any incentive as an inducement to deny, reduce, limit or delay any appropriate treatment. D. The following provision is added as Section 4.11: 4.11 PMI does not authorize or deny services provided by a Panel Dentist. All Benefits provided by a Panel Dentist are in accordance with Dental Care Guidelines which establish the standard of care to be followed by Panel Dentists. PMI's "processing policies" and the Dental Care Guidelines are reviewed by PMI's Dental Advisory Committee, and updated as needed. An Enrollee may contact PMI's Customer Relations Department at 1-800-422-4234 for information regarding PMI's "processing policies". E. The following provision is added as Section 4.12: 4.12 PMI may request that an Enrollee obtain a second opinion to verify the necessity and appropriateness of dental treatment or application of Benefits. When PMI requests a second • opinion, it will pay for all second opinion charges. An Enrollee may also request a second opinion if he or she disagrees with the 2 dialpsis and/or treatment plan determinatifade by his ;,r her Pan Dentist. In such cases, the Enrollee s uld contact PMI's Customer Relations Department for assistance in requesting authorization for a second opinion. Second opinions will only be authorized at a Panel Dentist's office, unless otherwise authorized • by PMI's Dental Consultant. Charges for second opinions that are not authorized by PMI are excluded from coverage. 3. Article 5. COORDINATION OF BENEFITS is modified as follows: A. Section 5.01 is replaced by the following: 5.01 This Contract provides Benefits without regard to coverage by any other group insurance policy or any other group benefits program if the other policy or program covers services in addition to dental care. Otherwise, Benefits under this Contract are coordinated with such other group insurance or any group health benefits program. B. The first paragraph of Section 5.02 is replaced by the following: 5.02 When Benefits are coordinated with another group insurance policy or group health benefits program, the determination of which policy or program is primary shall be governed by the following rules: 4. Article 6. COMPLAINT PROCEDURE, CLAIMS APPEAL AND ARBITRATION is modified as follows: A. All references to PMI's Quality Assurance Coordinator, are changed to • PMI's Quality Management Coordinator. B. The following provisions are added. If your Contract already includes provisions concerning this matter, the following provisions replace the provisions already in your Contract. Within 30 days after PMI receives an Enrollee's written complaint and the above information, PMI will send the Enrollee a report which describes the complaint and PMI's resolution, or explains why additional time is required to report on the complaint. In the event the Enrollee disagrees with the resolution of the complaint, he or she may submit a written request for reconsideration within 15 days after he or she receives that response. The Enrollee should provide the reason for the appeal and any additional information which he or she feels may affect his or her case. PMI may require additional documents as it deems necessary or desirable in making a review. Within 30 days after PMI receives the appeal and supporting documentation, PMI will forward to the Enrollee a written response or an explanation of why additional time is required. If an Enrollee is dissatisfied with PMI's response and he or she has been involved in PMI's grievance and appeals process for 60 days, the Enrollee may contact the Department of Corporations for assistance. The Enrollee may file a complaint with the • Department immediately in an emergency situation, which is one involving imminent and serious danger to his or her health. 3 The California Department of Corporations is responsible for regulating health service plans. The Department has a toll-free telephone number (1-800-400-0815) to receive complaints against health plans. If an Enrollee has a grievance against the health plan, he or she should contact • the plan and use the plan's grievance procedure. If the Enrollee needs the Department's help with a complaint involving an emergency procedure or with a grievance that has not been satisfactorily resolved by the plan, he or she may call the Department's toll-free telephone number. C. The following paragraph is added, and shall be the last paragraph in this Article: In the event of extreme hardship on the part of an enrollee or subscriber, and upon application for relief presented to the American Arbitration Association ("AAA"), PMI shall assume all or a portion of the arbitration fees and expenses as determined by the AAA in accordance with procedures established and administered by the AAA. 5. The third paragraph of the COBRA CONTINUATION OPTION in SCHEDULE E is replaced by the following two paragraphs: A Primary Enrollee who is entitled to continue coverage as a result of Qualifying Event (a) or (b) above may continue that coverage, for himself or herself and any Dependent Enrollees, for 29 months if the Primary Enrollee is determined under Title II or Title XVI of the Social Security Act to have been disabled at the time the Qualifying Event occurred or to have become so disabled within 60 days after such event occurred. The Primary Enrollee must notify the Applicant during the initial 18 months and within 60 days after the date of determination, and extended • coverage for disability will terminate on the first day of the month that begins more than 30 days after the date of final determination that the Primary Enrollee is no longer disabled. A Dependent Enrollee who has elected to continue coverage because (i) Qualifying Event (a) or (b) occurred to the Primary Enrollee, and (ii) the Primary Enrollee did not elect continued coverage for that Dependent Enrollee, and who is or becomes disabled within 60 days after that event, may also continue coverage, for himself or herself and any other Dependent Enrollees, for 29 months, subject to the notice and termination requirements described above with respect to the Primary Enrollee. IN WITNESS WHEREOF, PRIVATE MEDICAL-CARE, INC. has executed this Amendment on the 16th day of August, 1999 0 I ,1 em/`tee, Marilyn T. Masters Vice President, Underwriting • 4 Ca DELTA DRTAL® DENTAL HEALTH PLAN Affiliate of Delta Dental Plon Delta Dental Plan of California s ac.rromi, January 19,2000 City of Seal Beach P.O.Boa 3370 211 81h Street Cerritos Seal Beach,CA 90740 • California 90703 RE: City of Seal Beach 2s9s Towne Center Drive DeltaPreferred Option Program; Delta Group#7809 (Second rate revision Delta only) Cerritos DeltaCare Dental HMO Program; PMI Group#0140 California 90703 (562)403-4040 We are pleased to present your upcoming contract renewal, and to thank you for this opportunity to Headquarters Office: continue our successful partnership with the City of Seal Beach. P.O.Box 7736 Your employees are among the more than twelve million enrollees—representing more than 6,000 San Francisco client groups—who rely on Delta for quality, affordable dental coverage. California 94120 Under your DeltaPreferred Option Program, Delta is offering you a two-year renewal contract 100 First Street with a 12%rates increase. San Francisco California 94105 Current Rates 2 yr-Renewal Rates Renewal Change (415)972-8300 2/1/99-1/31/00 2/1/00-1/31/02 12% One Party $43.45 $48.66 Offices in: Two Party $72.80 $81.54 Sacramento Three Party+ $117.42 $131.51 San Diego Fresno A crucial assumption made by Delta in the calculation of your renewal rate is that all applicable guidelines are being met. Please be aware that if enrollment guidelines have been changed without Delta's approval, Delta may adjust your rates. Delta is adopting new standard policies that will affect your group contract effective January 1, 2000.The two changes outlined below are a continuation of Delta's cost management.We project your benefit costs to be one percent lower as a result of these changes. • Delta's standard examination policy will now cover no more than two examinations, consultations and office visits per year. Previously,two examinations and unlimited consultations and office visits were covered each year. • Delta's standard contract will now make an allowance toward the cost of posterior composite(resin) restorations based on the dentist's fee for the corresponding amalgam restoration.The patient will be responsible for the remainder of the cost. Use of composites on the facial surface of bicuspids will continue to be covered in full. • Upon renewal,you will also receive a revision to your Evidence of Coverage. ' • 0 • • • Under your DeltaCare Dental HMO Program,administered through affiliate PMI, the renewal date of your contract is February 1,2000. In order to maintain the same high standards and level of care currently provided, it is necessary to increase the dues to fulfill capitation, specialty care and administrative trend requirements. The new monthly dues for a one year contract renewal period are: Current Renewal Dues Dues Enrollee only $ 15.49 $15.80 Enrollee plus one dependent 27.12 27.66 Enrollee plus two or more dependents 39.98 40.78 To renew coverage for one year,simply begin paying the rates as outlined above for the new contract term. Should you choose however not to renew,written notification must be received by Certified Mail on or before January 1,2000. This renewal letter serves as an amendment to your Delta and PMI contracts. Also attached is an amendment to your PMI contract reflecting changes as required by state and federal law. The attached amendment and this renewal letter should be kept with your contract documents. If you have any questions regarding this renewal,or any other matter regarding your account,please feel free to contact Dick Cook at: Delta Dental Plan of Califomia • 12898 Towne Center Drive Cerritos,CA 90703 562-403-4040 Your continued confidence in Delta Dental is appreciated. It has been our pleasure to serve you and we look forward to a long and mutually successful relationship in the future. Sincerely, DELTA DENTAL PLAN OF CALIFORNIA &A_ Dick Cook John W. Crooms,Jr. Account Executive Vice President, Sales PRIVATE MEDICAL-CARE, INC. (PM() Marilyn T. Masters Vice President, Underwriting cc: Emile J. Bayle 411 • PRIVATE MEDICAL -CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924 - 8311 (800) 801 - 7105 APPLICATION FOR DeltaCare GROUP DENTAL SERVICE CONTRACT The undersigned group ( "Applicant ") hereby applies for a DeltaCare GROUP DENTAL SERVICE CONTRACT with PRIVATE MEDICAL -CARE, INC. ( "PMI ") on the following terms: I. Applicant hereby authorizes PMI to furnish the dental Benefits described in the attached Contract, subject to all of the terms and conditions of the Contract. II. Applicant or Enrollees agree to pay to PMI, in advance, the Premiums specified in Schedule D to the Contract. III. Upon acceptance of this Application by PMI, and payment of the initial Premiums, the Contract shall be effective at 12:01 a.m. on the Effective Date shown on Schedule D and the Contract shall continue until terminated as provided. IV. Applicant agrees to make available to Eligible Employees or Enrollees any notices concerning Benefits required to be furnished by PMI. V. "PMI WILL PROVIDE DIRECTLY TO EACH ELIGIBLE PERSON OR ENROLLEE A COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM (EOC). THE EOC WILL DISCLOSE THE TERMS AND CONDITIONS OF COVERAGE, BUT WILL CONSTITUTE ONLY A SUMMARY OF THE PROGRAM. AS REQUIRED BY THE CALIFORNIA HEALTH & SAFETY CODE, THE CONTRACT MUST BE CONSULTED TO DETERMINE THE EXACT TERMS AND CONDITIONS OF THE COVERAGE • PROVIDED. A COPY OF THE CONTRACT WILL BE FURNISHED UPON REQUEST. ENROLLEES SHOULD READ THE EOC CAREFULLY. PERSONS WITH SPECIAL HEALTHCARE NEEDS SHOULD READ THE SECTION ENTITLED "SPECIAL NEEDS ". ENROLLEES MAY ALSO OBTAIN INFORMATION ABOUT BENEFITS BY CALLING PMI'S CUSTOMER RELATIONS DEPARTMENT AT (800) 422 -4234. VI. Applicant agrees to receive, on behalf of Enrollees, all applicable notices concerning Benefits under this Contract. VII. THE PREMIUMS PAYABLE UNDER THIS CONTRACT ARE SUBJECT TO INCREASE UPON RENEWAL AFTER THE END OF THE INITIAL CONTRACT TERM OR ANY SUBSEQUENT CONTRACT TERM. VIII. THIS CONTRACT IS SUBJECT TO ARBITRATION IN ACCORDANCE WITH ARTICLE 6. e / .1 / (Date) 3T12 (Group Number) HCM /City of Seal Beach (Applicant) City Hall 211 Eighth St., Seal Beach, CA 90740 .plicant Address) • By: M. A. - h By: Walk A (Authorized Signa. e) ( icense Registered Agent) CP PMI -CA 1 3T12.AT.doc PRIVATE MEDICAL -CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924 - 8311 (800) 801 - 7105 DeltaCare GROUP DENTAL SERVICE CONTRACT IN CONSIDERATION of the Application, a copy of which is attached hereto and made a part of this DeltaCare GROUP DENTAL SERVICE CONTRACT ( "Contract ") and IN CONSIDERATION of payment of the required Premiums, PRIVATE MEDICAL -CARE, INC. ( "PMI") agrees to provide • the Benefits described for the Contract Term shown on Schedule D and from year to year thereafter, unless this Contract is terminated as provided. Premiums are payable in advance of the Effective Date and thereafter as provided. This Contract is issued and delivered in the State of California, is governed by the laws thereof, and is subject to the terms and conditions recited on the following pages. IN WITNESS WHEREOF, PMI has caused this Contract to be executed on: Date: n O • • PRIVATE MEDICAL -CARE, INC. • By: mm . `yt zv • cP PMI -CA 2 3T12.AT.doc • • ARTICLE 1. DEFINITIONS For the purpose of this Contract, the following definitions shall apply: 1.01 "Acute Condition" means a condition requiring Emergency Services while a New Enrollee is within thirty -five (35) miles from the office of the assigned Panel Dentist. 1.02 "Applicant" means the employer, union or other organization or group contracting to obtain dental Benefits. 1.03 `Benefits" mean those dental services which are provided under the terms of this Contract as specified in Article 4 and Schedule A. 1.04 "Contract" means this agreement between PMI and Applicant including the Application for this Contract, the attached schedules, and any appendices, endorsements or riders. This Contract constitutes the entire agreement between the parties. 1.05 "Contract Term" means the period commencing and terminating on the dates shown on Schedule D, and each yearly period thereafter during which this Contract remains in effect. • 1.06 "Copayment" means the fee charged to an Enrollee by a Dentist for the Benefits provided under this Contract. 1.07 "Dentist" means a duly licensed Dentist legally entitled to practice Dentistry at the time and in the state or jurisdiction in which services are performed. 1.08 "Effective Date" means the date this Contract becomes effective as provided in Schedule D. 1.09 "Eligibility Date" means the date upon which an Eligible Person's eligibility for Benefits becomes effective under this Contract. 1.10 "Eligible Employee" means any employee or member of Applicant who meets the conditions of eligibility outlined in Article 2. 1.11 "Eligible Dependent" means any of the dependents of an Eligible Employee who are eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in Article 2. 1.12 "Eligible Person" means an Eligible Employee or Eligible Dependent. . I 1.13 "Emergency Services" mean only those dental services immediately required for alleviation of severe pain, swelling or bleeding, or immediately required to avoid placing the patient's • health in serious jeopardy. 1.14 "Enrollee" means an Eligible Employee ( "Primary Enrollee ") or an Eligible Dependent ( "Dependent Enrollee ") enrolled to receive Benefits. PMI -CA DEF 3 3T12.AT.doc • • 1.15 "New Enrollee" means an Enrollee who is enrolled less than thirty (30) days from the date he or she is eligible for Benefits. 1.16 "Open Enrollment Period" means the period preceding the date of commencement of the Contract Term or the 30 -day period immediately preceding the annual anniversary of the commencement of the Contract Term or a period as otherwise requested by the Applicant and agreed to by PMI. 1.17 "Panel Dentist" means a Dentist who has contracted with PMI to provide Benefits to Enrollees. 1.18 "Premiums" mean amounts payable by Applicant or an Enrollee as provided in Article 3 and Schedule D. 1.19 "Special Health Care Need," means a physical or mental impairment, limitation or condition that substantially interferes with an Enrollee's ability to obtain Benefits. Examples of such a Special Health Care Need are (i) the Enrollee's inability to obtain access to the assigned Panel Dentist's office because of a physical handicap and (ii) the Enrollee's inability to comply with the Panel Dentist's instructions during examination or treatment because of physical handicap or mental incapacity. • 1.20 "Specialist Services" mean services performed by a Dentist who specializes in a particular type of dental care (i.e., oral surgery, endodontics, periodontics or pedodontia) and which must be preauthorized in writing by PMI. . I PMI -CA 4 DEF 3T12.AT.doc • • ARTICLE 2. ELIGIBILITY, ENROLLMENT AND CANCELLATION OF ENROLLMENT 2.01 Eligible Employees are those employees or group members described in Schedule D. New employees shall become eligible for coverage as specified in Schedule D. Eligible Dependents of an Eligible Employee are spouse (unless legally separated or divorced) and unmarried dependent children from birth to age 19, or to age 23 while enrolled as full -time students in an accredited school, college or university, provided that the student is chiefly dependent upon the Eligible Employee for maintenance and support. Children include step - children, adopted children and foster children, provided such children are dependent upon the employee for support and maintenance. Dependents become eligible coincident with the Eligible Employee or upon attainment of dependent status. Newborn • infants are eligible from and after the moment of birth. Adopted children are eligible from and after the moment the child is placed in the physical custody of the Eligible Employee for adoption. An unmarried dependent 19 years or over may continue to be eligible as a dependent if incapable of self - support because of physical or mental disability that commenced prior to reaching age 19, or prior to reaching age 23 while enrolled as a full -time student in an accredited school, college or university, and if chiefly dependent on the Eligible Employee for support and maintenance, provided proof of such disability and dependency is submitted • not less than 31 days prior to the dependent's attainment of the limiting age, and subsequently as may be required by either PMI or Applicant, but not more frequently than annually after the disabled and dependent child has attained the limiting age. Dependents in military service are not eligible. No one may be an Eligible Dependent if eligible as an Eligible Employee and no one may be an Eligible Dependent of more than one Eligible Employee. Medicare eligibility shall not affect eligibility of an Eligible Employee or Eligible Dependent. 2.02 Eligible Employees must complete and sign enrollment forms provided by PMI during the Open Enrollment Period in order to receive Benefits and for their Eligible Dependents to receive Benefits. Persons not originally eligible during the Open Enrollment Period may be enrolled immediately upon attainment of dependent status. Subject to cancellation as provided under this Contract, enrollment of Eligible Employees and any Eligible Dependents is for a minimum period of one year. Applicant shall compile and furnish to PMI on or prior to the first day of every month, a list of all Primary Enrollees showing their Social Security numbers and, if applicable, location codes and all Dependent Enrollees. PMI shall be obligated to provide Benefits only to Primary Enrollees and their Dependent Enrollees who are enrolled and are reported on the • list of Primary Enrollees submitted by Applicant and for whom the appropriate Premiums are paid pursuant to Article 3 and Schedule D of this Contract for the period in which covered dental services are provided. Newborn infants are covered from the moment of birth ELG PMI -CA 5 3T12:AT.doc ® ! • up to 31 days, and thereafter if notification of birth and the appropriate Premiums are received by PMI within 31 days after the date of birth. 2.03 Subject to any rights provided under Article 6, enrollment under this Contract may be cancelled, or renewal of enrollment refused, in the following events: a) Upon 30 days' notice if the Contract is terminated or not renewed. b) Immediately upon loss of eligibility. c) Upon 15 days' written notice if the Premiums are not paid by or on behalf of the Enrollee on the date due. However, the Enrollee may continue to receive Benefits during the 15 -day period and may be reinstated during the term of this Contract upon payment of any unpaid Premiums. d) Immediately if the Enrollee is guilty of misconduct detrimental to the delivery of services while in the office of a Panel Dentist. e) Upon 15 days' written notice if the Enrollee knowingly perpetrates or permits another person to perpetrate fraud or deception in obtaining Benefits under this Contract. f) Upon 30 days' written notice if the Enrollee fails to pay Copayments; provided, • however, that the Enrollee may be reinstated during the term of this Contract upon payment of all delinquent charges. g) Upon 30 days' written notice, if (i) the Enrollee and a Panel Dentist fail to establish a satisfactory patient- Dentist relationship, (ii) it is shown that PMI has, in good faith, provided the Enrollee with the opportunity to select an alternative Panel Dentist, (iii) the Enrollee has been notified in writing at least 30 days in advance that PMI considers the patient- Dentist relationship to be unsatisfactory and PMI specifies the changes that are necessary in order to avoid cancellation, and (iv) the Enrollee has failed to make such changes. Cancellation of a Primary Enrollee's enrollment shall automatically cancel the enrollment of any of his or her Dependent Enrollees. 2.04 An Enrollee who believes that enrollment has been cancelled or not renewed because of the Enrollee's health status or requirements for health care services, may request a review by the Director of the California Department of Managed Health Care in accordance with Section 1365(b) of the California Health and Safety Code. • ELG PMI -CA 6 3T12.AT.doc • t' ID • ARTICLE 3. PREMIUMS AND COPAYMENTS 3.01 In accordance with Schedule D, Applicant agrees to pay Premiums on behalf of Primary Enrollees and to collect Premiums by means of payroll deductions for Dependent Enrollees voluntarily enrolled for Benefits under this Contract. Applicant shall remit one check each period as required by Schedule D. Should an Enrollee voluntarily cancel enrollment and subsequently desire to re- enroll dependent(s), all Premiums retroactive to the date of cancellation (but not to exceed 12 months) must be paid before the Dependent(s) shall be re- enrolled. 3.02 This Contract shall not be in effect until initial Premiums are received. Subsequent Premiums shall be payable in accordance with Schedule D. 3.03 PMI may change the amount of Premiums whenever the terms of this Contract are changed by amendment or PMI's liability is changed by law or regulation. However, in the absence of an amendment mutually agreed upon between Applicant and PMI or such a change in liability, no change in the Premiums shall become effective within a Contract Term except as provided in Section 3.04. 3.04 If during a Contract Term, any new tax is imposed on PMI by any government agency on the amount of Premiums payable under this Contract or the number of the persons covered, or • if the rate of an existing tax on the amount of Premiums or the number of persons covered is increased, the Premiums stated in Schedule D shall be increased by the amount of any such new tax or increased taxes upon 30 days' written notice. 3.05 Upon discovery of clerical errors made by PMI with respect to enrollment data for a Primary Enrollee, Premiums may be adjusted back to the Primary Enrollee's Enrollment Date. The amount of credit which may be taken with respect to a Primary Enrollee shall not exceed the Premiums for the current month in which Premiums are due, plus two (2) months of retroactive Premiums. In addition, the total amount of credit which may be taken on any due date shall not exceed 10% of the billed amount for that due date. 3.06 Enrollees are required to pay any Copayments listed in the Description of Benefits and Copayments (attached as Schedule A) directly to the Dentist. Charges for broken appointments (unless notice is received by the Dentist at least 24 hours in advance or an emergency prevented such notice) and charges for emergency visits after normal visiting it hours are shown on Schedule A. 3.07 In the event of cancellation of enrollment by PMI (except in the case of fraud or deception in obtaining Benefits from PMI or knowingly permitting such fraud or deception by another), PMI shall return to Applicant the pro rata portion of the Premiums paid to PMI which • corresponds to any unexpired period for which payment had been received, together with any amounts due on claims, if any, less any amounts owed to PMI. PMI -CA PREM 7 3T12.AT.doc 0 • • ARTICLE 4. BENEFITS, LIMITATIONS AND EXCLUSIONS 4.01 PMI shall provide the Benefits in Schedule A, subject to the Limitations and Exclusions in Schedule B, and in accordance with the Governing Administrative Policies in Schedule C. Benefits are available to each Enrollee on the Eligibility Date. 4.02 PMI shall provide Panel Dentists at convenient locations during the term of this Contract. A list of Panel Dentists shall be furnished to all Primary Enrollees. A Primary Enrollee may select any Panel Dentist whose name is on said list at the time of enrollment, to render services to the Primary Enrollee and any Dependent Enrollees. If a Primary Enrollee fails to select a Panel Dentist or the Panel Dentist selected becomes unavailable, PMI shall request the selection of another Panel Dentist or shall assign that Enrollee to another Panel Dentist. A Primary Enrollee may make a change to any other Panel Dentist during the open enrollment period. Upon the approval of PMI, an Enrollee may select another Panel. Dentist if the Enrollee has a change in family status or residence or fails to establish a satisfactory patient/doctor relationship with the Panel Dentist. The change must be requested prior to the 21st of the month to become effective on the first day of the following month. 4.03 The services which are Benefits shall be rendered by Panel Dentists, and PMI shall have no obligation or liability with respect to services rendered by non -Panel Dentists, with the exception of Emergency Services as provided in Section 4.04, or Specialist Services recommended by a Panel Dentist, and approved in writing by PMI. All services other than Emergency Services or Specialist Services shall be rendered at the office of the Panel Dentist. Referral of Specialist Services must be by a Panel Dentist and must be authorized in writing by PMI. All approved Specialist Services claims will be paid by PMI less any applicable Copayments. A Panel Dentist may provide services either personally, or through associated Dentists, or the other technicians or hygienists who may lawfully perform the services. If an Enrollee is assigned to a dental school clinic for Specialist Services, those services may be provided by a Dentist, a dental student, a clinician or a dental instructor. 4.04 If an Enrollee is more than 35 miles from the office of the assigned Panel Dentist, and requires Emergency Services, PMI shall reimburse the Enrollee for the cost of such treatment, less any applicable Copayments, up to a maximum of $1 00.00 during any 12- month period upon submission to PMI of a verifiable claim within 90 days after such treatment is received. If an Enrollee has been enrolled less than 30 days, and if the Enrollee is currently experiencing an Acute Condition, he or she should contact PMI's Customer Relations Department at 1- 800 - 422 -4234 for authorization for treatment of the condition. If PMI determines that the circumstances of the Acute Condition require that the Enrollee obtain treatment from a Dentist who is not one of PMI's Panel Dentists, the Enrollee will be instructed: a) to seek treatment immediately necessary to alleviate severe pain, swelling or bleeding, or immediately necessary to avoid placing his or her health in serious jeopardy; • b) that treatment for an Acute Condition does not include any services other than Emergency Services; BEN PMI -CA 8 3T12.AT.doc • • • • c) that PMI will reimburse the Enrollee for the cost of such treatment up to a maximum of $100.00 during any 12 -month period; d) that the Enrollee must submit a claim within 90 days after receiving the treatment; and e) that the Enrollee must visit his or her Panel Dentist for further treatment. PMI may require a non -Panel Dentist providing treatment to an Enrollee of an Acute Condition to agree in writing to meet the same contractual terms and conditions which are imposed upon Dentists who have signed a contract with PMI. PMI is not liable for actions resulting solely from the negligence, malpractice or other tortious or wrongful acts arising out of the treatment provided by a non -Panel Dentist. 4.05 In the event that PMI fails to pay a Panel Dentist, the Enrollee shall not be liable to that Dentist for any sums owed by PMI. In the event that PMI fails to pay a Dentist who is not a Panel Dentist, the Enrollee may be liable to that Dentist for the cost of services. 4.06 Claims for Specialist Services or Emergency Services which are Benefits must be submitted within 90 days after termination of treatment. Failure to submit a claim within such time shall not invalidate nor reduce any claim for reimbursement if it shall be shown not to have been reasonably possible to submit the claim within such time and that such claim was submitted as soon as reasonably possible, but in no event later than one year from the time otherwise required. • PMI shall acknowledge receipt of a claim within 20 working days unless payment of the claim is made within that time. Within 30 working days after receipt of a claim, PMI shall accept or deny the claim, in whole or in part, unless more time is required to determine whether the claim should be accepted or denied. If more time is required, PMI shall notify the Dentist within 30 working days of receipt of the claim of the reasons more time is required. PMI shall notify the Dentist again 45 days thereafter of the reasons any additional time is required to determine whether the claim should be accepted or denied. 4.07 Upon termination of a contract with a Panel Dentist, PMI shall be liable for Benefits rendered by such Panel Dentist to an Enrollee who is under the care of such Dentist at the time of such termination until any single procedure commenced prior to termination by such Dentist is completed, unless PMI makes reasonable and medically appropriate provisions for the completion of such procedure by another Panel Dentist. PMI shall give written notice to Applicant within a reasonable time of any termination or breach of contract by, or inability to perform of, any Panel Dentist if Applicant will be materially and adversely affected. If an Enrollee's assigned Network Dentist's contract with PMI terminates, that Network Dentist will complete (a) a partial or full denture for which final impressions have been taken, and (b) all work on every tooth upon which work has started (such as completion of root canals in progress and delivery of browns when teeth have been prepared.) 4.08 In the absence of an amendment mutually agreed upon between Applicant and PMI, no change in Benefits shall be made during a Contract Term. 110 4.09 All Benefits shall terminate for any Enrollee as of the date that this Contract such person ceases to be eligible under the terns of this Contract, or such person's enrollment is cancelled under this Contract. PMI shall not be obligated to continue to provide Benefits PMI -CA BEN 9 3T12.AT.doc • t: 0 • to any such person in such event, except for completion of single procedures commenced while this Contract was in effect. 4.10 A Panel Dentist is compensated by PMI through monthly capitation (an amount based on the number of Enrollees assigned to the Dentist), and by Enrollees through required Copayments for treatment received. A Specialist is compensated by PMI through an agreed -upon amount for each covered procedure, and by Enrollees through applicable Copayments. In no event does PMI pay a Dentist or a Specialist any incentive as an inducement to deny, reduce, limit or delay any appropriate treatment. An Enrollee may obtain further information concerning compensation of providers by calling PMI at 1- 800 - 422 -4234. 4.11 PMI does not authorize or deny services provided by a Panel Dentist. All Benefits provided by a Panel Dentist are in accordance with dental care guidelines which establish the standard of care to be followed by Panel Dentists. PMI's dental care guidelines are reviewed by PMI's Dental Advisory Committee, and updated as an needed. An Enrollee may contact PMI's Customer Relations Department at 1- 800 - 422 -4234 for information regarding PMI's dental care guidelines. 4.12 PMI may request that an Enrollee obtain a second opinion to verify the necessity and appropriateness of dental treatment or application of Benefits. When PMI requests a second opinion, it will pay for all second opinion charges. An Enrollee may also request a second opinion if he or she disagrees with the diagnosis and/or treatment plan determination made by his or her Panel Dentist. In such cases, the Enrollee should contact PMI's Customer Relations Department for assistance in requesting authorization for a second opinion. • Second opinions will only be authorized at a Panel Dentist's office, unless otherwise authorized by PMI's Dental Consultant. Charges for second opinions that are not authorized by PMI are excluded from coverage. 4.13 If an Enrollee believes he or she has a Special Health Care Need, the Enrollee should contact PMI's Customer Relations Department at 1 (800) 422 -4234. PMI will confirm whether such a Special Health Care Need exists, and what arrangements can be made to assist the Enrollee in obtaining such Benefits. PMI shall not be responsible for the failure of any Panel Dentist to comply with any law or regulation concerning treatment of persons with Special Health Care Needs which is applicable to the Dentist. . I f i • ! PMI -CA BEN 10 3T12.AT.doc ID 411/ • ARTICLE 5. COORDINATION OF BENEFITS 5.01 This Contract provides Benefits without regard to coverage by any other group insurance policy or any other group health benefits program if the other policy or program covers services or expenses in addition to dental care. Otherwise, Benefits under this Contract are coordinated with such other group insurance policy or any group health benefits program. 5.02 When Benefits are coordinated with another group insurance policy or group health benefits program, the determination of which policy or program is primary shall be governed by the following rules: a) The policy or program covering the patient as other than a dependent shall be primary over the policy or program covering the patient as a dependent. b) The policy or program covering a child as a dependent of a parent whose birthday occurs earlier in a calendar year shall be primary over the policy or program covering a child as a dependent of a parent whose birthday occurs later in a calendar year (except for a dependent child whose parents are separated or divorced as described in c) below). c) In the case of a dependent child whose parents are legally separated or divorced: • 1) If the parent with custody has not remarried, the policy or program covering the child as a dependent of the parent with custody shall be primary over the policy or program covering the child as a dependent of the parent without custody. 2) If the parent with custody has remarried, the policy or program covering the child as a dependent of the parent with custody shall be primary over the policy or program covering the child as a dependent of the step - parent, and the policy or program covering the child as a dependent of the step-parent shall be primary over the policy or program covering the child as a dependent of the parent without custody. 3) If there is a court decree that establishes financial responsibility for dental services which are Benefits under this program, notwithstanding c) 1) and 2), the policy or program covering the child as a dependent of the parent with such financial responsibility shall be primary over any other policy or program covering the child. d) If the primary policy or program cannot be determined by the rules described in a), b) or c), the policy or program which has covered the Enrollee for a longer period of time shall be primary, with the following exception: A policy or program covering the Enrollee as a laid -off or retired employee or the dependent of a laid -off or retired • employee shall not be primary under this rule d) over a policy or program covering the Enrollee as an employee or the dependent of an employee. However, if the provisions of the other policy or program do not include this exception, which results in benefits under neither being primary, then this exception shall not apply. pp Y• PMI -CA COB 11 3T12.AT.doc • • • 5.03 An Enrollee shall provide to PMI, and PMI may release to insurance company or other organization, any information about the Enrollee that a s y needed to administer coordination of benefits. PMI shall, in its sole discretion, determine whether any reimbursement to an insurance company or other organization is warranted under these coordination of benefits provisions, and any such reimbursement paid shall be deemed to be Benefits under this Contract. PMI shall have the right to recover from a Dentist, Enrollee, insurance company or other organization, as PMI chooses, the amount of any Benefits paid by PMI which exceed its obligations under these coordination of benefit provisions. • • I • f • COB PMI -CA 12 3T12.AT.doc 411 ARTICLE 6. COMPLAINT PROCEDURE, CLAIMS APPEAL AND ARBITRATION PMI shall provide notification if any dental services or claims are denied, in whole or in part, stating the specific reason or reasons for the denial. If an Enrollee has any complaint regarding eligibility, the denial of dental services or claims, the policies, procedures or operations of PMI, or the quality . of dental services performed by a Panel Dentist, he or she may call PMI's Customer Relations Department at 1 -800- 422 -4234, or the complaint may be addressed in writing to: PMI Quality Management Coordinator 12898 Towne Center Drive Cerritos, California 90703 and must include 1) the name of the patient, 2) the name, address, telephone number and social security number of the Primary Enrollee, 3) the name of the Applicant and 4) the Dentist's name and address. Within 5 calendar days of the receipt of a complaint and the above information, the PMI Quality Management Coordinator will forward to the complainant an acknowledgment of receipt of the complaint. Those complaints requiring professional expertise shall be referred to the PMI Executive Dental Director for response. Certain complaints may also require that the complainant be referred to a Dentist for a clinical evaluation of the dental services provided. PMI will respond, within 3 days • of receipt, to complaints involving severe pain and /or imminent and serious threat to a patient's health. Within 30 days of the receipt of the complaint, PMI shall send to the complainant a written report which describes the complaint and PMI's resolution. The report shall advise that a review of PMI's decision shall be undertaken if a written request for an appeal of the determination is made within 30 days of the date of receipt of the report. The complainant should provide the reason for the appeal and any additional information which may affect the case. PMI shall undertake a full and fair review upon any request for review. PMI may require additional documents as it deems necessary or desirable in making such a review. PMI shall provide a written response to the complainant within 30 days after PMI receives the appeal and supporting documentation. !` An Enrollee may file a complaint with the Department of Managed Health Care after he or she has completed PMI's grievance procedure or after he or she has been involved in PMI's grievance procedure for 30 days. An Enrollee may file a complaint with the Department immediately in an emergency situation, which is one involving severe pain and /or imminent and serious threat to the Enrollee's health. The California Department of Managed Health Care is responsible for regulating health care services plans. The Department has a toll -free number (1- 888 - HMO -2219) to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service's toll -free numbers [1- 800 - 735 -2929 TT ( Y)] or [1- 888 - 877 -5378 (TTY)] to contact the Department. The Department's website (http: / /www,hmohelp.ca.gov) has complaint forms and instructions online. If you have a grievance against your health plan you should first telephone your plan at (1 - 800 - 422 - 4234) and use the plan's grievance process before contacting the Department. If you PMI -CA COMPL 13 3T12.AT.doc 0 • • need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your plan, or a grievance that has been unresolved for more than 30 days, you may call the Department for assistance. The plan's grievance process and the Department's complaint review process are in addition to any other dispute resolution procedures that may be available to you, and your failure to use these processes does not preclude your use of any other remedy provided by law. Any dispute arising out of or relating to this Contract or this dental health care program, including any disagreement with a claim determination made by PMI after exhaustion of the procedures outlined above, or any complaint regarding the quality of dental services performed by a Panel Dentist, is subject to arbitration in accordance with the Consumer Rules of the American Arbitration Association ( "AAA "). Any party to a dispute may initiate arbitration by written notice to each other party to the dispute by filing two copies of such notice with the AAA Regional Office in San • Francisco or Los Angeles, together with the fee required by the AAA. In the event of extreme hardship on the part of an enrollee or subscriber, and upon an application for relief presented to the AAA, PMI shall assume all or a portion of the Enrollee's share of arbitration fees and expenses as determined by the AAA in accordance with procedures established and administered by the AAA. • COMPL PMI -CA 14 3T12.AT.doc ARTICLE 7. GENERAL PROVISIONS 7.01 The Contract, the Contract application, and any attached schedules, appendices, endorsements and riders, constitute the entire agreement between PMI and Applicant. No agent has authority to amend this Contract or waive any of its provisions. No amendment to this Contract shall be valid unless approved by an executive officer of PMI and evidenced by endorsements. 7.02 If any portion of this Contract or any amendment thereof shall be determined by any arbitrator, court or other competent authority to be illegal, void or unenforceable, such determination shall not abrogate this Contract or any portion thereof other than such portion determined to be illegal, void or unenforceable, and all other portions of this Contract shall remain in full force and effect. 7.03 The parties agree that all questions regarding interpretation or enforcement of this Contract shall be governed by the laws of the State of California, where the Contract is entered into and is to be performed. PMI is subject to the requirements of Chapter 2.2 of Division 2 of the California Health and Safety Code and of Subchapter 5.5 of Chapter 3, of Title 10 of the California Code of Regulations. Any provisions required to be in the Contract by either of the above shall bind PMI whether or not provided in this Contract. • 7.04 PMI will issue to the Applicant for delivery to each Primary Enrollee an evidence of coverage summarizing the Benefits to which each Enrollee is entitled. If any amendment to this Contract shall materially affect any provisions described in such evidence of coverage, new evidences of coverage or riders showing the change shall be issued. Any direct conflict between the evidence of coverage and this Contract shall be resolved according to the terms most favorable to the Enrollee. 7.05 Both parties to this Contract agree to consult to the extent reasonably practical concerning all material published or distributed relating to this Contract. No such material shall be published or distributed which is contrary to the terms of this Contract. 7.06 Applicant shall designate in writing a representative for purposes of receiving notices from PMI under this Contract. Applicant may change its representative at any time on 30 days' notice to PMI. Any notice under this Contract shall be sufficient if given by either Applicant or PMI to the other addressed as stated on the Application of this Contract, and shall be effective 48 hours after deposit in the United States mail with postage fully prepaid. Any notice required from PMI to any Enrollee may be given to Applicant's representative, who shall disseminate such notice to Enrollees by next regular communication but in no event later than 30 days after receipt thereof. 7.07 PMI shall be excused from performance under this Contract for any period and to the extent • that it is prevented from performing any services in whole or in part as a result of an act of God, war, civil disturbance, strike, court order, or other cause beyond its reasonable control and which it could not have prevented by reasonable precautions. PMI -CA GENPROV 15 3T12.AT.doc . • • ARTICLE 8. TERMINATION AND RENEWAL 8.01 This Contract may be terminated by PMI upon Applicant's failure (i) to furnish PMI with the eligibility list as required by Article 2, or (ii) to pay Premiums in the amount and manner required by Article 3, provided Applicant has been notified of such failure and at least 15 days have elapsed since such notification. 8.02 Termination at the end of a Contract Term shall be by at least 30 days' advance written notice of termination by certified mail given by the party desiring to terminate to the other party. In the event that PMI shall desire to change Premiums or Benefits effective at the end of any Contract Term, advice of such changes will be given to Applicant upon at least 30 days' written notice, and such notice shall renew the Contract for another Contract Term at the rates and with the coverage as stated in the notice unless Applicant provides written notification to PMI by certified mail on or before the date stated in the notice that Applicant does not choose to renew. 8.03 Acceptance by PMI of the proper Premiums after termination of this Contract and without requiring a new application, shall continue this Contract as though it had never terminated, unless PMI shall, within 20 business days of receipt of such payment, either i) refuse the payment so made, or ii) issue to Applicant a new Contract accompanied by written notice stating clearly those respects in which the new Contract differs from this terminated Contract in Benefits, coverage or otherwise. • PMI -CA TERM -REN 16 3T12.AT.doc • • ARTICLE 9. ATTACHMENTS The following schedules are a part of this Contract: Schedule A - Description of Benefits and Copayments Schedule B - Limitations and Exclusions of Benefits Schedule C - Governing Administrative Policies Schedule D - Group Variables and Premiums Schedule E - COBRA Continuation Option Schedule F - Accident Injury Rider • • PMI -CA ATT 17 3T12.AT.doc • ' I . „ 0 • III SCHEDULE A PLAN CA735 CODES ENROLLEE I. DIAGNOSTIC PAYS Office visit, per visit (in addition to other services) No Cost 0120 Periodic oral evaluation 0140 Limited oral evaluation -- problem focused No Cost 0150 Comprehensive oral evaluation No Cost 0160 Detailed and extensive oral evaluation -- problem focused No Cost 0210 Intraoral radiographs -- complete series No Cost (including bitewings) No Cost 0220,0230 Intraoral periapical film 0240 Intraoral occlusal film No Cost 0270, No Cost 0272,0274 Bitewing radiograph(s) 0330 Panoramic film No Cost No Cost II. PREVENTIVE 1110,1120 Prophylaxis (cleaning)-- adultichild - 1 per 6 month period No Cost • 1201 Topical application of fluoride, including prophylaxis (to age 19) - 1 per 6 month period No Cost 1203 Topical application of fluoride, excluding prophylaxis (to age 19) - 1 per 6 month period No Cost 1330 Oral hygiene instructions 1351 Sealant, per tooth $ 1 Cost 1510 Space maintainer -- fixed -- unilateral $ 10.00 1515 Space maintainer -- fixed -- bilateral $ 15.00 1520 Space maintainer -- removable -- unilateral $ 15.00 $ 15.00 1525 Space maintainer -- removable -- bilateral 1550 Recementation of space maintainers $ 15.00 No Cost III. RESTORATIVE (Fillings) (Includes indirect pulp capping, bases, liners and acid etch procedures) 2110 Amalgam- -one surface, primary 2120 Amalgam- -two surfaces, primary No Cost 2130 Amalgam- -three surfaces, primary No Cost 2131 Amalgam- -four or more surfaces, primary No Cost 2140 No Cost Amalgam- -one surface, permanent No Cost 2150 Amalgam- -two surfaces, permanent 2160 Amalgam- -three surfaces, permanent No Cost 2161 Amalgam- -four or more surfaces, permanent No Cost 2330 Resin - -one surface anterior No Cost • 2331 Resin - -two surface anterior No Cost 2332 Resin - -three surface anterior No Cost 2335 Resin - -four or more surfaces or involving No Cost incisal angle (anterior) No Cost SCH -A PMI -CA 18 3T12.AT.doc ' . 4 • CODES ENROLLEE PAYS 2336 Composite resin crown, anterior -- primary 2940 Sedative filling No Cost 2951 Pin retention - -per tooth, in addition to restoration $ 1 Cost $ 10.00 IV. ORAL SURGERY (Includes preoperative and postoperative evaluations and treatment under local anesthetic) 7110,7120 Single tooth extraction/each additional 7130 Root removal -- exposed roots No Cost 7210 Surgical removal of erupted tooth No Cost 7220 Removal of impacted tooth - -soft tissue No Cost 7230 Removal of impacted tooth -- partially bony $ No Cost 7240,7241 Removal of impacted tooth -- completely bony $ 45.00 7250 Surgical removal of residual tooth roots $ 65.00 (cutting procedure) 7286 Biopsy of oral tissue - -soft No Cost 7310 Alveoloplasty in conjunction with extractions, per quadrant $ No Cost 7320 Alveoloplasty not in conjunction with extractions, per quadrant $ 50.00 7470 Removal of exostosis -- maxilla or mandible 7510 Incision and drainage of abscess -- intraoral soft tissue No Cost 7960 Frenulectomy-- (frenectomy or frenotomy) No Cost • separate procedure No Cost V. PERIODONTICS (Includes preoperative and postoperative evaluations and treatment under a local anesthetic) 4210 ! Gingivectomy or gingivoplasty, per quadrant 4211 Gingivectomy or gingivoplasty, per tooth $100.00 (fewer than six teeth) $ 20.00 4220 Gingival curettage surgical, per quadrant 4240 Gingival flap procedures including $ 10.00 j root planing (per quadrant) 4260 Osseous surgery, flap entry and closure, per quadrant $100.00 4341 Periodontal scaling and root planing, quadrant $20.00 4355 Full mouth debridement to enable comprehensive periodontal $ 10.00 evaluation and diagnosis i 4910 Periodontal maintenance (following active therapy) $ 8. $ 8. 00 00 VI. PROSTHETICS (Crowns, bridges and dentures) 2510 Inlay- -one surface- -base metal noble 2520,6520 Inlay- -two surfaces- -base metal noble No Cost 2530,6530 Inlay- -three or more surfaces - -base metal noble No Cost 2543,6543 Onlay- -three surfaces- -base metal noble No Cost 0 2544,6544 Onlay- -four or more surfaces- -base metal noble No Cost 2710 Crown- -resin (laboratory) $ 4 Cost 2740 Crown-- porcelain/ceramic j. $ 45.00 2750 Crown -- porcelain fused to high noble metal *t $ 75.00 2751 Crown -- porcelain fused to predominantly base metalt $ 75.00 2752 Crown -- porcelain fused to noble metalt $ 75.00 $ 75.00 PMI -CA 19 SCH -A 3T12.AT.doc • • • • CODES ENROLLEE PAYS 2790 Crown - -full cast high noble metal* 2791 Crown - -full cast predominantly base metal $ 75.00 $ 75.00 2792 Crown - -full cast noble metal 2810 Crown - -3/4 cast metal noble $ 75.00 2910 Recement inlay $ 75.00 2920 Recement crown No Cost 2930,2931 Crown -- prefabricated stainless steel -- primary/permanent No Cost 2950 Crown buildup (restorative material and pins) Cost $ 2952 Cast post and core* (in addition to crown) $ 10.00 $ 10.00 2954 Prefabricated post and core (in addition to crown) 10.00 5110,5120. Denture -- complete maxillary or mandibular (upper or lower) $ 95.00 5130,5140 Immediate denture -- maxillary or mandibular (upper or lower) $110.00 5213,5214 Denture -- maxillary or mandibular (upper or lower) partial with metal lingual or palatal bar, clasps and acrylic saddles, and acrylic base or cast metal framework and teeth $110.00 5410 Adjust complete denture -- maxillary 5411 Adjust complete denture -- mandibular $ 5.00 5421 Adjust partial denture -- maxillary $ 5.00 5422 Adjust partial denture -- mandibular $ 5.00 5510 Repair broken complete denture base $ 5. 0 00 5520 Replace missing or broken teeth -- complete denture (per tooth) $ 10.00 5610 Repair resin denture base • 5620 Repair cast framework $ 15.00 5630 Repair or replace broken clasp $ 15.00 5640 Replace broken teeth (per tooth) $ 15.00 5650 Add tooth to existing partial denture $ 10.00 5660 Add clasp to existing partial denture $ 10.00 5730 Reline complete maxillary denture (chairside) $ 10.00 5731 Reline complete mandibular denture (chairside) $ 20.00 $ 20.00 5740 Reline maxillary partial denture (chairside) 5741 Reline mandibular partial denture (chairside) $ 20.00 $ 20.00 5710 Rebase complete maxillary denture 5711 Rebase complete mandibular denture $ 40.00 5720 Rebase maxillary partial denture $ 40.00 5721 Rebase mandibular partial denture $ 40.00 5750 Reline complete maxillary denture (lab) $ 40.00 5751 Reline complete mandibular denture (lab) $ 40.00 $ 40.00 5760 Reline maxillary partial denture (lab) 5761 Reline mandibular partial denture (lab) $ 40.00 5820 Interim partial denture (maxillary) $ 40.00 5821 No Cost Interim partial denture (mandibular) 5850,5851 Tissue conditioning - -per denture No Cost 6210 No Cost Pontic- -cast high noble metal* 6211 Pontic - -cast predominantly base metal $ 75.00 6212 Pontic- -cast noble metal $ 75.00 6240 Pontic -- porcelain fused to high noble metal *t $ 75.00 6241 Pontic -- porcelain fused to predominantly base metalt $ 75.00 111 $ 6242 Pontic -- porcelain fused to noble metal- 75.00 6750 Crown -- porcelain fused to high noble metal *f $ 75.00 6751 Crown -- porcelain fused to predominantly base metalt $ 75.00 6752 Crown -- porcelain fused to noble metalt $ 75.00 6790 Crown - -full cast high noble metal* $ 75.00 6791 Crown - -full cast predominantly base metal $ 75.00 $ 75.00 PMI -CA SCH -A 20 3T12.AT.doc 0 • II CODES ENROLLEE PAYS 6792 Crown - -full cast noble metal 6930 Recement bridge (fixed partial denture) $ 75.00 6940 Stress breaker, per unit (in addition to mixed partial No Cost denture, retainer) 6970 Cast post and core* (includes canal preparation) $ 1 Cost 6972 Prefabricated post and core buildup (including canal $ 10.00 preparation, restorative material and any pins) $ 10.00 * Base or noble metal is the benefit. High noble metal (precious), if used, will be charged to the enrollee at the additional laboratory cost of the high noble metal. This applies to crowns, bridges, cast and post cores, inlays and onlays. t Porcelain on molars is considered optional treatment. VII. ENDODONTICS 3110,3120 Pulp capping (direct/indirect) 3220 Therapeutic pulpotomy (excluding final restoration No Cost 3310 Root canal therapy--anterior $ No Cost PY anterior (excludi 3320 ng final restoration) $ 40.00 3330 Root canal therapy -- bicuspid (excluding final restoration) $ 80.00 Root canal therapy - -molar (excluding final restoration) $120.00 3410 Apicoectomy /periradicular surge • 3421 rY- -anterior $ 50.00 Apicoectomy /periradicular surgery-- bicuspid (first root) 3425 Apicoectomy /periradicular sure $ 50.00 3426 Apicoectomy /periradicular surgery (each additional root) No Cost 3430 Retrograde filling, per root 3450 Root amputation, per root $ 50.00 No Cost VIII. ADJUNCTIVE GENERAL SERVICES 9110 Palliative (emergency) treatment of dental pain 9211 Regional block anesthesia $ 5.00 9212 Trigeminal division block anesthesia No Cost 9215 Local anesthesia No Cost 9310 Consultation (diagnostic services provided by a dentist or No Cost physician other than practitioner providing treatment) No Cost 9440 Office visit after regularly scheduled hours 0125 Failed appointment without 24 hour notification, $ 20.00 per 15 minutes of appointment time $ 10.00 IX. ORTHODONTICS Start-up fees (excluding records) i Dependent children to age 19 $ 350.00 Adults and covered full -time students $1600.00 $1800.00 411 Any procedure not listed is available on a UCR basis. The above procedures are performed as needed and deemed necessary subject to the Limitations, Exclusions and Governing Administrative Policies of the Program. Dentist PMI -CA 21 SCH -A 3T12.AT.doc • • SCHEDULE B LIMITATIONS OF BENEFITS 1. Prophylaxis is limited to one treatment each six month period (includes periodontal maintenance following active therapy); 2. Full maxillary and/or mandibular dentures including immediate dentures are not to exceed one each in any five year period from initial placement; 3. Partial dentures are not to be replaced within any five year period from initial placement, unless necessary due to natural tooth loss where the addition or replacement of teeth to the existing partial is not feasible; 4. Crown(s) and bridges are not to be replaced within any five year period from initial placement; 5. Denture relines are limited to one per denture during any 12 consecutive months; 6. Periodontal treatments (root planing/subgingival curettage) are limited to four quadrants during any 12 consecutive months; 7. Full mouth debridement (gross scale) is limited to one treatment in any 12 consecutive month period; 8. Bitewing x -rays are limited to not more than one series of four films in any six month period; 9. Full mouth x -rays are limited to one set every 24 consecutive months; 10. Sealant benefits include the application of sealants only to permanent first and second molars with no decay, with no restorations and with the occlusal surface intact, for first molars up to j age nine and second molars up to age fourteen. Sealant benefits do not include the repair or replacement of a sealant on any tooth within three years of its application. 11. Accidental injury except as noted in Accident Injury Rider, Schedule F. Accidental injury is defined as damage to the hard and soft tissues of the oral cavity resulting from forces external to the mouth. Damages to the hard and soft tissues of the oral cavity from normal masticatory (chewing) function will be covered at the normal schedule of benefits. j EXCLUSIONS OF BENEFITS 1. General anesthesia and the services of a special anesthesiologist; • 2. Cosmetic dental care; 3. Dental conditions arising out of and due to enrollee's employment or for which Worker's Compensation is payable. Services which are provided to the enrollee by state government or agency thereof, or are provided without cost to the enrollee by any municipality, county or SCH -B PMI -CA 22 3T12.AT.doc ® • • other subdivision, except as provided in Section 1373(a Code; of the California Health and Safety 4. Treatment required by reason of war; 5. Dental services performed in a hospital and related hospital fees; 6. Treatment of fractures and dislocations; 7. Loss or theft of fixed and removable prosthetics (crowns, bridges, full or partial dentures); 8. Dental expenses incurred in connection with any dental procedures started after termination of eligibility for coverage; 9. Any service that is not specifically listed as a covered expense; 10. Dental expenses incurred in connection with any dental procedure started prior to enrollee's eligibility with the DeltaCare program. Example: teeth prepared for crowns, root canals in progress; 11. Congenital malformations (e.g. congenitally missing teeth, supernumerary); • 12. Cysts and malignancies; 13. Dispensing of drugs not normally supplied in a dental office; 14. Cases which in the professional judgment of the attending dentist a satisfactory result cannot be obtained or where the prognosis is poor or guarded; 15. Dental services received from any dental office other than the assigned dental office, unless expressly authorized in writing by DeltaCare or as cited under "Out of Area Emergency Treatment "; 16. Prophylactic removal of impactions (asymptomatic nonpathological); 17. "Specialist consultations" for noncovered benefits; 18. Implant placement or removal, appliances placed on or services associated with implants, including but not limited to prophylaxis and periodontal treatment; 19. Crown lengthening procedures. 11111 SCH -B PMI -CA 23 3T12.AT.doc • • ORTHODONTIC LIMITATIONS The program provides coverage for orthodontic treatment plans provided through DeltaCare panel orthodontists. The start-up fees and the cost to the enrollee for the treatment plan are listed in the Description of Benefits and Copayments (Schedule A) subject to the following: 1. Orthodontic treatment must be provided by a DeltaCare orthodontist; 2. Plan benefits cover 24 months of usual and customary orthodontic treatment; 3. Should an enrollee's coverage be cancelled or terminated for any reason, and at the time of cancellation or termination be receiving any orthodontic treatment, the enrollee and not PMI will be responsible for payment of balance due for treatment provided after cancellation or termination. In such a case the enrollee's payment shall be based on a maximum of $2,300 for dependent children to age 19 and $2,500 for covered full -time students and adults. The amount will be pro -rated over the number of months to completion of the treatment and, will be payable by the enrollee on such terms and conditions as are arranged between the enrollee and the orthodontist. Start-up fees are included in these amounts; 4. Start-up fees cover the initial examination, diagnosis, consultation and the retention phase of treatment of up to two years maximum. This includes initial construction, placement and • adjustments to retainers and office visits for a maximum period of two years; 5. If treatment is not required or the enrollee chooses not to start treatment after the diagnosis and consultation has been completed by the orthodontist, the enrollee will be charged a consultation fee of $25 in addition to diagnostic record fees. 6. Three (3) recementations or replacements of a bracket/band on the same tooth or a total of five (5) rebracketings /rebandings on different teeth during the covered course of treatment is a benefit. If any additional recementations or replacements of brackets/bands are performed, the patient is responsible for the cost; 7. Comprehensive orthodontic treatment (Phase II) consists of repositioning all or nearly all of the permanent teeth in an effort to make the patient's occlusion as ideal as possible. This treatment usually requires complete fixed appliances; however, when the DeltaCare orthodontist deems it suitable, a European or removable appliance therapy may be substituted at the same copayment amount as for fixed appliances. An orthodontic treatment in progress provision is available subject to the following: • Treatment in progress is only through the dental HMO benefits plan previously sponsored by the Applicant; • The Enrollee is in active treatment (as defined under the previous dental HMO benefit plan) at the time of the Applicant's original effective date with PMI; • • Qualifying orthodontic cases are subject to all copayments, fees and contract provisions of the prior dental HMO benefit plan; • PMI is financially responsible only for amounts owed and unpaid by the previous dental HMO carrier after the Applicant's original effective date with PMI; and only while the Enrollee remains eligible for coverage under the DeltaCare program. PMI -CA SCH -B 24 3T12.AT.doc • • ORTHODONTIC EXCLUSIONS 1. Pre, mid and post treatment records which include cephalometric x -rays, tracings, photographs and study models; 2. Lost, stolen or broken orthodontic appliances, functional appliances, headgear, retainers and expansion appliances; 3. Retreatment of orthodontic cases; 4. Changes in treatment necessitated by accident of any kind, and/or lack of patient cooperation; 5. Surgical procedures incidental to orthodontic treatment; 6. Myofunctional therapy; 7. Surgical procedures related to cleft palate, micrognathia, or macrognathia; 8. Treatment related to temporomandibular joint disturbances and/or hormonal imbalance; 9. Supplemental appliances not routinely utilized in typical Phase II orthodontics; • 10. Treatment that extends more than 24 months from the point of banding dentition will be subject to an office visit charge at orthodontist's usual, customary and reasonable fee; 11. Restorative work caused by orthodontic treatment; 12. Phase I* orthodontics is an exclusion as well as activator appliances and minor treatment for tooth guidance and/or arch expansion; 13. Extractions solely for the purpose of orthodontics; 14. Treatment in progress at inception of eligibility, unless qualified for the one -time orthodontic treatment in progress provision; 15. Transfer after banding has been initiated. * Phase I is defined as early treatment including interceptive orthodontia prior to the development of late mixed dentition. SCH -B PMI -CA 25 3T12.AT.doc • • SCHEDULE C GOVERNING ADMINISTRATIVE POLICIES Unlike medical care where the diagnosis dictates more specifically the method of treatment to be rendered, in dental care, the dentist and patient frequently consider various treatment plans. The following guidelines are an integral part of the dental program and are consistent with the principles of accepted dental practice and the continued maintenance of good dental health. In all cases in which the patient selects a more expensive plan of treatment than is customarily provided, the more expensive treatment is considered optional. The patient must pay the difference in cost between the dentist's usual fees for the covered benefit and the optional treatment plus any copayment for covered benefits. Replacement of prosthetic appliances (crowns, bridges, partials and full dentures) shall be considered only if the existing appliance is no longer functional or cannot be made functional by repair or adjustment and meets the five year limitation for replacement. A. PARTIAL DENTURES • A removable cast metal artial denture e is considered an adequate restoration. If the patient selects another course of treatment, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and the optional treatment, plus any copayment for the covered benefit. If a cast metal partial denture will restore the case, the Panel Dentist will apply the difference of the cost of such procedure toward a more complicated precision appliance which the patient and dentist may choose to use. The patient must pay the difference in cost between the dentist's usual fees for the covered benefit and the optional treatment plus any copayment for the covered benefit. An acrylic partial denture may be considered a covered benefit in cases involving extensive periodontal disease. Patient shall pay the applicable copayment for a cast metal partial denture. B. COMPLETE DENTURES If, in the construction of a denture, the patient and the Panel Dentist decide on personalized restorations or employ specialized techniques as opposed to standard procedures, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. Full upper and/or lower dentures are not to exceed one each in any five year period from initial placement. The patient is entitled to a new upper or lower denture only if the existing denture is more than five years old and cannot be made satisfactory by either reline or repair. SCH -C PMI -CA 26 3T12.AT.doc • C. FILLINGS AND CROWNS Crowns will be covered only if there is not enough retentive quality left in the tooth to hold a filling. For example, the buccal or lingual walls are either fractured or decayed to the extent that they will not hold a filling. Porcelain or porcelain fused to metal crowns on all molars are considered optional treatment. If performed, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. The DeltaCare program provides amalgam and resin restorations for treatment of caries. If the tooth can be restored with such materials, any other restoration such as a crown or jacket is considered optional, and if provided, the patient must pay the difference in cost between the • dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. • A restoration is a covered benefit only when required for restorative reasons (radiographic evidence of decay or missing tooth structure). Restorations placed for any other purposes including but not limited to cosmetics, abrasion, attrition, erosion, restoring or altering vertical dimension, congenital or developmental malformation of teeth, or the anticipation of future fractures, are not covered benefits. • Composite resin restorations in osterior teeth th are considered optional treatment. If provided, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. Porcelain crowns, porcelain fused to metal or plastic processed to metal type crowns are not a benefit for children under sixteen years of age. An allowance will be made for an acrylic crown. If performed, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. A crown placed on a specific tooth is allowable only once in a five year period from initial placement. A pulp cap is a benefit only on a permanent tooth with an open apex. D. FIXED BRIDGES A fixed bridge is considered standard dental treatment when it is necessary to replace one missing permanent anterior tooth in a person sixteen years old or older. Such treatment will be covered if the patient's oral health and general dental condition permits. • Fixed bridges used to replace missing posterior teeth are . considered optional when the abutment teeth are dentally sound and would be crowned only for the purpose of supporting a pontic. A fixed bridge used under these circumstances is considered optional dental treatment. The patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. SCH -C PMI -CA 27 3T12.AT.doc " • • Fixed bridges are not a benefit when provided in connection with a partial denture on the same arch. If provided, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. Replacement of an existing nonfunctional bridge is limited to once in a five year period from initial placement and shall be covered only when the replacement duplicates the original bridge. Fixed bridges are not a benefit for patients under the age of sixteen. A fixed bridge under these circumstances is considered optional dental treatment. If performed, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. E. RECONSTRUCTION The DeltaCare program provides coverage for procedures necessary to eliminate oral disease and to replace missing teeth. Appliances or restorations necessary to increase vertical dimension, replace or stabilize tooth structure loss by attrition, realignment of teeth, periodontal splinting, gnathologic recordings, equilibration or treatment of disturbances of the temporomandibular joint (TMJ) are not covered benefits. Extensive treatment plans involving 10 or more crowns or units of fixed bridgework is considered full mouth reconstruction and is • not a benefit of the DeltaCare program. The program will allow for complete or partial denture(s). F. SPECIALIZED TECHNIQUES Precious metal for removable appliances, precision abutments for partials or bridges (overlays, implants, and appliances associated therewith), personalization and characterization, are all considered optional treatment. If performed, the patient must pay the difference in cost between the dentist's usual fees for the covered benefit and optional treatment, plus any copayment for the covered benefit. G. PREVENTIVE CONTROL PROGRAMS Soft tissue management programs are not covered. The periodontal pocket charting, root planing/scaling /curettage, oral hygiene instruction and prophylaxis are covered benefits and, if performed as part of a soft tissue management program, will be provided for listed copayments, if any. Irrigation, infusion, special tooth brush, etc., is considered as optional treatment. If performed, the patient is responsible for the cost. H. STAYPLATES • Stayplates in conjunction with fixed or removable appliances, are only a benefit to replace extracted anterior teeth for adults during a healing period and as anterior space maintainers for children. SCH -C PMI -CA 28 3 T 12.AT.doc 0 • • I. FRENECTOMY The frenum can be excised when the tongue has limited mobility; or has a large diastema between teeth; or when the frenum interferes with a prosthetic appliance. J. PEDODONTIA Pedodontic referrals must be preauthorized by DeltaCare. Benefits for dependent children through age three are covered at 100% of the agreed upon fee less any applicable copayments for covered benefits and children four years and older are at 50% of agreed upon fee less any applicable copayments for covered services. • K. TREATMENT PLANNING The objective of this Program is to see that all patients are brought to a good level of oral health and that this level of oral health is maintained. To achieve this objective takes careful treatment planning. Priorities have been established on the following basis: 1. Priority attention is given to those procedures that, if not done first, could have an immediate effect on the patient's overall oral health. • 2. Priority is next given to work such as active dental decay and periodontal problems that would not have an immediate effect on the patient's oral health. 3. Priority is then given to replacement of missing teeth not causing a gross lack of function. • Exceptions are made to this treatment planning concept based on individual circumstances. • PMI -CA SCH -C 29 3T12.AT.doc • 1 • • SCHEDULE D GROUP VARIABLES AND PREMIUMS A. Group Name: HCM /City of Seal Beach B. Group Number: 3T12 C. Effective Date: May 1, 2001 D. Contract Term: 24 months E. Eligible Present Employees: First of the month following 30 days of continuous employment at 32 hours per week Eligible New Employees: First of the month following 30 days of continuous employment at 32 hours per week F. Premiums per Month: Plan Type: CA735 California Primary Enrollee: $15.75 California Primary Enrollee Plus One Dependent Enrollee: $25.99 California Primary Enrollee Plus Two or More Dependent Enrollees: $38.44 G. Remit Premium Payment to: PMI, Dept. #0170 Los Angeles, California 90084 -0170 • SCH -D PMI -CA 30 3T12.AT.doc • • SCHEDULE E OPTIONAL CONTINUATION OF COVERAGE (COBRA OR CAL - COBRA) The federal Consolidated Omnibus Budget Reconciliation Act (or COBRA, pertaining to certain employers having 20 or more employees) and the California Continuation Benefits Replacement Act (or Cal - COBRA, pertaining to employers with 2 to 19 employees), both require that continued health care coverage be made available to "Qualified Beneficiaries" who lose health care coverage under the group plan as a result of a "Qualifying Event." An employee or dependent may be entitled to continue coverage under this program, at the Qualified Beneficiary's expense, if certain conditions are met. The period of continued coverage depends on the Qualifying Event. DEFINITIONS The meaning of key terms used in this section are shown below. Qualified Beneficiary means a person enrolled in the DeltaCare plan on the day before the Qualifying Event, including: 1. an employee and his or her dependents, or; 2. a child who is born to or placed for adoption with the employee during the period of continued coverage, provided such child is enrolled within 30 days of birth or placement for adoption. Qualifying Event mean any of the following events which, except for the election of this continued coverage, would result in a loss of coverage under the dental plan: Event 1: The termination of employment (other than termination for gross misconduct), or the reduction in work hours, by the employer; +' Event 2: the employee's death; Event 3: the employee's divorce or legal separation from his or her spouse; Event 4: Dependents' loss of dependent status under the plan; and Event 5: As to dependents only, the employee's entitlement to Medicare. PERIODS OF CONTINUED COVERAGE An employee or dependent may continue coverage for 18 months following the occurrence of Qualifying Event 1. This 18 month period can be extended for a total of 29 months, provided: 41) 1. a determination is made under Title II or Title XVI of the Social Security Act that an individual is disabled on the date of the Qualifying Event or became disabled at any time during the first 60 days of continued coverage; and 2. notice of the determination is given to the employer during the initial 18 months of continued coverage and within 60 days of the date of the determination. SCH -E PMI -CA 31 3 T 12.AT.doc • • • This period of coverage will end on the first of the month that begins more than 30 days g y after the date of the final determination that the disabled individual is no longer disabled. The employee must notify the employer /administrator within 30 days of any such determination. If, during the 18 month continuation period resulting from Qualifying Event 1, dependents experience Qualifying Events 2, 3, 4 or 5, they may choose to extend coverage for up to a total of 36 months (inclusive of the period continued under Qualifying Event 1). Enrolled dependents may continue coverage for 36 months following the occurrence of Qualifying Event2,3,4or5. Under federal COBRA law only, when an employer has filed for bankruptcy under Title II, United States Code, benefits may be substantially reduced or eliminated for retired employees and their dependents, or the surviving spouse of a deceased retired employee. If this benefit reduction or elimination occurs within one year before or one year after the filing, it is considered a Qualifying Event. If the employee is the retiree, and has lost coverage because of this Qualifying Event, he or she may choose to continue coverage until his or her death. Dependents who have lost coverage because of this Qualifying Event may choose to continue coverage for up to 36 months following the employee's death. ELECTION OF CONTINUED COVERAGE The employee's former employer shall notify PMI in writing within 30 days of Qualifying Event 1. • A Qualified Beneficiary must notify the Administrator in writing within 60 days of Qualifying Events 2, 3, 4, or 5. Otherwise, the option of continued coverage will be lost. Within 14 days of receiving notice of a Qualifying Event, PMI will provide a Qualified Beneficiary with the necessary benefits information, monthly premium charge, enrollment forms, and instructions to allow election of continued coverage. A ualified Beneficiary ary will then have 60 days to give PMI written notice of the election to continue coverage. Failure to provide this written notice of election to PMI within 60 days will result in the loss of the right to continue coverage. A Qualified Beneficiary has 45 days from the written election of continued coverage to pay the initial premium to PMI, which includes the premium for each month since the loss of coverage. Failure to pay the required premium within the 45 days will result in loss of the right to continued coverage, and any premiums received after that date will be returned to the Qualified Beneficiary. A Qualified Beneficiary who is eligible for coverage under the federal COBRA law may not be covered under Cal - COBRA. CONTINUED COVERAGE BENEFITS The benefits under the continued coverage will be the same as those provided to active employees • and their dependents who are still enrolled in the dental plan. If the employer changes the coverage for active employees, the continued coverage will change as well. Premiums will be adjusted to 1 reflect the changes made. SCH -E PMI -CA 32 3T12.AT.doc • 1 • S TERMINATION OF COVERAGE A Qualified Beneficiary's coverage will terminate at the end of the month in which any of the following events first occurs: 1. the allowable number of consecutive months of continued coverage is reached; 2. the individual fails to pay the required premium in a timely manner; 3. the individual first obtains coverage for dental benefits after the date of the election of continued coverage, under another group health plan (as an employee or dependent) which does not contain or apply any exclusion or limitation with respect to any pre- existing condition of such person, if that pre- existing condition is covered under this program; 4. the employer ceases to provide any group dental plan to its employees; 5. the individual becomes entitled to Medicare; 6. the individual moves . out of the plan's service area; 7. the individual becomes eligible for coverage under the federal COBRA law. The employer shall notify PMI within 30 days of the date when a Qualified Beneficiary becomes so eligible. TERMINATION OF THE EMPLOYER'S DENTAL CONTRACT If the dental contract between the employer and PMI terminates prior to the time that the continuation coverage would otherwise terminate, the employer shall notify a Qualified Beneficiary under Cal -COBRA (either 30 days prior to the termination or when all Enrollees are notified whichever is later) of that person's ability to elect continuation coverage under the employer's subsequent dental plan, if any. The employer must notify the successor plan of the Qualified Beneficiaries receiving continuation coverage so they may be notified of how to continue coverage under that plan. The continuation coverage will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the DeltaCare program had such program with the former employer not terminated. The continuation coverage will terminate if a Qualified Beneficiary fails to comply with the requirements pertaining to enrollment in, and payment of premium to the new group benefit plan within 30 days of receiving notice of the termination of the DeltaCare program. OPEN ENROLLMENT CHANGE OF COVERAGE A Qualified Beneficiary under Cal -COBRA may elect to change continuation coverage during any subsequent open enrollment period, if the employer has contracted with another plan to provide coverage to its active employees. The continuation coverage under the other plan will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the DeltaCare program. SCH -E PMI -CA 33 3T12.AT.doc 1 • SCHEDULE F ACCIDENT INJURY RIDER PMI shall pay or otherwise discharge 1 00% of the Dentist's Usual, Customary and Reasonable fees not to exceed the "Prevailing Fee" as determined by PMI or of Fees Actually Charged, whichever is less, less any applicable patient copayment(s), for the following Dental Accident Benefits: Services described in the Schedule of Benefits and Copayments, Schedule A, and in paragraph II of this Rider, Schedule F are subject to the following maximum, limitation and exclusions when provided for conditions caused directly and independently of all other causes, by external, violent and accidental means. I. DEFINITIONS For the purpose of this Rider, the following additional definitions shall apply: A. "Attending Dentist's Statement" means the standard form used to file a claim. B. "Dental Accident Benefits" means those dental services which are provided under the terms of • this Rider for conditions caused directly and independently of all other causes, by external, violent and accidental means. C. "Fee Actually Charged" means the fee for a particular dental service or procedure which a Dentists reports to PMI on an Attending Dentist's Statement, less any portion of such fee which is discounted, waived, rebated or which the Dentist does not in good faith attempt to collect. D. "Prevailing Fee" means the fee for a Single Procedure which satisfies the majority of Dentists in California, as determined by PMI. E. "Single Procedure" means a dental procedure listed on a separate line in Schedule A and in paragraph lI of this Rider, Schedule F. F. Each of the words in the term "Usual, Customary and Reasonable" as used in this Rider shall have the following meanings: USUAL - A usual fee is the fee regularly charged and received by an individual Dentist, (i.e., his own usual fee). If more than one fee is charged for a given service, the fee determined to be the usual fee shall not exceed the lowest fee which is regularly charged or which is offered to patients. CUSTOMARY - A fee is customary when it is within the accepted range of usual fees charged and received by dentists of similar training for the same service within the geographic area determined by PMI to be statistically relevant. SCH -F PMI -CA 34 3T12.AT.doc 1 1 1 • REASONABLE - A fee is reasonable if it is "usual" and "customary," or if it falls above "customary" and is justifiable due to a level of treatment superior to that customarily provided. Additionally, a specific fee to a specific patient is reasonable if it is justifiable considering special circumstances, or extraordinary difficulties of the case in question. II. DENTAL ACCIDENT BENEFITS For the purpose of this Rider, the following additional benefits shall apply: A. Intra -oral grafting B. Reimplantation C. Splinting D. Stayplate III. MAXIMUM The program shall provide Dental Accident Benefits for an Eligible Person up to a maximum of $1,600 • per patient per any twelve (12) month period. IV. LIMITATION Dental Accident Benefits shall be limited to services provided to an Eligible Person within 180 days following the date of accident, and shall not include any services for conditions caused by an accident occurring prior to the patient's eligibility date. V. EXCLUSIONS The following services are not Dental Accident Benefits: A. Services for injuries or conditions which are benefits provided to the eligible person through a medical carrier or are compensable under Workers' Compensation or Employers' Liability Laws; services which are provided to the Eligible Person by any federal or state government agency or are provided without cost to the Eligible Person by any municipality, county or other political subdivision, except as provided in Section 1373 (a) of the California Health and Safety Code. • B. Services with respect to congenital (hereditary) or developmental (following birth) malformations or cosmetic surgery or dentistry for purely cosmetic reasons, including but not limited to: cleft palate, maxillary and mandibular (upper and lower jaw) malformations, enamel hypoplasia (lack of development), fluorosis (a type of discoloration of the teeth), and anodontia (congenitally missing teeth). SCH -F PMI -CA 35 3T12.AT.doc • C. Services for restoring or stabilizing tooth structure lost from wear, or for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion. Such services include but are not limited to : equilibration and periodontal splinting. D. Prosthodontic services or any Single Procedure started prior to the date the person became eligible for such services under this Contract. E. Prescribed drugs, pre- medication or analgesia. F. Experimental procedures. G. Prophylaxis. H. All hospital costs and any additional fees charged by the. Dentist for hospital treatment. I.. Charges for general anesthesia. J. Extra -oral grafts (grafting of tissues from outside the mouth to oral tissue). K. Implants (materials implanted into or on bone or soft tissue), the removal of implants or procedures related to the placement or removal of implants. • L. Diagnosis or treatment by any method of any condition related to the temporomandibular (jaw) joint or associated musculature, nerves and other tissues. M. Replacement of existing restorations due to carious lesions. N. Orthodontic services (treatment of malalignment of teeth and/or jaws). SCH -F PMI -CA 36 3T12.ATodoc r PRIVATE MEDICAL -CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924 -8311 (800) 801 -7105 APPLICATION FOR DeltaCare GROUP DENTAL SERVICE CONTRACT The undersigned group ( "Applicant ") hereby applies for a DeltaCare GROUP DENTAL SERVICE CONTRACT with PRIVATE MEDICAL -CARE, INC. ( "PMI") on the following terms: I. Applicant hereby authorizes PMI to furnish the dental Benefits described in the attached Contract, subject to all of the terms and conditions of the Contract. II. Applicant or Enrollees agree to pay to PMI, in advance, the Premiums specified in Schedule D to the Contract. III. Upon acceptance of this Application by PMI, and payment of the initial Premiums, the Contract shall be effective at 12:01 a.m. on the Effective Date shown on Schedule D and the Contract shall continue until terminated as provided. IV. Applicant agrees to make available to Eligible Employees or Enrollees any notices concerning Benefits required to be furnished by PMI. V. PMI will provide directly to each Eligible Person or Enrollee a combined Evidence of Coverage and Disclosure Form (EOC). PMI's Enrollment materials advise Eligible Persons that an EOC is also available upon request, prior to enrollment by contacting PMI's Customer Relations department. A matrix which describes the program's major Benefits and coverage is included at the beginning of the EOC and as Schedule F within this Contract. The EOC will disclose the terms and conditions of coverage, but will constitute only a summary of the program. As required by the California Health & Safety Code, the Contract must be consulted to determine the exact terms and conditions of the coverage provided. A copy of the Contract will be furnished upon request. Enrollees should read the EOC carefully. Persons with special healthcare needs should read the section entitled "Special Needs ". Pursuant to California Health and Safety Code, the EOC provides Enrollees with information regarding the societal benefits of organ donation and the method whereby an Enrollee may elect to be an organ or tissue donor. Enrollees may also obtain information about Benefits by calling PMI's Customer Relations department at (800) 422 -4234. VI. Applicant agrees to receive, on behalf of Enrollees, all applicable notices concerning Benefits under this Contract. VII. THE PREMIUMS PAYABLE UNDER THIS CONTRACT ARE SUBJECT TO INCREASE UPON RENEWAL AFTER THE END OF THE INITIAL CONTRACT TERM OR ANY SUBSEQUENT CONTRACT TERM. VIII. THIS CONTRACT IS SUBJECT TO ARBITRATION IN ACCORDANCE WITH ARTICLE 6. (Date) (See Appendix A) (Group Number) City of Seal Beach (Applicant) City Hall, 211 Eighth Street, Seal Beach, CA 90740 -6379 (Applicant Address) By: X ` A 2 ' 4 By: (Authorized Sign. re) (Licensed Registered Agent) Revised 04/11/03 CP PMI -CA 1 02012-0047.3T12-1.AT • • PRIVATE MEDICAL -CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924 -8311 (800) 801 -7105 DeltaCare GROUP DENTAL SERVICE CONTRACT 1N CONSIDERATION of the Application, a copy of which is attached hereto and made a part of this DeltaCare GROUP DENTAL SERVICE CONTRACT ( "Contract ") and IN CONSIDERATION of payment of the required Premiums, PRIVATE MEDICAL -CARE, INC. ( "PMI") agrees to provide the Benefits described for the Contract Term shown on Schedule D and from year to year thereafter, unless this Contract is terminated as provided. Premiums are payable in advance of the Effective Date and thereafter as provided. This Contract is issued and delivered in the State of California, is governed by the laws thereof, and is subject to the terms and conditions recited on the following pages. IN WITNESS WHEREOF, PMI has caused this Contract to be executed on: Date: April 11, 2003 PRIVATE MEDICAL -CARE, INC. By: /L., . ±A, 9 • CP PMI -CA 2 02012-0047.3T12-1.AT g • • ARTICLE 1. DEFINITIONS For the purpose of this Contract, the following definitions shall apply: 1.01 "Acute Condition" means a condition requiring Emergency Services while a New Enrollee is within thirty-five (35) miles from the facility of the assigned Contract Dentist. 1.02 "Applicant" means the employer, union or other organization or group contracting to obtain dental Benefits. 1.03 "Benefits" mean those dental services which are provided under the terms of this Contract as specified in Article 4 and Schedule A. 1.04 "Contract" means this agreement between PMI and Applicant including the Application for this Contract, the attached schedules, and any appendices, endorsements or riders. This Contract constitutes the entire agreement between the parties. 1.05 "Contract Dentist" means a Dentist who provides services in general dentistry and who has contracted with PMI to provide Benefits to Enrollees under this Contract. 1.06 "Contract Orthodontist" means a Dentist who specializes in orthodontics, and who has contracted with PMI to provide Benefits to Enrollees under this Contract. 1.07 "Contract Specialist" means a Dentist who provides Specialist Services and has contracted with PMI to provide Benefits to Enrollees under this Contract. 1.08 "Contract Term" means the period commencing and terminating on the dates shown on Schedule D, and each yearly period thereafter during which this Contract remains in effect. 1.09 "Copayment" means the amount charged to an Enrollee by a Dentist for the Benefits provided under this Contract. 1.10 "Dentist" means a duly licensed Dentist legally entitled to practice Dentistry at the time and in the state or jurisdiction in which services are performed. 1.11 "Effective Date" means the date this Contract becomes effective as provided in Schedule D. 1.12 "Eligibility Date" means the date upon which an Eligible Person's eligibility for Benefits becomes effective under this Contract. 1.13 "Eligible Employee" means any employee or member of Applicant who meets the conditions of eligibility outlined in Article 2. 1.14 "Eligible Dependent" means any of the dependents of an Eligible Employee who are eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in Article 2. 1.15 "Eligible Person" means an Eligible Employee or Eligible Dependent. DEF PMI -CA 3 02012- 0047.3T12 -1.AT • • 1.16 "Emergency Services" mean only those dental services immediately required for alleviation of severe pain, swelling or bleeding, or immediately required to avoid placing the patient's health in serious jeopardy. 1.17 "Enrollee" means an Eligible Employee ( "Primary Enrollee ") or an Eligible Dependent ( "Dependent Enrollee ") enrolled to receive Benefits. 1.18 "New Enrollee" means an Enrollee who is enrolled less than thirty (30) days from the date he or she is eligible for Benefits. 1.19 "Open Enrollment Period" means the period preceding the date of commencement of the Contract Term or the 30 -day period immediately preceding the annual anniversary of the commencement of the Contract Term or a period as otherwise requested by the Applicant and agreed to by PMI. 1.20 "Optional" means any alternative procedure presented by the Contract Dentist that satisfies the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the Limitations and Exclusions of this Contract. 1.21 "Premiums" mean amounts payable by Applicant or an Enrollee as provided in Article 3 and Schedule D. 1.22 "Special Health Care Need," means a physical or mental impairment, limitation or condition that substantially interferes with an Enrollee's ability to obtain Benefits. Examples of such a Special Health Care Need are (i) the Enrollee's inability to obtain access to the assigned Contract Dentist's facility because of a physical disability and (ii) the Enrollee's inability to comply with the Contract Dentist's instructions during examination or treatment because of physical disability or mental incapacity. 1.23 "Specialist Services" mean services performed by a Dentist who specializes in the practice of oral surgery, endodontics, pediatric dentistry or periodontics and which must be preauthorized in writing by PMI. DEF PMI -CA 4 02012- 0047.3T12 -1.AT , • • ARTICLE 2. ELIGIBILITY, ENROLLMENT AND CANCELLATION OF ENROLLMENT 2.01 Eligible Employees are those employees or group members described in Schedule D. New employees shall become eligible for coverage as specified in Schedule D. Eligible Dependents of an Eligible Employee are spouse (unless legally separated or divorced) and unmarried dependent children from birth to age 19, or to age 23 while enrolled as full -time students in an accredited school, college or university, provided that the student is chiefly dependent upon the Eligible Employee for maintenance and support. Children include step - children, adopted children and foster children, provided such children are dependent upon the employee for support and maintenance. Dependents become eligible coincident with the Eligible Employee, upon attainment of dependent status, or at any time subject to a change in legal custody or lawful order to provide Benefits. Newborn infants are eligible from and after the moment of birth. Adopted children are eligible from and after the moment the child is placed in the physical custody of the Eligible Employee for adoption. An unmarried dependent 19 years or over may continue to be eligible as a dependent if incapable of self - support because of physical or mental disability that commenced prior to reaching age 19, or prior to reaching age 23 while enrolled as a full -time student in an accredited school, college or university, and if chiefly dependent on the Eligible Employee for support and maintenance, provided proof of such disability and dependency is submitted not less than 31 days prior to the dependent's attainment of the limiting age, and subsequently as may be required by either PMI or Applicant, but not more frequently than annually after the disabled and dependent child has attained the limiting age. Dependents in military service are not eligible. No one may be an Eligible Dependent if eligible as an Eligible Employee and no one may be an Eligible Dependent of more than one Eligible Employee. Medicare eligibility shall not affect eligibility of an Eligible Employee or Eligible Dependent. 2.02 Eligible Employees must complete and sign enrollment forms provided by PMI during the Open Enrollment Period in order to receive Benefits and for their Eligible Dependents to receive Benefits. Persons not originally eligible during the Open Enrollment Period may be enrolled immediately upon attainment of dependent status or at any time subject to a change in legal custody or lawful order to provide Benefits. Subject to cancellation as provided under this Contract, enrollment of Eligible Employees and any Eligible Dependents is for a minimum period of one year. Applicant shall compile and furnish to PMI on or prior to the first day of every month, a list of all Primary Enrollees showing their Social Security numbers and, if applicable, location codes and all Dependent Enrollees. PMI shall be obligated to provide Benefits only to Primary Enrollees and their Dependent Enrollees who are enrolled and are reported on the list of Primary Enrollees submitted by Applicant and for whom the appropriate Premiums are paid pursuant to Article 3 and Schedule D of this Contract for the period in which covered dental services are provided. Newborn infants are covered from the moment of birth up to 31 days, and thereafter if notification of birth and the appropriate Premiums are received by PMI within 31 days after the date of birth. ELG PMI -CA 5 02012-0047.3T12-1.AT , • • 2.03 Subject to any rights provided under Article 6, enrollment under this Contract may be cancelled, or renewal of enrollment refused, in the following events: a) Upon 30 days' notice if the Contract is terminated or not renewed. b) Immediately upon loss of eligibility. c) Upon 15 days' written notice if the Premiums are not paid by or on behalf of the Enrollee on the date due. However, the Enrollee may continue to receive Benefits during the 15 -day period and may be reinstated during the term of this Contract upon payment of any unpaid Premiums. d) Immediately if the Enrollee is guilty of misconduct detrimental to the delivery of services while in the facility of a Contract Dentist. e) Upon 15 days' written notice if the Enrollee knowingly perpetrates or permits another person to perpetrate fraud or deception in obtaining Benefits under this Contract. f) Upon 30 days' written notice if the Enrollee fails to pay Copayments; provided, however, that the Enrollee may be reinstated during the term of this Contract upon payment of all delinquent charges. g) Upon 30 days' written notice, if (i) the Enrollee and a Contract Dentist fail to establish a satisfactory patient- Dentist relationship, (ii) it is shown that PMI has, in good faith, provided the Enrollee with the opportunity to select an alternative Contract Dentist, (iii) the Enrollee has been notified in writing at least 30 days in advance that PMI considers the patient- Dentist relationship to be unsatisfactory and PMI specifies the changes that are necessary in order to avoid cancellation, and (iv) the Enrollee has failed to make such changes. Cancellation of a Primary Enrollee's enrollment shall automatically cancel the enrollment of any of his or her Dependent Enrollees. 2.04 An Enrollee who believes that enrollment has been cancelled or not renewed because of the Enrollee's health status or requirements for health care services, may request a review by the Director of the California Department of Managed Health Care in accordance with Section 1365(b) of the California Health and Safety Code. ELG PMI -CA 6 02012-0047.3T12-1.AT , • ® • • ARTICLE 3. PREMIUMS AND COPAYMENTS 3.01 In accordance with Schedule D, Applicant agrees to pay Premiums on behalf of Primary Enrollees and to collect Premiums by means of payroll deductions for Dependent Enrollees voluntarily enrolled for Benefits under this Contract. Applicant shall remit one check each period as required by Schedule D. Should an Enrollee voluntarily cancel enrollment and subsequently desire to re- enroll dependent(s), all Premiums retroactive to the date of cancellation (but not to exceed 12 months) must be paid before the Dependent(s) shall be re- enrolled. COBRA - In accordance with Schedule D, Applicant agrees to collect Premiums by means of payroll deductions for Primary Enrollees and Dependent Enrollees voluntarily enrolled for Benefits under this Contract. Applicant shall remit one check each period as required by Schedule D. Should an Enrollee voluntarily cancel enrollment and subsequently desire to re- enroll, all Premiums retroactive to the date of cancellation (but not to exceed 12 months) must be paid before the Enrollee shall be re- enrolled. 3.02 This Contract shall not be in effect until initial Premiums are received. Subsequent Premiums shall be payable in accordance with Schedule D. 3.03 _ PMI may change the amount of Premiums whenever the terms of this Contract are changed by amendment or PMI's liability is changed by law or regulation. However, in the absence of an amendment mutually agreed upon between Applicant and PMI or such a change in liability, no change in the Premiums shall become effective within a Contract Term except as provided in Section 3.04. 3.04 If during a Contract Term, any new tax is imposed on PMI by any government agency on the amount of Premiums payable under this Contract or the number of the persons covered, or if the rate of an existing tax on the amount of Premiums or the number of persons covered is increased, the Premiums stated in Schedule D shall be increased by the amount of any such new tax or increased taxes upon 30 days' written notice. 3.05 Upon discovery of clerical errors made by PMI with respect to enrollment data for a Primary Enrollee, Premiums may be adjusted back to the Primary Enrollee's Enrollment Date. The amount of credit which may be taken with respect to a Primary Enrollee shall not exceed the Premiums for the current month in which Premiums are due, plus two (2) months of retroactive Premiums. In addition, the total amount of credit which may be taken on any due date shall not exceed 10% of the billed amount for that due date. 3.06 Enrollees are required to pay any Copayments listed in the Description of Benefits and Copayments (attached as Schedule A) directly to the Dentist. Charges for broken appointments (unless notice is received by the Dentist at least 24 hours in advance or an emergency prevented such notice) and charges for emergency visits after normal visiting hours are shown on Schedule A. 3.07 In the event of cancellation of enrollment by PMI (except in the case of fraud or deception in obtaining Benefits from PMI or knowingly permitting such fraud or deception by another), PMI shall return to Applicant the pro rata portion of the Premiums paid to PMI which corresponds to any unexpired period for which payment had been received, together with any amounts due on claims, if any, less any amounts owed to PMI. PREM PMI -CA 7 02012-0047.3T12-1.AT • • ARTICLE 4. BENEFITS, LIMITATIONS AND EXCLUSIONS 4.01 PMI shall provide the Benefits in Schedule A, subject to the Limitations and Exclusions in Schedule B. Benefits are available to each Enrollee on the Eligibility Date. 4.02 PMI shall provide Contract Dentists at convenient locations during the term of this Contract. A list of Contract Dentists shall be furnished to all Primary Enrollees. Enrollees may select any Contract Dentist whose name is on said list at the time of enrollment. Enrollees in the same family may collectively select no more than three Contract Dentist facilities. If an ' Enrollee fails to select a Contract Dentist or the Contract Dentist selected becomes unavailable, PMI shall request the selection of another Contract Dentist or shall assign that Enrollee to another Contract Dentist. An Enrollee may make a change to any other Contract Dentist during the open enrollment period. Upon the approval of PMI, an Enrollee may select another Contract Dentist if the Enrollee has a change in family status or residence or fails to establish a satisfactory patient/doctor relationship with the Contract Dentist. The change must be requested prior to the 21st of the month to become effective on the first day of the following month. 4.03 The services which are Benefits shall be rendered by Contract Dentists, and PMI shall have no obligation or liability with respect to services rendered by non - Contract Dentists, with the exception of Emergency Services as provided in Section 4.04, or Specialist Services recommended by a Contract Dentist, and approved in writing by PMI. All services other • than Emergency Services or Specialist Services shall be rendered at the facility of the Contract Dentist. Referral of Specialist Services must be by a Contract Dentist and must be authorized in writing by PMI. All approved Specialist Services claims will be paid by PMI less any applicable Copayments. A Contract Dentist may provide services either personally, or through associated Dentists, or the other technicians or hygienists who may lawfully perform the services. If an Enrollee is assigned to a dental school clinic for Specialist Services, those services may be provided by a Dentist, a dental student, a clinician or a dental instructor. 4.04 If an Enrollee is more than 35 miles from the facility of the assigned Contract Dentist, and requires Emergency Services, PMI shall reimburse the Enrollee for the cost of such treatment, less any applicable Copayments, up to a maximum of $100.00 during any 12- month period upon submission to PMI of a verifiable claim within 90 days after such treatment is received. If an Enrollee has been enrolled less than 30 days, and if the Enrollee is currently experiencing an Acute Condition, he or she should contact PMI's Customer Relations department at (800) 422 -4234 for authorization for treatment of the condition. If PMI determines that the circumstances of the Acute Condition require that the Enrollee obtain treatment from a Dentist who is not one of PMI's Contract Dentists, the Enrollee will be instructed: a) to seek treatment immediately necessary to alleviate severe pain, swelling or bleeding, or immediately necessary to avoid placing his or her health in serious jeopardy; BEN PMI -CA 8 02012- 0047.3T12 -1.AT ' • • b) that treatment for an Acute Condition does not include any services other than Emergency Services; c) that PMI will reimburse the Enrollee for the cost of such treatment up to a maximum of $100.00 during any 12 -month period; d) that the Enrollee must submit a claim within 90 days after receiving the treatment; and e) that the Enrollee must visit his or her Contract Dentist for further treatment. PMI may require a non - Contract Dentist providing treatment to an Enrollee of an Acute Condition to agree in writing to meet the same contractual terms and conditions which are imposed upon Dentists who have signed a contract with PMI. PMI is not liable for actions resulting solely from the negligence, malpractice or other tortious or wrongful acts arising out of the treatment provided by a non - Contract Dentist. 4.05 In the event that PMI fails to pay a Contract Dentist; the Enrollee shall not be liable to that Dentist for any sums owed by PMI. In the event that PMI fails to pay a Dentist who is not a Contract Dentist, the Enrollee may be liable ,to that Dentist for the cost of services. 4.06 Claims for Specialist Services or Emergency Services which are Benefits must be submitted within 90 days after termination of treatment. Failure to submit a claim within such time shall not invalidate nor reduce any claim for reimbursement if it shall be shown not to have been reasonably possible to submit the claim within such time and that such claim was submitted as soon as reasonably possible, but in no event later than one year from the time otherwise required. PMI shall acknowledge receipt of a claim within 20 working days unless payment of the claim is made within that time. Within 30 working days after receipt of a claim, PMI shall accept or deny the claim, in whole or in part, unless more time is required to determine whether the claim should be accepted or denied. If more time is required, PMI shall notify the Dentist within 30 working days of receipt of the claim of the reasons more time is required. PMI shall notify the Dentist again 45 days thereafter of the reasons any additional time is required to determine whether the claim should be accepted or denied. 4.07 Upon termination of a contract with a Contract Dentist, PMI shall be liable for Benefits rendered by such Contract Dentist to an Enrollee who is under the care of such Dentist at the time of such termination until any single procedure commenced prior to termination by such Dentist is completed, unless PMI makes reasonable and medically appropriate provisions for the completion of such procedure by another Contract Dentist. PMI shall give written notice to Applicant within a reasonable time of any termination or breach of contract by, or inability to perform of, any Contract Dentist if Applicant will be materially and adversely affected. If an Enrollee's assigned Network Dentist's contract with PMI terminates, that Network Dentist will complete (a) a partial or full denture for which final impressions have been taken, and (b) all work on every tooth upon which work has started (such as completion of root canals in progress and delivery of crowns when teeth have been prepared.) 4.08 In the absence of an amendment mutually agreed upon between Applicant and PMI, no change in Benefits shall be made during a Contract Term. BEN PMI -CA 9 02012-0047.3T12-1.AT • • • 4.09 All Benefits shall terminate for any Enrollee as of the date that this Contract is terminated, such person ceases to be eligible under the terms of this Contract, or such person's enrollment is cancelled under this Contract. PMI shall not be obligated to continue to provide Benefits to any such person in such event, except for completion of single procedures commenced while this Contract was in effect. 4.10 A Contract Dentist is compensated by PMI through monthly capitation (an amount based on the number of Enrollees assigned to the Dentist), and by Enrollees through required Copayments for treatment received. A Contract Specialist is compensated by PMI through an agreed -upon amount for each covered procedure, and by Enrollees through applicable Copayments. In no event does PMI pay a Dentist or a Specialist any incentive as an inducement to deny, reduce, limit or delay any appropriate treatment. An Enrollee may obtain further information concerning compensation of providers by calling PMI at (800) 422 -4234. 4.11 PMI does not authorize or deny services provided by a Contract Dentist. All Benefits provided by a Contract Dentist are in accordance with dental care guidelines which establish the standard of care to be followed by Contract Dentists. PMI's dental care guidelines are reviewed by PMI's Dental Advisory Committee, and updated as needed. An Enrollee may contact PMI's Customer Relations department at (800) 422 -4234 for information regarding PMI's dental care guidelines. 4.12 An Enrollee may request a second opinion if he or she disagrees with or questions the diagnosis and/or treatment plan determination made by his or her Contract Dentist. PMI may also request that an Enrollee obtain a second opinion to verify the necessity and appropriateness of dental treatment or the application of Benefits. Second opinions will be rendered in a timely manner, appropriate to the nature of the Enrollee's condition by a licensed Dentist. Requests involving cases of imminent and serious health threat will be expedited (authorization approved or denied within 72 hours of receipt of the request, whenever possible). For assistance or additional information regarding the procedures and timeframes for second opinion authorizations, the Enrollee should contact PMI's Customer Relations department at (800) 422 -4234 or write to PMI. Second opinions will be provided at another Contract Dentist's facility, unless otherwise authorized by PMI's dental consultant. PMI will only pay for a second opinion which PMI has approved or authorized. 4.13 If an Enrollee believes he or she has a Special Health Care Need, the Enrollee should contact PMI's Customer Relations department at (800) 422 -4234. PMI will confirm whether such a Special Health Care Need exists, and what arrangements can be made to assist the Enrollee in obtaining such Benefits. PMI shall not be responsible for the failure of any Contract Dentist to comply with any law or regulation concerning treatment of persons with Special Health Care Needs which is applicable to the Dentist. BEN PMI -CA 10 02012- 0047.3T 12 -1.AT 1 ARTICLE 5. COORDINATION OF BENEFITS 5.01 This Contract provides Benefits without regard to coverage by any other group insurance policy or any other group health benefits program if the other policy or program covers services or expenses in addition to dental care. Otherwise, Benefits under this Contract are coordinated with such other group insurance policy or any group health benefits program. 5.02 When Benefits are coordinated with another group insurance policy or group health benefits program, the determination of which policy or program is primary shall be governed by the following rules: a) The policy or program covering the patient as other than a dependent shall be primary over the policy or program covering the patient as a dependent. b) The policy or program covering a child as a dependent of a parent whose birthday occurs earlier in a calendar year shall be primary over the policy or program covering a child as a dependent of a parent whose birthday occurs later in a calendar year (except for a dependent child whose parents are separated or divorced as described in c) below). c) In the case of a dependent child whose parents are legally separated or divorced: 1) If the parent with custody has not remarried, the policy or program covering the child as a dependent of the parent with custody shall be pnmary over the policy or program covering the child as a dependent of the parent without custody. 2) If the parent with custody has remarried, the policy or program covering the child as a dependent of the parent with custody shall be primary over the policy or program covering the child as a dependent of the step - parent, and the policy or program covering the child as a dependent of the step - parent shall be primary over the policy or program covering the child as a dependent of the parent without custody. 3) If there is a court decree that establishes financial responsibility for dental services which are Benefits under this program, notwithstanding c) 1) and 2), the policy or program covering the child as a dependent of the parent with such financial responsibility shall be primary over any other policy or program covering the child. d) If the primary policy or program cannot be determined by the rules described in a), b) or c), the policy or program which has covered the Enrollee for a longer period of time shall be primary, with the following exception: A policy or program covering the Enrollee as a laid -off or retired employee or the dependent of a laid -off or retired employee shall not be primary under this rule d) over a policy or program covering the Enrollee as an employee or the dependent of an employee. However, if the provisions of the other policy or program do not include this exception, which results in benefits under neither being primary, then this exception shall not apply. 5.03 An Enrollee shall provide to PMI, and PMI may release to or obtain from any insurance company or other organization, any information about the Enrollee that is needed to administer coordination of benefits. PMI shall, in its sole discretion, determine whether any reimbursement to an insurance company or other organization is warranted under these coordination of benefits provisions, and any such reimbursement paid shall be deemed to be Benefits under this Contract. PMI shall have the right to recover from a Dentist, Enrollee, insurance company or other organization, as PMI chooses, the amount of any Benefits paid by PMI which exceed its obligations under these coordination of benefit provisions. COB PMI -CA 11 02012- 0047.3T12 -1.AT s e ' • • ARTICLE 6. COMPLAINT PROCEDURE, CLAIMS APPEAL AND ARBITRATION PMI shall provide notification if any dental services or claims are denied, in whole or in part, stating the specific reason or reasons for the denial. If an Enrollee has any complaint regarding eligibility, the denial of dental services or claims, the policies, procedures or operations of PMI, or the quality of dental services performed by a Contract Dentist, he or she may call PMI's Customer Relations department at (800) 422 4234, or the complaint may be addressed in writing to: PMI Quality Management Coordinator 12898 Towne Center Drive Cerritos, California 90703 and must include 1) the name of the patient, 2) the name, address, telephone number and social security number of the Primary Enrollee, 3) the name of the Applicant and 4) the Dentist's name and address. Within 5 calendar days of the receipt of a complaint and the above information, the PMI Quality Management Coordinator will forward to the complainant an acknowledgment of receipt of the complaint. Those complaints requiring professional expertise shall be referred to a licensed PMI dental consultant or Dental Director for review. Certain complaints may also require that the complainant be referred to a Dentist for a clinical evaluation of the dental services provided. PMI will respond, within 3 days of receipt, to complaints involving severe pain and/or imminent and serious threat to a patient's health. Within 30 days of the receipt of the complaint, PMI shall send to the complainant a written report which describes the complaint and PMI's resolution. The report shall advise that a review of PMI's decision shall be undertaken if a written request for an appeal of the determination is made within 30 days of the date of receipt of the report. The complainant should provide the reason for the appeal and any additional information which may affect the case. PMI shall undertake a full and fair review upon any request for review. PMI may require additional documents as it deems necessary or desirable in making such a review. PMI shall provide a written response to the complainant within 30 days after PMI receives the appeal and supporting documentation. An Enrollee may file a complaint with the Department of Managed Health Care after he or she has completed PMI's grievance procedure or after he or she has been involved in PMI's grievance procedure for 30 days. An Enrollee may file a complaint with the Department immediately in an emergency situation, which is one involving severe pain and /or imminent and serious threat to the Enrollee's health. The California Department of Managed Health Care is responsible for regulating health care services plans. The Department has a toll -free number (1- 888 - HMO -2219) to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service's toll -free numbers [1- 800 - 735 -2929 (TTY)] or [1- 888 - 877 -5378 (TTY)] to contact the Department. The Department's website (http: / /www.hmohelp.ca.gov) has complaint forms and instructions online. If you have a grievance against your health plan you should first telephone your plan at [(800) 422 -4234] and use the plan's grievance process before contacting the Department. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily C OMPL PMI -CA 12 02012-0047.3T12-1.AT F • • resolved by your plan, or a grievance that has been unresolved for more than 30 days, you may call the Department for assistance. The plan's grievance process and the Department's complaint review process are in addition to any other dispute resolution procedures that may be available to you, and your failure to use these processes does not preclude your use of any other remedy provided by law. _ Any dispute arising out of or relating to this Contract or this dental health care program, including any disagreement with a claim determination made by PMI after exhaustion of the procedures outlined above, or any complaint regarding the quality of dental services performed by a Contract Dentist, is subject to arbitration in accordance with the Consumer Rules . of the American Arbitration Association ( "AAA "). Any party to a dispute may initiate arbitration by written notice to each other party to the dispute by filing two copies of such notice with the AAA Regional Office in San Francisco or Los Angeles, together with the fee required by the AAA. In the event of extreme hardship on the part of an enrollee or subscriber, and upon an application for relief presented to the AAA, PMI shall assume all or a portion of the Enrollee's share of arbitration fees and expenses as determined by the AAA in accordance with procedures established and administered by the AAA. • • COMPL PMI -CA 13 02012-0047.3T12-1.AT ID • ARTICLE 7. GENERAL PROVISIONS 7.01 The Contract, the Contract application, and any attached schedules, appendices, endorsements and riders, constitute the entire agreement between PMI and Applicant. No agent has authority to amend this Contract or waive any of its provisions. No amendment to this Contract shall be valid unless approved by an executive officer of PMI and evidenced by endorsements. 7.02 If any portion of this Contract or any amendment thereof shall be determined by any arbitrator, court or other competent authority to be illegal, void or unenforceable, such determination shall not abrogate this Contract or any portion thereof other than such portion determined to be illegal, void or unenforceable, and all other portions of this Contract shall remain in full force and effect. 7.03 The parties agree that all questions regarding interpretation or enforcement of this Contract shall be governed by the laws of the State of California, where the Contract is entered into and is to be performed. PMI is subject to the requirements of Chapter 2.2 of Division 2 of the California Health and Safety Code and of Chapter 1 of Division 1, of Title 28 of the California Code of Regulations. Any provisions required to be in the Contract by either of the above shall bind PMI whether or not provided in this Contract. 7.04 PMI will issue to the Applicant for delivery to each Primary Enrollee an evidence of coverage summarizing the Benefits to which each Enrollee is entitled. If any amendment to this Contract shall materially affect any provisions described in such evidence of coverage, new evidences of coverage or riders showing the change shall be issued. Any direct conflict between the evidence of coverage and this Contract shall be resolved according to the terms most favorable to the Enrollee. • ; 7.05 Both parties to this Contract agree to consult to the extent reasonably practical concerning all material published or distributed relating to this Contract. No such material shall be published or distributed which is contrary to the terms of this Contract. 7.06 Applicant shall designate in writing a representative for purposes of receiving notices from PMI under this Contract. Applicant may change its representative at any time on 30 days' notice to PMI. Any notice under this Contract shall be sufficient if given by either Applicant or PMI to the other addressed as stated on the Application of this Contract, and shall be effective 48 hours after deposit in the United States mail with postage fully prepaid. Any notice required from PMI to any Enrollee may be given to Applicant's representative, who shall disseminate such notice to Enrollees by next regular communication but in no event later than 30 days after receipt thereof. 7.07 PMI shall be excused from performance under this Contract for any period and to the extent that it is prevented from performing any services in whole or in part as a result of an act of God, war, civil disturbance, strike, court order, or other cause beyond its reasonable control • and which it could not have prevented by reasonable precautions. 7.08 Both parties to this Contract shall comply in all respects with all applicable federal, state and local laws and regulations relating to administrative simplification, security, and privacy of individually identifiable Enrollee information. Both parties agree that this Contract may be amended as necessary to comply with federal regulations issued under the Health Insurance Portability and Accountability Act of 1996 or to comply with any other enacted administrative simplification, security or privacy laws or regulations. GENPROV PMI -CA 14 02012-0047.3T12-1.AT • • • ARTICLE 8. TERMINATION AND RENEWAL 8.01 - This Contract may be terminated by PMI upon Applicant's failure (i) to furnish PMI with the eligibility list as required by Article 2, or (ii) to pay Premiums in the amount and manner required by Article 3, provided Applicant has been notified of such failure and at least 15 days have elapsed since such notification. 8.02 Termination at the end of a Contract Term shall be by at least 30 days' advance written notice of termination by certified mail given by the party desiring to terminate to the other party. In the event that PMI shall desire to change Premiums or Benefits effective at the end of any Contract Term, advice of such changes will be given to Applicant upon at least 30 days' written notice, and such notice shall renew the Contract for another Contract Term at the rates and with the coverage as stated in the notice unless Applicant provides written notification to PMI by certified mail on or before the date stated in the notice that Applicant does not choose to renew. 8.03 Acceptance by PMI of the proper Premiums after termination of this Contract and without requiring a new application, shall continue this Contract as though it had never terminated, unless PMI shall, within 20 business days of receipt of such payment, either i) refuse the payment so made, or ii) issue to Applicant a new Contract accompanied by written notice stating clearly those respects in which the new Contract differs from this terminated Contract in Benefits, coverage or otherwise. TERM -REN PMI - CA 15 02012-0047.3T12-1.AT • • ARTICLE 9. ATTACHMENTS The following schedules are a part of this Contract: Schedule A - Description of Benefits and Copayments Schedule B - Limitations and Exclusions of Benefits Schedule C - Non - Covered Procedures Schedule D - Group Variables and Premiums Schedule E - COBRA Continuation Option Schedule F - Benefits Summary Matrix Appendix A = Group Numbers ATT PMI -CA 16 02012-0047.3T12-1.AT ® � - • SCHEDULE A • DESCRIPTION OF BENEFITS ANDCOPAYMENTS PLAN CA508 The benefits shown below are performed as needed and deemed necessary by the attending Contract Dentist subject to the Limitations and Exclusions of the program. Please refer to Schedule B for further clarification of benefits. Codes and /or text that appear in italics below are specifically intended to clarify the delivery of Benefits under the DeltaCare program and are not to be interpreted as CDT -3 procedure codes, descriptors or nomenclature which are under copyright by the American Dental Association. ENROLLEE Code Description PAYS D0100 -D0999 I. Diagnostic 09800 Office visit, per visit (in addition to other services) No Cost D0120 Periodic oral evaluation No Cost D0140 Limited oral evaluation _ problem focused No Cost D0150 Comprehensive oral evaluation No Cost D0160 Detailed and extensive oral evaluation - problem focused No Cost D0170 ,Re- evaluation - limited, problem focused (Established patient; not post - operative visit) No Cost D0210 Intraoral radiographs - complete series (including bitewings) - limited to 1 series every 24 months No Cost D0220 Intraoral - periapical first film No Cost D0230 Intraoral - periapical, each additional film No Cost D0240 Intraoral - occlusal film No Cost D0270 Bitewing radiograph - single film No Cost D0272 Bitewings radiographs - two films No Cost D0274 Bitewings radiographs - four films - limited to 1 series every 6 months No Cost D0330 Panoramic film No Cost D0460 Pulp vitality tests No Cost D0470 Diagnostic casts No Cost D0501 Histopathologic examinations only if peOrrined after a prior approved biopsy (D7286) by an oral surgeon No Cost D1000 -D1999 II. Preventive D1110 Prophylaxis cleaning- adult - 1 per 6 month period No Cost D1120 Prophylaxis cleaning- child - 1 per 6 month period No Cost D1201 Topical application of fluoride (including prophylaxis) - child - to age 19; 1 per 6 month period No Cost D1203 Topical application of fluoride (prophylaxis not included) - child - to age 19; 1 per 6 month period No Cost D1330 Oral hygiene instructions No Cost D1351 Sealant - per tooth - limited to permanent molars through age 15 $ 10.00 D1510 Space maintainer - fixed - unilateral $ 15.00 D1515 Space maintainer - fixed - bilateral $ 15.00 D1520 Space maintainer - removable - unilateral $ 15.00 D1525 Space maintainer - removable - bilateral $ 15.00 D1550 Recementation of space maintainer • No Cost SCH -A • S- A- CA(508) 17 02012- 0047.3T12 -1.AT Q • • • ENROLLEE Code Description PAYS D2000 -D2999 III. Restorative Includes polishing, all adhesives and bonding agents, indirect pulp capping, bases, liners and acid etch procedures. * Optional is defined as any alternative procedure presented by the Contract Dentist that sati f es the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the Limitations and Exclusions of the program. The applicable charge to the Enrollee is the difference between the Contract Dentist's `filed fee "for the Optional procedure and the covered procedure, plus any applicable Copayment or material / laboratory upgrade for the covered procedure. Optional treatment does not apply when alternative choices are benefits. `Filed fees" mean the Contract Dentist's fees on file with PMI. Questions regarding the DeltaCar' program should be directed to PMI's Customer Relations department at (800) 422 -4234. 1 An amalgam is the benefit. 2 Base or noble metal is the benefit. High noble metal (precious), if used, will be charged to the Enrollee at the additional maximum cost to the Enrollee of $100.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to $ 100.00 per tooth may be charged for the upgraded post and core. 3 Porcelain and other tooth - colored materials on molars are considered a material upgrade with a maximum additional charge to the Enrollee of $150.00. 4 Coverage of replacement is subject to a limitation requiring the existing restoration to be 5+ years old. D2110 Amalgam - one surface, primary No Cost D2120 Amalgam - two surfaces, primary No Cost • D2130 Amalgam - three surfaces, primary No Cost D2131 Amalgam - four or more surfaces, primary No Cost D2140 Amalgam - one surface, permanent No Cost D2150 Amalgam - two surfaces, permanent No Cost D2160 Amalgam - three surfaces, permanent No Cost D2161 Amalgam - four or more surfaces, permanent No Cost D2330 Resin -based composite - one surface, anterior No Cost D2331 Resin -based composite - two surfaces, anterior No Cost D2332 Resin -based composite - three surfaces, anterior No Cost D2335 Resin -based composite - four or more surfaces or involving incisal angle (anterior) No Cost D2336 Resin -based composite crown, anterior - primary No Cost D2380 Resin -based composite - one surface, posterior - primary * Optional D2381 Resin -based composite - two surfaces, posterior - primary * Optional D2382 Resin -based composite - three or more surfaces, posterior - primary * 1 Optional D2385 Resin -based composite - one surface, posterior - permanent * Optional D2386 Resin -based composite - two surfaces, posterior - permanent * 1 Optional D2387 Resin -based composite - three surfaces, posterior - permanent* 1 Optional D2388 Resin -based composite - four or more surfaces, posterior - permanent * Optional D2510 Inlay - metallic - one surface 2,4 No Cost D2520 Inlay - metallic - two surfaces 2,4 No Cost D2530 Inlay - metallic - three or more surfaces 2,4 No Cost D2542 Onlay - metallic - two surfaces 2,4 No Cost D2543 Onlay - metallic - three surfaces 2,4 • No Cost D2544 Onlay - metallic - four or more surfaces 2,4 No Cost D2610 Inlay - porcelain /ceramic - one surface * 4 Optional D2620 Inlay - porcelain /ceramic - two surfaces * 4 Optional D2630 Inlay - porcelain /ceramic - three or more surfaces * 4 Optional D2642 Onlay - porcelain /ceramic - two surfaces * 4 Optional D2643 Onlay - porcelain /ceramic - three surfaces * 4 Optional D2644 Onlay - porcelain /ceramic - four or more surfaces * 4 Optional D2650 Inlay - resin -based composite composite /resin - one surface * 4 Optional D2651 Inlay - resin -based composite composite /resin - two surfaces * 4 Optional SCH -A S- A- CA(508) 18 02012-0047.3T12-1.AT 0 • ^ ' ENROLLEE Code Description PAYS D2652 Inlay - resin -based composite composite /resin - three or more surfaces * 4 Optional D2662 Onlay - resin -based composite composite /resin - two surfaces * 4 Optional D2663 Onlay - resin -based composite composite /resin - three surfaces * 4 Optional D2664 Onlay - resin -based composite composite /resin - four or more surfaces * 4 Optional D2710 Crown - resin (laboratory) 3,4 $ 45.00 D2720 Crown - resin with high noble metal 2,3,4 $ 75.00 D2721 Crown - resin with predominantly base metal 34 • $ 75.00 D2722 Crown - resin with noble metal 3,4 $ 75.00 D2740 Crown - porcelain /ceramic substrate 3,4 $ 75.00 D2750 Crown - porcelain fused to high noble metal 2,3,4 $ 75.00 D2751 Crown - porcelain fused to predominantly base metal 3,4 $ 75.00 D2752 Crown - porcelain fused to noble metal 3,4 $ 75.00 D2780 Crown - 3 /4 cast high noble metal 2,4 $ 75.00 D2781 Crown - 3 /4 cast predominantly base metal 4 • $ 75.00 D2782 Crown - 3 /4 cast noble metal 4 $ 75.00 D2790 Crown - full cast high noble metal 2,4 $ 75.00 D2791 Crown - full cast predominantly base metal 4 $ 75.00 D2792 Crown _ full cast noble metal 4 $ 75.00 D2910 Recement inlay No Cost D2920 Recement crown No Cost D2930 Prefabricated stainless steel crown - primary tooth No Cost D2931 Prefabricated stainless steel crown - permanent tooth No Cost D2932 Prefabricated resin crown - anterior primary tooth $ 10.00 D2933 Prefabricated stainless steel crown with resin window - anterior primary tooth $ 10.00 D2940 Sedative filling $ 10.00 D2950 Core buildup, including any pins $ 10.00 ' D2951 Pin retention - per tooth, in addition to restoration $ 10.00 D2952 Cast post and core in addition to crown - includes canal preparation 2 $ 10.00 D2953 Each additional cast post - same tooth - includes canal preparation 2 • $ 10.00 D2954 Prefabricated post and core in addition to crown - base metal post; includes canal preparation $ 10.00 D2957 Each additional prefabricated post - same tooth - base - metal post; includes canal preparation $ 10.00 D2970 Temporary crown (fractured tooth) - palliative treatment only $ 10.00 D2980 Crown repair $ 10.00 D3000 -D3999 IV. Endodontics • 5 A benefit for permanent teeth only. D3110 Pulp cap - direct (excluding final restoration) No Cost D3120 . Pulp cap - indirect (excluding final restoration) No Cost D3220 • Therapeutic pulpotomy (excluding final restoration) - removal of pulp I . coronal to the dentinocemental junction and application of medicament No Cost D3221 • Gross pulpal debridement, primary and permanent teeth $ 7.00 D3230 Pulpal therapy (resorbable filling) - anterior, , primary tooth (excluding final restoration) $ 7.00 D3240 - Pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration) $ 7.00 D3310 Root canal = anterior (excluding final restoration) 5 - $ 40.00 SCH -A • S- A- CA(508) 19 02012-0047.3T12-1.AT m o 4 ENROLLEE Code Description PAYS D3320 Root canal - bicuspid (excluding final restoration) 5 $ 80.00 D3330 Root canal - molar (excluding final restoration) 5 $120.00 D3346 Retreatment of previous root canal therapy - anterior 5 $ 55.00 D3347 Retreatment of previous root canal therapy - bicuspid 5 $ 95.00 D3348 Retreatment of previous root canal therapy - molar 5 $135.00 D3410 Apicoectomy / periradicular surgery - anterior 5 $ 50.00 D3421 Apicoectomy /periradicular surgery - bicuspid (first root) 5 $ 50.00 D3425 Apicoectomy / periradicular surgery - molar (first root) 5 $ 50.00 D3426 Apicoectomy / periradicular surgery (each additional root) 5 No Cost D3430 Retrograde filling - per root 5 $ 50.00 D3450 Root amputation, per root - not covered in conjunction with procedure D3920 5 No Cost D4000 -D4999 V. Periodontics Includes preoperative and postoperative evaluations and treatment under a local anesthetic. D4210 Gingivectomy or gingivoplasty - per quadrant $100.00 D4211 Gingivectomy or gingivoplasty - per tooth -fewer than 6 teeth $ 20.00 D4220 Gingival curettage, surgical - per quadrant $ 10.00 D4240 Gingival flap procedure, including root planing - per quadrant $100.00 D4260 Osseous surgery (including flap entry and closure) - per quadrant $200.00 D4341 Periodontal scaling and root planing, per quadrant - limited to 4 quadrants during any 12 consecutive months $ 10.00 D4355 Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis - limited to 1 treatment in any 12 consecutive months $ 10.00 D4910 Periodontal maintenance procedures (following active therapy) - limited to 1 treatment each 6 month period $ 8.00 D5000 -D5899 VI. Prosthodontics (removable) 6 Includes after delivery adjustments and tissue conditioning, if needed, for the first six months after placement, if the Enrollee continues to be eligible and the service is provided at the Contract Dentist's facilig where the denture was originally delivered. ' Limited to 1 per denture during any 12 consecutive months. 8 Coverage of replacement is subject to a limitation requiring the existing denture to be 5+ years old. D5110 Complete denture - maxillary 6,8 $ 95.00 D5120 Complete denture - mandibular 6,8 $ 95.00 D5130 Immediate denture - maxillary 68 $110.00 D5140 Immediate denture - mandibular 6,8 $110.00 D5211 Maxillary partial denture - resin base (including any conventional clasps, rests and teeth) 6,8 $105.00 D5212 Mandibular partial denture - resin base (including any conventional clasps, rests and teeth) 68 $105.00 D5213 Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) 6,8 $110.00 D5214 Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) 68 $110.00 D5410 Adjust complete denture - maxillary 6 $ 5.00 D5411 Adjust complete denture - mandibular 6 $ 5.00 D5421 Adjust partial denture - maxillary 6 $ 5.00 D5422 Adjust partial denture - mandibular 6 $ 5.00 D5510 Repair broken complete denture base $ 15.00 D5520 Replace missing or broken teeth - complete denture (each tooth) $ 10.00 D5610 Repair resin denture base $ 15.00 SCH -A S- A- CA(508) 20 02012- 0047.3T 12 -1.AT z n • • ENROLLEE Code Description PAYS • D5620 Repair cast framework $ 15.00 D5630 Repair or replace broken clasp $ 15.00 D5640 Replace broken teeth - per tooth $ 10.00 D5650 Add tooth to existing partial denture $ 10.00 D5660 Add clasp to existing partial denture $ 10.00 D5710 Rebase complete maxillary denture 7 $ 40.00 D5711 Rebase complete mandibular denture 7 $ 40.00 D5720 Rebase maxillary partial denture 7 $ 40.00 D5721 Rebase mandibular partial denture 7 $ 40.00 D5730 Reline complete maxillary denture (chairside) 7 $ 20.00 D5731 Reline complete mandibular denture ( chairside) 7 $ 20.00 D5740 Reline maxillary partial denture (chairside) 7 $ 20.00 D5741 Reline mandibular partial denture (chairside) 7 $ 20.00 D5750 Reline complete maxillary denture (laboratory) 7 $ 40.00 D5751 Reline complete mandibular denture (laboratory) 7 $ 40.00 D5760 Reline maxillary partial denture (laboratory) 7 $: 40.00 D5761 Reline mandibular partial denture (laboratory) 7 $ 40.00 D5820 Interim partial denture (maxillary) - limited to initial placement of interim partial denture /stayplate to replace extracted anterior teeth during healing 6 No Cost D5821 Interim partial denture (mandibular) - limited to initial placement of interim partial denture /stayplate to replace extracted anterior teeth during healing 6 No Cost D5850 Tissue conditioning, maxillary 67 No Cost D5851 Tissue conditioning, mandibular 67 No Cost D5900 -D5999 VII. Maxillofacial Prosthetics - refer to Schedule C, Non - Covered Procedures D6000 -D6199 VIII. Implant Services - refer to Schedule C, Non - Covered Procedures D6200 -D6999 IX. Prosthodontics, fixed (each retainer and each pontic constitutes a unit in a fixed partial denture [bridge]). * Optional is defined as any alternative procedure presented by the Contract Dentist that satisfies the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the Limitations and Exclusions of the program. The applicable charge to the Enrollee is the difference between the Contract Dentist's filed fee "for the Optional procedure and the covered procedure, plus any applicable Copayment or material / laboratory upgrade for the covered procedure. Optional treatment does not apply when alternative choices are benefits. `Filed fees" mean the Contract Dentist's fees on file with PMI. Questions regarding the DeltaCare program should be directed to PMI's Customer Relations department at (800) 4224234. 2 Base or noble metal is the benefit. High noble metal (precious), if used, will be charged to the Enrollee at the additional maximum cost to the Enrollee of,$100.00 per tooth. If a cast post and core is made of high noble metal, an additional fee up to 8100.00 per tooth may be charged for the upgraded post and core. -3 Porcelain and other tooth - colored materials on molars are considered a material upgrade with a maximum additional charge to the Enrollee of 8150.00. 9 Coverage of replacement is subject to a limitation requiring the existing bridge to be 5 +, years old. D6210 Pontic - cast high noble metal 2,9 $ 75.00 D6211 Pontic - cast predominantly base metal 9 $ 75.00 D6212 Pontic - cast noble metal 9 $ 75.00 D6240 Pontic - porcelain fused to high noble metal 2,3,9 $ 75.00 D6241 Pontic - porcelain fused to predominantly base meta1 $ 75.00 D6242 Pontic - porcelain fused to noble metal 3,9 • $ 75.00 D6245 Pontic - porcelain /ceramic * 9 Optional D6250 Pontic - resin with high noble metal 2,3,9 $ 75.00 D6251 Pontic - resin with predominantly base metal 3,9 $ 75.00 SCH -A S- A- CA(508) 21 02012- 0047.3T12 -1.AT rV q ` • • ENROLLEE Code Description PAYS D6252 Pontic - resin with noble metal 3,9 $ 75.00 D6519 Inlay /onlay - porcelain /ceramic * 9 Optional • D6520 Inlay - metallic - two surfaces 29 No Cost D6530 Inlay - metallic - three or more surfaces 2,9 No Cost D6543 Onlay - metallic - three surfaces 29 No Cost D6544 Onlay - metallic - four or more surfaces Z No Cost D6720 Crown - resin with high noble metal 2,3,9 $ 75.00 D6721 Crown - resin with predominantly base metal 3,9 $ 75.00 D6722 Crown - resin with noble metal 3,9 $ 75.00 D6740 Crown - porcelain /ceramic * 9 Optional D6750 Crown - porcelain fused to high noble metal 2,3,9 $ 75.00 D6751 Crown - porcelain fused to predominantly base metal 3 ' 9 $ 75.00 D6752 Crown - porcelain fused to noble metal 3,9 $ 75.00 D6780 Crown - 3 /4 cast high noble metal 2,9 $ 75.00 D6781 Crown - 3 /4 cast predominantly base metal 9 $ 75.00 D6782 Crown - 3 /4 cast noble metal 9 $ 75.00 D6790 Crown - full cast high noble metal 2,9 $ 75.00 D6791 Crown - full cast predominantly base metal 9 $ 75.00 D6792 Crown - full cast noble metal 9 $ 75.00 D6930 Recement fixed partial denture No Cost D6940 Stress breaker 9 No Cost D6970 Cast post and core in addition to fixed partial denture retainer - includes canal preparation 2 $ 10.00 D6971 Cast post as part of fixed partial denture retainer - includes canal preparation 2 $ 10.00 D6972 Prefabricated post and core in addition to fixed partial denture retainer . - base metal post; includes canal preparation $ 10.00 D6973 Core buildup for retainer, including any pins $ 10.00 D6976 Additional cast post - same tooth - includes canal preparation 2 $ 10.00 D6977 Each additional prefabricated post - same tooth - base metal post; includes canal preparation $ 10.00 D6980 Fixed partial denture repair $ 15.00 D7000 -D7999 X. Oral and Maxillofacial Surgery ' Includes preoperative and postoperative evaluations and treatment under local anesthetic. D7110 Single tooth No Cost D7120 Each additional tooth No Cost D7130 Root removal - exposed roots No Cost D7210 Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and /or section of tooth No Cost D7220 Removal of impacted tooth - soft tissue No Cost D7230 Removal of impacted tooth - partially bony $ 45.00 D7240 Removal of impacted tooth - completely bony $ 65.00 D7241 Removal of impacted tooth - completely bony, with unusual surgical complications $ 65.00 D7250 Surgical removal of residual tooth roots (cutting procedure) No Cost D7286 Biopsy of oral tissue - soft (all others) - does not include histopathologic examination or other pathology laboratory procedures No Cost D7310 Alveoloplasty in conjunction with extractions - per quadrant $ 35.00 D7320 Alveoloplasty not in conjunction with extractions - per quadrant $ 50.00 D7471 Removal of exostosis - per site No Cost D7510 Incision and drainage of abscess - intraoral soft tissue No Cost SCH -A S- A- CA(508) 22 02012-0047.3T12-1.AT e • , , • • ENROLLEE Code Description PAYS D7960 Frenulectomy (frenectomy or frenotomy) - separate procedure No Cost D8000 -D8999 XI. Orthodontics 10 Listed Copayment covers up to 24 months of active orthodontic treatment excluding the services listed for 08237 "Start -up fee." Beyond 24 months of active treatment, an additional monthly fee of $75.00 applies. 11 In the event comprehensive orthodontic treatment is not required or is declined by the Enrollee, a fee of $25.00 will apply. The Enrollee is also responsible for any incurred orthodontic diagnostic record fees. 12 Includes adjustments and /or office visits up to 24 months. After 24 months, a monthly fee of $75.00 applies. D8070 Comprehensive orthodontic treatment of the transitional dentition - child or adolescent to age 19 10 $1600.00 D8080 Comprehensive orthodontic treatment of the adolescent dentition - adolescent to age 19 $1600.00 D8090 Comprehensive orthodontic treatment of the adult dentition - adults, including dependent adults covered as full -time students 1° $1800.00 08237 Start -up fee, which includes initial examination, diagnosis, consultation and initial banding $ 350.00 D8660 Pre - orthodontic treatment visit - not to be charged with any other consultation procedures(s) No Cost D8680 Orthodontic retention (removal of appliances, construction and placement of retainers) 12 No Cost D9000 -D9999 XII. Adjunctive General Services D9110 Palliative (emergency) treatment of dental pain - minor procedure $ 5.00 D9211 Regional block anesthesia No Cost D9212 Trigeminal division block anesthesia No Cost D9215 Local anesthesia No Cost D9310 Consultation (diagnostic services provided by a dentist or physician other than practitioner providing treatment) No Cost D9430 Office visit for observation (during regularly scheduled hours) - no other services performed $ 5.00 D9440 Office visit - after regularly scheduled hours $ 20.00 00125 Failed appointment without 24 hour notice - per 15 minutes of appointment time $ 10.00 Procedures not listed above are not covered however may be available at the Contract Dentist's "filed fees ". "Filed fees" means the Contract Dentist's fees on file with PMI. Questions regarding these fees should be directed to PMI's Customer Relations department at (800) 422 -4234. SCH -A S- A- CA(508) 23 02012- 0047.3T 12 -1.AT • • SCHEDULE B • LIMITATIONS OF BENEFITS 1. Full mouth x -rays are limited to one set every twenty -four consecutive months and include any combination of periapicals, bitewings and /or panoramic film; 2. Bitewing x -rays are limited to not more than one series of four films in any six month period; 3. Diagnostic casts are limited to aid in diagnosis by the Contract Dentist for covered benefits; 4. If a biopsy (D7286) is prior- approved by PMI to an oral surgeon, then histopathologic examination (D0501) of the resulting biopsy specimen is covered and available at no additional cost; 5. Prophylaxis or periodontal maintenance following active therapy is limited to one procedure each six month period; 6. Benefits for sealants include the application of sealants only to permanent first and second molars with no decay, with no restorations and with the occlusal surface intact, for first molars through age nine and second molars through age fifteen. Benefits for sealants do not include the repair or replacement of a sealant on any tooth within three years of its application; 7. A filling is a benefit for the removal of decay, for minor repairs of tooth structure or to replace a lost filling; 8. A crown is a benefit when there is insufficient tooth structure to support a filling or to replace an existing crown that is non - functional or non - restorable and meets the five year limitation (Limitation #12); 9. A covered metallic inlay, onlay, crown or fixed partial denture (bridge) using base or noble metal is available for listed Copayment(s). If the Enrollee elects to have high noble metal used instead, the maximum additional cost of this material upgrade is $100.00 per tooth or pontic. For a cast post and core, the benefit is for base or noble metal. If the Enrollee elects to have a high noble metal cast post and core instead, the maximum additional cost of this material upgrade is $100.00 per tooth; 10. For molars, a covered inlay, onlay, crown, or unit of a fixed partial denture (bridge) is metallic without porcelain or other tooth - colored material. If the Enrollee elects to have porcelain, porcelain- fused -to- metal, resin or resin - with -metal used instead, the maximum additional cost for this tooth- colored material upgrade is $150.00 per molar; 11. If a porcelain margin is also chosen by the Enrollee for a covered porcelain- fused -to -metal crown, the maximum additional cost for this laboratory upgrade is $75.00; SCH -B S- B- CA(508) 24 02012- 0047.3T12 -1.AT • i • 12. The replacement of an existing inlay, onlay, crown, fixed partial denture (bridge) or a ' removable full or partial denture is covered when: a. The existing restoration /bridge /denture is no longer functional and cannot be made functional by repair or adjustment, and b. Either of the following: - The existing non - functional restoration /bridge /denture was placed five or more years prior to its replacement, or - If an existing partial denture is less than five years old, but must be replaced by a new partial denture due to the loss of a natural tooth, which cannot be replaced by adding another tooth to the existing partial denture; 13. A direct or indirect pulp cap is a benefit only on a vital permanent tooth with an open apex or a vital primary tooth; 14. With the exception of pulp caps and pulpotomies, endodontic procedures (e.g. root canal therapy, apicoectomy, retrofill, etc.) are only a benefit on a permanent tooth; r- 15. A therapeutic pulpotomy on a permanent tooth is limited to palliative treatment when the Contract Dentist is not performing root canal therapy; 16. Periodontal scaling and root planing are limited to four quadrants during any twelve month period; 17. Full mouth debridement (gross scale) is limited to one treatment in any twelve month period; 18. Coverage for the placement of a fixed partial denture (bridge) requires that: a. No cantilevered posterior pontic (prosthetic tooth) be included; and b. Either of the following: - The sole tooth to be replaced in the arch is a permanent tooth, which cannot be replaced by adding another tooth to an existing removable partial denture; or • - The new bridge would replace an existing, non - functional bridge (see Limitation #12); or - Each abutment tooth to be crowned meets Limitation #8; 19. Relines, tissue conditioning and rebases are limited to one per denture during any twelve consecutive months; 20. Interim partial dentures (stayplates), in conjunction with fixed or removable appliances, are limited to: - The replacement of extracted anterior teeth for adults during a healing period when the • teeth cannot be added to an existing partial denture; or - The replacement of permanent tooth /teeth for children under sixteen years of age; 21. Retained primary teeth shall be covered as primary teeth; 22. Excision of the frenum is a benefit only when it results in limited mobility of the tongue, it causes a large diastema between teeth or it interferes with a prosthetic appliance; 23. Benefits provided by a pediatric Dentist are limited to children through age seven following an attempt by the assigned Contract Dentist to treat the child and upon prior authorization by PMI, less applicable Copayments. Exceptions for medical conditions, regardless of age limitation, will be considered on an individual basis; SCH -B S- B- CA(508) 25 0201210047.3T12 -1.AT • Y , • 24. In cases of accidental injury, benefits available are described in Schedule B, Accident Injury Benefit. Damages to the hard and soft tissues of the oral cavity from normal masticatory (chewing) function, exclusive attrition and normal wear, will be covered as described in Schedules A, Description of Benefits and Copayments; and B, Limitations and Exclusions of Benefits; 25. Soft tissue management programs are limited to periodontal pocket charting, root planing, scaling, curettage, oral hygiene instruction, periodontal maintenance and /or prophylaxis. If an Enrollee declines non - covered services within a soft tissue management program, it does not eliminate or alter other covered benefits; 26. A new removable partial, complete or immediate denture includes after delivery adjustments and tissue conditioning at no additional cost for the first six months after placement if the Enrollee continues to be eligible and the service is provided at the Contract Dentist's facility where the denture was originally delivered; 27. An Optional procedure is defined as any alternative procedure presented by the Contract Dentist that satisfies the same dental need as a covered procedure, is chosen by the Enrollee, and is subject to the Limitations and Exclusions of the program. The applicable charge to the Enrollee is the difference between the Contract Dentist's "filed fee" for the Optional procedure and the covered procedure, plus any applicable Copayment or material /laboratory upgrade for the covered procedure. Optional treatment does not apply when alternative choices are benefits. Optional procedures include: - The use of a tooth- colored material when restoring a posterior tooth with a filling, inlay or onlay; and - Units in a fixed partial denture (bridge) made of porcelain /ceramic, which is not fused to and supported by underlying cast metal. "Filed fee" means the Contract Dentist's fees on file with PMI. Questions regarding these fees should be . directed to PMI's Customer Relations depatunent at (800) 422 -4234. • SCH -B S- B- CA(508) 26 02012-0047.3T12-1.AT • • EXCLUSIONS OF BENEFITS 1. All procedures as shown on Schedule C, Non - Covered Procedures; 2. ' Dental conditions arising out of and due to Enrollee's employment for which Worker's Compensation is paid. Services that are provided to the Enrollee by state government or agency thereof, or are provided without cost to the Enrollee by any municipality, county or other subdivision, except as provided in Section 1373(a) of the California Health and Safety Code; 3. All related fees for admission, use, or stays in a hospital, out - patient surgery center, extended care facility, or other similar care facility; 4. Loss or theft of full or partial dentures, space maintainers, crowns and fixed partial dentures (bridges); 5. Dental expenses incurred in connection with any dental procedures started after termination of eligibility for coverage; 6. Dental expenses incurred in connection with any dental procedure started before the Enrollee's eligibility with the DeltaCare program. Examples include: teeth prepared for crowns, root canals • in progress, orthodontics; 7. Congenital malformations (e.g. congenitally missing teeth, supernumerary teeth, enamel and dentinal dysplasias, etc.), except for the treatment of newborn children with congenital defects or birth abnormalities; 8. Dispensing of drugs not normally supplied in a dental facility; 9. Any procedure that in the professional opinion of the Contract Dentist or PMI's dental consultant: a. has poor prognosis for a successful result and reasonable longevity based on the condition of the tooth or teeth and /or surrounding structures, or b. is inconsistent with generally accepted standards for dentistry; 10. Dental services received from any dental facility other than the assigned Contract Dentist including the services of a dental specialist, unless expressly authorized in writing by PMI or as cited under Article 4.04. To obtain written authorization, the Enrollee should call PMI's Customer Relations department at (800) 422 -4234; 11. Consultations for non - covered benefits; 12. Implant placement or removal, appliances placed on or services associated with implants, including but not limited to prophylaxis and periodontal treatment; 13. Porcelain crowns, porcelain fused to metal or resin with metal type crowns and fixed partial dentures (bridges) for children under sixteen years of age; 14. Restorations placed solely due to cosmetics, abrasions, attrition, erosion, restoring or altering vertical dimension, congenital or developmental malformation of teeth; SCH -B S- B- CA(508) 27 02012- 0047.3T 12 -1.AT • • • 15. Appliances or restorations necessary to increase vertical dimension, replace or stabilize tooth structure loss by attrition, realignment of teeth, periodontal splinting, gnathologic recordings, equilibration or treatment of disturbances of the temporomandibular joint (TMJ); 16. An initial treatment plan which involves the removal and reestablishment of the occlusal contacts of ten or more teeth with crowns, onlays, fixed partial dentures (bridges), or any combination of these is considered to be full mouth construction under the DeltaCare program. Crowns, onlays and fixed partial dentures associated with such a treatment plan are not covered benefits. This exclusion does not affect any other benefits; 17. Precious metal for removable appliances, metallic or permanent soft bases for complete dentures, porcelain denture teeth, precision abutments for removable partials or fixed partial dentures (overlays, implants, and appliances associated therewith) and personalization and characterization of complete and partial dentures; 18. Extraction of teeth, when teeth are asymptomatic /non - pathologic (no signs or symptoms of pathology or infection), including but not limited to the removal of third molars and orthodontic extractions; 19. Treatment or extraction of primary teeth when exfoliation (normal shedding and loss) is imminent; 20. Treatment required by reason of war declared or undeclared. SCH -B S- B- CA(508) 28 02012-0047.3T12-1.AT . • • ORTHODONTIC LIMITATIONS The DeltaCare program provides coverage for orthodontic treatment plans provided through PMI's Contract Orthodontists. The start-up fees and the cost to the Enrollee for the treatment plan are listed in Schedule A, Description of Benefits and Copayments and subject to the following: 1. Orthodontic treatment must be provided by the Contract Orthodontist; 2. Benefits cover twenty -four months of active comprehensive orthodontic treatment. Included is the initial examination, diagnosis, consultation, initial banding, twenty -four months of active treatment, de- banding and the retention phase of treatment. The retention phase includes the initial construction, placement and adjustment to retainers and office visits for a maximum of two years; 3. Treatment plans extending beyond twenty -four months of active treatment, or twenty -four months of the retention phase of treatment will be subject to a monthly office visit fee to the Enrollee not to exceed $75.00 per month; 4. Should an Enrollee's coverage be cancelled or terminated for any reason, and at the time of cancellation or termination be receiving any orthodontic treatment, the Enrollee and not PMI will be responsible for payment of any balance due for treatment provided after cancellation or termination. In such a case the Enrollee's payment shall be based on a maximum of $2,800.00 for covered dependent children to age nineteen and $3,000.00 for covered adults and dependent children to age twenty - three. The amount will be prorated over the number of months to completion of the treatment and, will be payable by the Enrollee on such terms and conditions as are arranged between the Enrollee and the Contract Orthodontist; 5. If treatment is not required or the Enrollee chooses not to start treatment after the diagnosis and consultation has been completed by the Contract Orthodontist, the Enrollee will be charged a consultation fee of $25.00 in addition to diagnostic record fees. 6. Three recementations or replacements of a bracket /band on the same tooth or a total of five rebracketings /rebandings on different teeth during the covered course of treatment are benefits. If any additional recementations or replacements of brackets /bands are performed, the Enrollee is responsible for the cost at the Contract Orthodontist's usual and customary fee; 7. Comprehensive orthodontic treatment (Phase II) consists of repositioning all or nearly all of the permanent teeth in an effort to make the Enrollee's occlusion as ideal as possible. This treatment usually requires complete fixed appliances; however, when the Contract Orthodontist deems it suitable, a European or removable appliance therapy may be substituted at the same Copayments amount as for fixed appliances. • SCH -B S- B- CA(508) 29 02012- 0047.3T12 -1.AT • • ORTHODONTIC EXCLUSIONS 1. Pre -, mid- and post - treatment records which include cephalometric x -rays, tracings, photographs and study models; 2. Lost, stolen or broken orthodontic appliances; 3. Retreatment of orthodontic cases; 4. Changes in treatment necessitated by accident of any kind, and /or lack of Enrollee cooperation; 5. Surgical procedures incidental to orthodontic treatment; 6. Myofunctional therapy; 7. Surgical procedures related to cleft palate, micrognathia, or macrognathia; 8. Treatment related to temporomandibnlar joint disturbances; 9. Supplemental appliances not routinely used in typical comprehensive orthodontics; 10. Restorative work caused by orthodontic treatment; 11. Phase I orthodontics/ as well as activator appliances and minor treatment for tooth guidance and /or arch expansion; 12. Extractions solely for the purpose of orthodontics; 13. Treatment in progress at inception of eligibility; 14. Transfer after banding has been initiated; 15. Composite bands, lingual adaptation of orthodontic bands, and other specialized or cosmetic alternatives to standard fixed and removable orthodontic appliances. 13 Phase 1 orthodontics is defined as early treatment including interceptive orthodontia prior to the development of late mixed dentition. SCH -B S- B- CA(508) 30 02012- 0047.3T12 -1.AT • • ACCIDENT INJURY BENEFIT An accident injury is damage to the hard and soft tissue of the mouth caused directly and independently of all other causes by external forces. Damage to the hard and soft tissue of the mouth from normal chewing function is covered under Schedule A, Description of Benefits and Copayments. PMI will pay up to 100% of the Contract Dentist's "filed fees ", for expenses an Enrollee incurs for an accident injury, less any applicable Copayment(s), up to a Maximum of $1,600.00 in any twelve month period. • Accident injury benefits include the following procedure in addition to those listed in Schedule A, Description of Benefits and Copayments. CODE D7270 Tooth reimplantation and /or stabilization of accidentally evulsed or displaced tooth and /or alveolus - includes splinting and /or stabilization. Payment of accident injury benefits is subject to Schedule B, Limitations and Exclusions of Benefits, in addition to the following provisions: MAXIMUM Accident injury benefits will be provided for each Enrollee up to a maximum of $1,600.00 in any twelve month period. • LIMITATION Accident injury benefits are limited to services provided as a result of an accident which occurred (a) while the Enrollee was covered under the DeltaCare program, or (b) while the Enrollee was covered under another DeltaCare program, and if the benefits for the expenses incurred would have been paid 1 if the Enrollee had remained covered under that program. EXCLUSIONS In addition to Schedule B, Limitations #13, #15, #20, #21 and #24 and Exclusions #1 -9, #11 -15 and #18 -20, the following exclusions apply: 1. Prophylaxis; 2. Extra -oral grafts (grafting of tissues from outside the mouth to oral tissue); 3. Replacement of existing restorations due to decay; 4. Orthodontic services (treatment of malalignment of teeth and /or jaws); 5. Replacement of existing restorations, crowns, bridges, dentures and other dental or orthodontic appliances damaged by accident injury. "Filed fees" means the Contract Dentist's fees on file with PMI. Questions regarding these fees should be directed to PMI's Customer Relations department at (800) 422 -4234. SCH -B S B- CA(508) 31 _ 02012- 0047.3T 12 -1.AT . a . • SCHEDULE C NON - COVERED PROCEDURES The following procedures are not covered under the DeltaCare program. However, these procedures are available at the Contract Dentist's "filed fees." Non- Covered Procedures D0250 Extraoral - first film • D0260 Extraoral - each additional film D0277 Vertical bitewings - 7 to 8 films D0290 Posterior - anterior or lateral skull and facial bone survey film D0310 Sialography D0320 Temporomandibular joint arthrogram, including injection D0321 Other temporomandibular joint films, by report D0322 Tomographic survey D0340 Cephalometric film D0350 Oral /facial images (includes intra and extraoral images) D0415 . Bacteriologic studies for determination of pathologic agents D0425 Caries susceptibility tests D0472 Accession of tissue, gross examination, preparation and transmission of written report D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report D0474 Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report D0480 Processing and interpretation of cytologic smears, including the preparation and transmission of written report D0502 Other oral pathology procedures, by report D0999 Unspecified diagnostic procedure, by report D1204 Topical application of fluoride (prophylaxis not included) - adult D1205 Topical application of fluoride (including prophylaxis) - adult D1310 Nutritional counseling for control of dental disease D1320 Tobacco counseling for the control and prevention of oral disease D2337 Resin -based composite crown, anterior - permanent D2410 Gold foil - one surface D2420 Gold foil - two surfaces D2430 Gold foil - three surfaces D2783 Crown - 3 /4 porcelain /ceramic D2799 Provisional crown D2955 Post removal (not in conjunction with endodontic therapy) D2960 Labial veneer (resin laminate) - chairside D2961 Labial veneer (resin laminate) - laboratory D2962 Labial veneer (porcelain laminate) - laboratory D2999 Unspecified restorative procedure, by report D3331 Treatment of root canal obstruction; non - surgical access D3332 Incomplete endodontic therapy; inoperable or fractured tooth D3333 Internal root repair of perforation defects D3351 Apexification /recalcification - initial visit (apical closure /calcific repair of perforations, root resorption, etc.) D3352 Apexification /recalcification - interim medication replacement (apical closure /calcific repair of perforations, root resorption, etc.) D3353 Apexification/recalcification - final visit (includes completed root canal therapy - apical closure /calcific repair of perforations, root resorption, etc.) D3460 Endodontic endosseous implant D3470 Intentional reimplantation (including necessary splinting) D3910 Surgical procedure for isolation of tooth with rubber dam D3920 Hemisection (including any root removal), not including root canal therapy D3950 Canal preparation and fitting of preformed dowel or post "Filed fee" means the Contract Dentist's fees on file with PMI. Questions regarding these fees should be directed to PMI's Customer Relations department at (800) 422 -4234. SCH -C S- C- CA(508) 32 02012- 0047.3T12 -1.AT D3999 Unspecified endodontic procedure, by report D4245 Apically positioned flap . D4249 Clinical crown lengthening - hard tissue D4263 Bone replacement graft - first site in quadrant D4264 Bone replacement graft - each additional site in quadrant . D4266 Guided tissue regeneration - resorbable barrier, per site .i , D4267 Guided tissue regeneration - nonresorbable barrier, per site (includes membrane removal) D4268 Surgical revision procedure, per tooth D4270 Pedicle soft tissue graft procedure ' D4271 Free soft tissue graft procedure (including donor site surgery) D4273 Subepithelial connective tissue graft procedure (including donor site surgery) D4274 Distal or proximal wedge procedure (when not performed in conjunction with surgical procedures in the same anatomical area) D4320 Provisional splinting - intracoronal D4321 Provisional splinting - extracoronal . D4381 Localized delivery of chemotherapeutic agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report D4920 Unscheduled dressing change (by someone other than treating dentist) D4999 Unspecified periodontal procedure, by report D5281 Removable unilateral partial denture - one piece cast metal (including clasps and teeth) D5810 Interim complete denture (maxillary) D5811 Interim complete denture (mandibular) D5860 Overdenture - complete, by report D5861 • Overdenture - partial, by report D5862 Precision attachment, by report D5867 Replacement of replaceable part of semi - precision or precision attachment (male or female component) D5875 Modification of removable prosthesis following implant surgery D5899 Unspecified removable prosthodontic procedure, by report D5911 Facial moulage (sectional) D5912 Facial moulage (complete) . D5913 Nasal prosthesis D5914 Auricular prosthesis D5915 Orbital prosthesis D5916 Ocular prosthesis ' D5919 Facial prosthesis D5922 Nasal septal prosthesis , D5923 Ocular prosthesis, interim D5924 Cranial prosthesis D5925 Facial augmentation implant prosthesis D5926 Nasal prosthesis, replacement ' D5927 Auricular prosthesis, replacement • D5928 Orbital prosthesis, replacement D5929 Facial prosthesis, replacement . . D5931 Obturator prosthesis, surgical D5932 Obturator prosthesis, definitive D5933 Obturator prosthesis, modification D5934 Mandibular resection prosthesis with guide flange D5935 Mandibular resection prosthesis without guide flange . D5936 Obturator prosthesis, interim • D5937 Trismus appliance (not for TMD treatment) D5951 Feeding aid . D5952 \ Speech aid prosthesis, pediatric D5953 Speech aid prosthesis, adult, D5954 Palatal augmentation prosthesis D5955 Palatal lift prosthesis, definitive D5958 Palatal lift prosthesis, interim . D5959 Palatal lift prosthesis, modification . D5960 Speech aid prosthesis, modification D5982 Surgical stent D5983 Radiation carrier D5984 Radiation shield D5985 Radiation cone locator . D5986 Fluoride gel carrier ' SCH -C S- C- CA(508) , 33 02012- 0047.3T12 -1.AT . • • b ♦ • • D5987 Commissure splint • D5988 Surgical splint • D5999 Unspecified maxillofacial prosthesis, by report . D6010 Surgical placement of implant body: endosteal implant D6020 Abutment placement or substitution: endosteal implant D6040 Surgical placement: eposteal implant D6050 Surgical placement: transosteal implant D6055 Dental implant supported connecting bar D6056 Prefabricated abutment • D6057 Custom abutment D6058 Abutment supported porcelain /ceramic crown D6059 Abutment supported porcelain fused to metal crown (high noble crown) D6060 Abutment supported porcelain fused to metal crown (predominantly base metal) D6061 Abutment supported porcelain fused to metal crown (noble metal) D6062 Abutment supported cast metal crown (high noble metal) D6063 Abutment supported cast metal crown (predominantly base metal) D6064 Abutment supported cast metal crown (noble metal) D6065 Implant supported porcelain /ceramic crown D6066 Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) • D6068 Abutment supported retainer for porcelain /ceramic FPD D6069 Abutment supported retainer for porcelain fused to metal FPD (high noble metal) D6070 Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) D6071 Abutment supported retainer for porcelain fused to metal'FPD (noble metal) D6072 Abutment supported retainer for cast metal FPD (high noble metal) D6073 Abutment supported retainer for cast metal FPD (predominantly base metal) D6074 Abutment supported retainer for cast metal FPD (noble metal) • D6075 Implant supported retainer for ceramic FPD D6076 Implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, high noble metal) D6077 Implant supported retainer for cast metal FPD (titanium, titanium alloy, high noble metal) D6078 Implant /abutment supported fixed denture for completely edentulous arch D6079 Implant /abutment supported fixed denture for partially edentulous arch D6080 Implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis D6090 Repair implant supported prosthesis, by report • . D6095 Repair implant abutment, by report D6100 Implant removal, by report D6199 Unspecified implant procedure, by report D6545 Retainer - cast metal for resin bonded fixed prosthesis • D6548 Retainer - porcelain /ceramic for resin bonded fixed prosthesis D6783 Crown - % porcelain /ceramic D6920 Connector bar D6950 Precision attachment D6975 Coping - metal D6999 Unspecified, fixed prosthodontic procedure, by report D7260 Oroantral fistula closure D7272 Tooth transplantation (includes reimplantation from one site to another and splinting and /or stabilization) D7280 Surgical exposure of impacted or unerupted tooth for orthodontic reasons (including orthodontic attachments) - D7281 Surgical exposure of impacted or unerupted tooth to aid eruption • D7285 Biopsy of oral tissue - hard (bone, tooth) D7290 Surgical repositioning of teeth D7291 Transseptal fiberotomy, by report D7340 Vestibuloplasty - ridge extension (secondary epithelialization) D7350 Vestibuloplasty - ridge, extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) D7410 Radical excision - lesion diameter up to 1.25 cm D7420 Radical excision - lesion diameter greater than 1.25 cm D7430 Excision of benign tumor - lesion diameter up to 1.25 'cm D7431 Excision of benign tumor - lesion diameter greater than 1.25 cm D7440 Excision of malignant tumor - lesion diameter up to 1.25 cm SCH -C S- C- CA(508) 34 02012-0047.3T12-1.AT • • D7441 Excision of malignant tumor - lesion diameter greater than 1.25 cm D7450 Removal of odontogenic cyst or tumor - lesion diameter up to 1.25 cm D7451 Removal of odontogenic cyst or tumor - lesion diameter greater than 1.25 cm D7460 Removal of nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm D7461 Removal of nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm D7465 Destruction of lesion(s) by physical or chemical method, by report D7480 Partial ostectomy (guttering or saucerization) D7490 Radical resection of mandible with bone graft D7520 Incision and drainage of abscess - extraoral soft tissue D7530 Removal of foreign body, skin, or subcutaneous alveolar tissue D7540 Removal of reaction - producing foreign bodies, musculoskeletal system D7550 Sequestrectomy for osteomyelitis D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body D7610 Maxilla - open reduction (teeth immobilized, if present) D7620 Maxilla - closed reduction (teeth immobilized, if present) D7630 Mandible - open reduction (teeth immobilized, if present) D7640 Mandible - closed reduction (teeth immobilized, if present) D7650 Malar and /or zygomatic arch - open reduction D7660 Malar and /or zygomatic arch - closed reduction D7670 Alveolus - stabilization of teeth, 'closed reduction splinting D7680 Facial bones - complicated reduction with fixation and multiple surgical approaches D7710 Maxilla - open reduction D7720 Maxilla - closed reduction D7730 Mandible - open reduction D7740 Mandible - closed reduction D7750 Malar and /or zygomatic arch - open reduction D7760 Malar and /or zygomatic arch - closed reduction D7770 Alveolus - stabilization of teeth, open reduction splinting D7780 Facial bones - complicated reduction with fixation and multiple surgical approaches D7810 Open reduction of dislocation D7820 Closed reduction of dislocation D7830 Manipulation under anesthesia D7840 Condylectomy D7850 Surgical discectomy, with /without implant D7852 Disc repair D7854 Synovectomy D7856 Myotomy D7858 Joint reconstruction • D7860 ' Arthrotomy D7865 Arthoplasty D7870 Arthrocentesis D7871 Non - arthroscopic lysis and lavage D7872 Arthroscopy - diagnosis, with or without biopsy • D7873 Arthroscopy - surgical: lavage and lysis of adhesions D7874 Arthroscopy - surgical: disc repositioning and stabilization D7875 Arthroscopy - surgical: synovectomy D7876 Arthroscopy - surgical: discectomy D7877 Arthroscopy - surgical: debridement D7880 Occlusal orthotic device, by report D7899 Unspecified TMD therapy, by report D7910 Suture of recent small wounds up to 5 cm D7911 Complicated suture - up to 5 cm D7912 Complicated suture - greater than 5 cm D7920 Skin grafts (identify defect covered, location and type of graft) D7940 Osteoplasty - for orthognathic deformities D7941 Osteotomy - mandibular rami D7943 Osteotomy - mandibular rami with bone graft; includes obtaining bone graft D7944 Osteotomy - segmented or subapical - per sextant or quadrant D7945 Osteotomy - body of mandible D7946 LeFort I (maxilla - total) D7947 LeFort I (maxilla - segmented) D7948 LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graft SCH -C S- C- CA(508) 35 02012- 0047.3T12 -1.AT • . D7949 LeFort II or LeFort III - with bone graft D7950 Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bones - autogenous or nonautogenous, by report D7955 Repair of maxillofacial soft and hard tissue defect D7970 Excision of hyperplastic tissue - per arch D7971 Excision of pericoronal gingiva D7980 Sialolithotomy • D7981 Excision of salivary gland, by report D7982 Sialodochoplasty D7983 Closure of salivary fistula • D7990 Emergency tracheotomy D7991 Coronoidectomy D7995 Synthetic graft - mandible or facial bones, by report D7996 Implant - mandible for augmentation purposes (excluding alveolar ridge), by report D7997 Appliance removal ( not by dentist who placed appliance), includes removal of archbar D7999 Unspecified oral surgery procedure, by report D8010 Limited orthodontic treatment of the primary dentition D8020 Limited orthodontic treatment of the transitional dentition D8030 Limited orthodontic treatment of the adolescent dentition D8040 Limited orthodontic treatment of the adult dentition D8050 Interceptive orthodontic treatment of the primary dentition D8060 Interceptive orthodontic treatment of the transitional dentition D8210 Removable appliance therapy D8220 Fixed appliance therapy D8670 Periodic orthodontic treatment visit (as part of contract) D8690 Orthodontic treatment (alternative billing to a contract fee) D8691 Repair of orthodontic appliance D8692 Replacement of lost or broken retainer D8999 Unspecified orthodontic procedure, by report D9210 Local anesthesia not in conjunction with operative or surgical procedures D9220 General anesthesia - first 30 minutes D9221 General anesthesia - each additional 15 minutes D9230 Analgesia, anxiolysis, inhalation of nitrous oxide D9241 Intravenous sedation /analgesia - first 30 minutes D9242 Intravenous sedation /analgesia, each additional 15 minutes D9248 Non - intravenous conscious sedation D9410 House /extended care facility call D9420 Hospital call D9610 Therapeutic drug injection, by report D9630 Other drugs and /or medicaments, by report D9910 Application of desensitizing medicament D9911 Application of desensitizing resin for cervical and /or root surface, per tooth D9920 Behavior management, by report D9930 Treatment of complications (post- surgical) - unusual circumstances, by report D9940 Occlusal guard, by report D9941 Fabrication of athletic mouthguard D9950 Occlusion analysis - mounted case D9951 Occlusal adjustment - limited D9952 Occlusal adjustment - complete D9970 Enamel microabrasion D9971 Odontoplasty 1 -2 teeth; includes removal of enamel projections D9972 External bleaching - per arch D9973 External bleaching - per tooth D9974 Internal bleaching - per tooth D9999 Unspecified adjunctive procedure, by report SCH -C S- C- CA(508) 36 02012- 0047.3T 12 -1.AT • • SCHEDULE D GROUP VARIABLES AND PREMIUMS A. Group Name: City of Seal Beach B. Group Number: (See Appendix A) C. Effective Date: June 1, 2003 D. Contract Term: 19 Months E. Eligible Present Employees: As defined by the Applicant. Eligible New Employees: As defined by the Applicant. F. Premiums per Month: Plan Type: CA508 California Primary Enrollee: $16.89 California Primary Enrollee Plus One Dependent Enrollee: $27.87 California Primary Enrollee Plus Two or More Dependent Enrollees: $41.23 G. Remit Premium Payment to: PMI, Dept. #0170, Los Angeles, California 90084 -0170 Revised 04/11/03 SCH -D PMI -CA 37 02012- 0047.3T 12 -1.AT m • • SCHEDULE E COBRA CONTINUATION OPTION Enrollees who lose coverage under this Contract due to certain "Qualifying Events" are entitled to elect continued coverage at their own expense. Primary Enrollees and Dependent Enrollees losing coverage due to either of the following Qualifying Events may elect to continue coverage for 18 months following the month in which the event occurs: a. A Primary Enrollee's termination of employment (other than for gross misconduct) or; b. A Primary Enrollee's reduction in work hours to less than any minimum required to be eligible under this Contract. A Primary Enrollee who is entitled to continue coverage as a result of Qualifying Event (a) or (b) above may continue that coverage, for himself or herself and any Dependent Enrollees, for 29 months if the Primary Enrollee is determined under Title II or Title XVI of the Social Security Act to have been disabled at the time the Qualifying Event occurred or to have become so disabled within 60 days after such event occurred. The Primary Enrollee must notify the Applicant during the initial 18 months and within 60 days after the date of determination, and extended coverage for disability will terminate on the first day of the month that begins more than 30 days after the date of final determination that the Primary Enrollee is no longer disabled. A Dependent Enrollee who has elected to continue coverage because (i) Qualifying Event (a) or (b) occurred to the Primary Enrollee, and (ii) the Primary Enrollee did not elect continued coverage for that Dependent Enrollee, and who is or becomes disabled within 60 days after that event, may also continue coverage, for himself or herself and any other Dependent Enrollees, for 29 months, subject to the notice and termination requirements described above with respect to the Primary Enrollee. Dependent Enrollees losing coverage due to any of the following Qualifying Events may elect to continue coverage for 36 months following the month in which the event occurs: a. A Primary Enrollee's death; b. A divorce or legal separation from a Primary Enrollee; ' A dependent child's ceasing to qualify as an Eligible Dependent under this contract; or d. A Primary Enrollee's qualification for Medicare benefits. Anyone who is entitled to elect continued coverage based on more than one Qualifying Event will be limited to continued coverage for a total of 36 months following the date of the first Qualifying Event. A proceeding in a case under Title 11, United States Code with respect to the Applicant, which results in a substantial elimination of coverage under this Contract (within one year before or one year after the date of commencement of the proceeding) of a retired employee (who retired on or before the date SCH -E PMI -CA 38 02012-0047.3T12-1.AT • �' • • of substantial elimination of coverage), of the spouse and dependent children of a retired employee, or of the surviving spouse of a retired employee, is a Qualifying Event, and the individuals losing coverage may elect to continue coverage until death (in the case of the retired employee or the surviving spouse of the retired employee) or for 36 months after the death of the retired employee (in the case of the spouse and dependent children of the retired employee). The Applicant must be notified within 60 days after a divorce or legal separation, or if a dependent child loses eligibility. Otherwise, the option of continued coverage based on one of these events will be lost. Once aware of a Qualifying Event, the Applicant shall notify the affected persons about their rights to elect continued coverage. This notice shall include the amount of monthly premium Applicant will charge them for continued coverage. Qualifying persons must advise Applicant within 60 days after receiving such notice, or 60 days after losing coverage due to the Qualifying Event, whichever is later. Persons desiring continued coverage will then have 45 days to pay the initial installment of premiums which includes the premiums for all months since the Qualifying Event. Continued coverage is the same as for Enrollees under this Contract. If coverage and or premiums are modified for Enrollees under this Contract, they will also be modified in the same manner for persons with continued coverage. A person's continued coverage elected under this Contract will terminate at the end of the month in which any of the following events first occurs: a. The allowable number of months of continued coverage (i.e. 18, 29 or 36 months) expires. b. This Contract terminates. c. Premiums are not paid for the person as required. d. The person becomes eligible for dental benefits under another group health plan (as an employee or otherwise) which does not contain any exclusion or limitation with respect to any preexisting condition of such person. e. The person becomes eligible for Medicare benefits. Once continued coverage terminates, it cannot be reinstated. SCH -E PMI -CA 39 02012- 0047.3T12 -1.AT • SCHEDULE F INFORMATION CONCERNING BENEFITS UNDER THE, DeltaCare PROGRAM THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND IS A SUMMARY ONLY. THE COMBINED EVIDENCE OF COVERAGE AND DISCLOSURE FORM AND THIS PLAN CONTRACT SHOULD BE CONSULTED FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS AND LIMITATIONS. (A) Deductibles None (B) Lifetime Maximums None (C) Professional Services An Enrollee may be required to pay a Copayment amount for each procedure as shown in the Schedule of Benefits and Copayments, subject to the Limitations and Exclusions. Copayments range by category of service. Examples are as follows: Diagnostic Services No Cost Preventive Services No Cost - $ 15.00 Restorative Services No Cost - $ 75.00 Endodontic Services No Cost - $ 135.00 Periodontic Services $ 8.00 - $ 200.00 Prosthodontic Services No Cost - $ 110.00 Oral and Maxillofacial Surgery No Cost - $ 65.00 Orthodontic Services No Cost - $1800.00 Adjunctive General Services No Cost - $ 20.00 NOTE: Some services may not be covered. Certain services may be covered only if provided by specified providers, or may be subject to an additional charge. Limitations apply to the frequency with which some services may be obtained. For example: cleanings are limited to once in each 6 month period; replacement of complete dentures, crowns and bridges is limited to once in any 5 year period; sealant benefits are available only once in any 3 years. (D) Outpatient Services Not Covered (E) Hospitalization Services Not Covered (F) Emergency Health Coverage The Enrollee may receive a maximum Benefit of up to $100 during each 12 months for out -of -area emergency services. (G) Ambulance Services Not Covered (H) Prescription Drug Services Not Covered (I) Durable Medical Equipment Not Covered (J) Mental Health Services Not Covered (K) Chemical Dependency Services Not Covered (L) Home Health Services Not Covered (M) Other Not Covered Each individual procedure within each category listed above, and which is covered under the Program has a specific Copayment, which is shown in Schedule A, Description of Benefits and Copayments, in the Combined Evidence of Coverage and Disclosure Form and this Contract. SCH -F -508 PMI -CA 40 02012-0047.3T12-1.AT J u • v . cy 04- • APPENDIX A Group # Group Name 02012 -0047 City of Seal Beach 02012 -0055 City of Seal Beach - COBRA APPENDIX PMI -CA 41 02012- 0047.3T12 -1.AT • • • PRIVATE MEDICAL -CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924 -8311 (800) 801 -7105 • • AMENDMENT TO • DeltaCare GROUP DENTAL SERVICE CONTRACT THIS AGREEMENT is made by and between PRIVATE MEDICAL -CARE, INC. and City of Seal Beach, DeltaCare Group #02012 - 0047 & #02012 -0055 (COBRA), for the purpose of amending the original Group Dental Service Contract effective January 1, 2005 as follows: 1. Article 1, DEFINITIONS, Paragraph 1.22 through 1.24, shall be amended to read: 1.22 "Registered Domestic Partners" are defined as same sex partners, who are both at least 18 years of age or older, and opposite sex partners when one or both partners are over the age of 62 and entitled to Social Security benefits. Registered Domestic Partners are • required to register with the Secretary of State of the State of California a Declaration of Domestic Partnership. A Registered Domestic Partner is subject to the same terms and conditions as any other dependent enrolled under this Contract. Registered Domestic Partners are eligible for continuation of coverage under COBRA. 1.23 • "Special Health Care Need," means a physical or mental impairment, limitation or condition that substantially interferes with an Enrollee's ability to obtain Benefits. Examples of such a Special Health Care Need are (i) the Enrollee's inability to obtain access to the assigned Contract Dentist's facility because of a physical disability and (ii) the Enrollee's inability to comply with the Contract Dentist's instructions during examination or treatment because of physical disability or mental incapacity. 1.24 "Specialist Services" mean services performed by a Dentist who specializes in the practice of oral surgery, endodontics, pediatric dentistry or periodontics and which must be preauthorized in writing by PMI. 2. Article 2, ELIGIBILITY, ENROLLMENT AND CANCELLATION OF ENROLLMENT, Item 2.01 shall be amended as follows: 2.01 Eligible Employees are those employees or group members described in Schedule -D. New employees shall become eligible for coverage as specified in Schedule D. Eligible Dependents of an Eligible Employee are spouse (unless legally separated or divorced) or Registered Domestic Partner (until such partnership is terminated by either or both parties) and unmarried dependent children from birth to age 19, or to age 23 while enrolled as full -time students in an accredited school, college or university, • provided that the student is chiefly dependent upon the Eligible Employee for maintenance and support. Children include step - children, adopted children, foster children and children of a Registered Domestic Partner, provided such children are dependent upon the employee for support and maintenance. Dependents become eligible coincident with the Eligible Employee, upon attainment of dependent status, or at any time subject to a change in legal custody or lawful order to provide Benefits. Newborn infants are eligible from and after the moment of birth. Adopted children are eligible from and after the moment the child is placed in the physical custody of the • Eligible Employee for adoption. 04/25/2005 Page 2 of 2 02012- 0047.AD • • An unmarried dependent 19 years or over may continue to be eligible as a dependent if incapable of self - support because of physical or mental disability that commenced prior to reaching age 19, or prior to reaching age 23 while enrolled as a full-time student in an accredited school, college or university, and if chiefly dependent on the Eligible Employee for support and maintenance, provided proof of such disability and dependency is submitted not less than 31 days prior to the dependent's attainment of the limiting age, and subsequently as may be required by either PMI or Applicant, but not more frequently than annually after the disabled and dependent child has attained the limiting age. Dependents in military service are not eligible. No one may be an Eligible Dependent if eligible as an Eligible Employee and no one may be an Eligible Dependent of more than one Eligible Employee. Medicare eligibility shall not affect eligibility of an Eligible Employee or Eligible Dependent. • 3. Schedule E, COBRA CONTINUATION OPTION, first paragraph, shall be amended as follows: Enrollees who lose coverage under this Contract due to certain "Qualifying Events" are entitled to elect continued coverage at their own expense. Registered Domestic Partners and their children are eligible for COBRA coverage. All other aspects of the Group Dental Service Contract currently in effect remain the same. IN WITNESS WHEREOF the parties have executed this Contract and have affixed their signatures on the 7 (1t4 day of 5(fp, u , 2005. • City of Seal Beach PRIVATE MEDICAL -CARE, INC. DeltaCare Group #02012 -0047 & 02012 -0055 (COBRA) • By: � hgA661- AYAZ�� 04/22/05 ���( B : �,0. rah a� G'1 y Signature and e Sigt4ture and Date 211 8th Street Vice President, Research Address Title Seal Beach CA 90740 City State Zip • 04/25/2005 Page 2 of 2 02012- 0047.AD • • AMENDMENT NO. 1 TO AGREEMENT GROUP #7809 AGREEMENT dated January 1, 2005, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta," is hereby amended, effective January 1, 2005, as follows: • Paragraph 2.4 is amended to read: 2.4 Dependents are the Primary Enrollee's legal spouse or registered domestic partner and unmarried dependent children from birth to age 19, or to age 23 if enrolled as full -time students in an accredited school, college or university. Children include stepchildren, children of a registered domestic partner, adopted children, children placed for adoption and foster children, provided they depend upon the Primary Enrollee for support and maintenance. The Dependents of Primary Enrollees are eligible to enroll on the same date that the employee, of whom they are a Dependent, becomes a Primary Enrollee. Later - acquired Dependents become eligible as soon as they acquire dependent status. Registered domestic partners are defined as same sex partners, who are both at least 18 years of age and opposite sex partners when one or both partners are over the age of 62 and entitled to Social Security Benefits. Registered domestic partners are required to register with the Secretary of State of the State of California a Declaration of Domestic Partnership. A registered domestic partner is subject to the same terms and conditions as any other Dependent enrolled under this Contract. Registered domestic partners are eligible for continuation of coverage under COBRA. DATED: April 6, 2005 CITY OF SEAL BEACH: DELTA DENTAL OF CALIFORNIA: By. 41 .0.-- By: ( MavA60 - 1,1L Vice President, Sales et. Z By: By: Vice President Underwriting & Actuarial • k • a 4�` t om' . °�I . i .,/, * ' -. trillii �� ,. 4EU'I� . vp �t qtr , t � GCO;M'B I�IIEED, V DENkCE t 3 t �� M 5 - 7, I t: „ I fat tw',° . +rr`�Ii I s a• v t v �'�t■t , i t �� r <i a c li _r, a ; . 'Fa COVERAGE E s ' 6 !.. ' tp s�'':5- ' # f tr I q), x IC ,,,,t-,F ?Birk' I Ittt t 4 f' "4N �' "$, "S" $ J t ., / t3 & DISC � OSUR;E :FORM • Delta Dental PPO Plan For Employees of CITY OF SEAL BEACH Group No. 7809 Effective Date: January 1, 2007 • • USING THIS BOOKLET • This booklet has been written with you in mind. It is designed to help you make the most of your Delta Dental plan. This combined Evidence of Coverage/Disclosure form discloses the terms and conditions of your coverage. The Combined Evidence of Coverage/Disclosure form should be read completely and carefully and individuals with special health care needs should read carefully those sections that apply to them (see CHOICE OF DENTISTS AND PROVIDERS section). You have a right to review it prior to your enrollment. Please read the "DEFINITIONS" section. It will explain to you any words that have special or technical meanings under your group Contract. A copy of the Contract will be furnished upon request. Please read this summary of your dental Benefits carefully. Keep in mind that YOU means the ENROLLEES whom Delta Dental covers. WE, US and OUR always refers to Delta Dental of California (Delta Dental). If you have any questions about your coverage that are not answered here, please check with your personnel office, or with Delta Dental. DELTA DENTAL OF CALIFORNIA 100 First Street San Francisco, CA 94105 For claims, eligibility and benefits inquiries, or additional information, call Delta Dental's Customer Service department toll-free at: 1-800-765-6003 or contact us on our web site: www.deltadentalca.org A STATEMENT DESCRIBING OUR POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST This Combined Evidence of Coverage/Disclosure Form constitutes only a summary of the dental plan. The dental Contract must be consulted to determine the exact terms and conditions of coverage. 1 • • TABLE OF CONTENTS DEFINITIONS 3 WHO IS COVERED? 4 WHO ARE YOUR ELIGIBLE DEPENDENTS? 4 ENROLLING YOUR DEPENDENTS 5 COVERAGE COSTS 5 WHEN YOU ARE NO LONGER COVERED 5 CANCELING THIS PLAN 5 YOUR BENEFITS 6 LIMITATIONS 7 EXCLUSIONS/SERVICES WE DO NOT COVER 8 OTHER CHARGES 9 COVERED FEES 9 CHOICE OF DENTISTS AND PROVIDERS 10 CONTINUITY OF CARE 11 PUBLIC POLICY PARTICIPATION BY ENROLLEES. 11 INTERNATIONAL DENTIST REFERRAL SERVICE 11 SAVING MONEY ON YOUR DENTAL BILLS 12 YOUR FIRST APPOINTMENT 12 ACCESSIBILITY AND SERVICES FOR AFTER-HOURS AND URGENT CARE 12 PREDETERMINATIONS 12 REIMBURSEMENT PROVISIONS 13 IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTAL DENTIST 14 SECOND OPINIONS 14 ORGAN AND TISSUE DONATION 15 GRIEVANCE PROCEDURE AND CLAIMS APPEAL 15 IF YOU HAVE ADDITIONAL COVERAGE 16 OPTIONAL CONTINUATION OF COVERAGE (COBRA) 16 NOTICE OF PRIVACY PRACTICES: Confidentiality of your health care information 19 2 • • DEFINITIONS Certain words that you will see in this booklet have specific meanings. These definitions should make your dental plan easier to understand. Benefits - those dental services available under the Contract and which are described in this booklet. Contract - the written agreement between your employer or sponsoring group and Delta Dental to provide dental Benefits. The Contract, together with this booklet, forms the terms and conditions of the Benefits you are provided. Covered Services - those dental services to.which Delta Dental will apply Benefit payments, according to the Contract. Delta Dental PPO Dentist - a Dentist with whom Delta Dental has a written agreement to provide services at the in-network level for Enrollees in this Delta Dental PPO Plan. Delta Dental Dentist - a Dentl3t-who has signed an agreement with Delta Dental or a Participating Plan, agreeing to provide services under the terms and conditions established by Delta Dental or the Participating Plan. Dependent - a Primary Enrollee's Dependent who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Effective Date - the date this plan starts. Enrollee - A Primary Enrollee or Dependent enrolled to receive Benefits or a person who chooses to pay for OPTIONAL CONTINUATION OF COVERAGE. • Maximum - the greatest dollar amount Delta Dental will pay for covered procedures in any calendar year and lifetime for Orthodontic Benefits. Participating Plan - Delta Dental and any other member of the Delta Dental Plans Association with whom Delta Dental contracts for assistance in administering your Benefits. Premiums - the money paid to Delta Dental each month for you and your Dependents' dental coverage. Primary Enrollee - any group member or employee who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Single Procedure - a dental procedure to which a separate Procedure Number has been assigned by the American Dental Association in the current version of Common Dental Terminology (CDT). Usual, Customary and Reasonable (UCR) - A Usual fee is the amount which an individual dentist regularly charges and receives for a given service or the fee actually charged, whichever is less. A Customary fee is within the range of usual fees charged and received for a particular service by dentists of similar training in the same geographic area. A Reasonable fee schedule is reasonable if it is Usual and Customary. Additionally, a specific fee to a specific patient is reasonable if it is justifiable considering special circumstances, or extraordinary difficulty, of the case in question. 3 • • WHO IS COVERED? All regular employees are required to enroll and will become eligible to receive Benefits on the first day of the month following 30 days of continuous full-time employment. Retirees residing out of state are eligible for this plan and will received the Delta Dental PPO in-network level of Benefits. You are not eligible if you are not reporting to work on a regular basis and are not actively employed. Coverage resumes on the first day of the month after you return to active employment, report to work regularly and amounts due to Delta Dental for coverage have been paid. But, coverage can continue without interruption if your employer continues to report you as a Primary Enrollee and amounts due Delta Dental for your coverage continue to be paid. Coverage is reinstated on the day employment is resumed for Enrollees that are members of the National Guard or a military reserve unit absent from work due to active military duty. Any waiting period applied as a result of ai Enrollee's absence from active employment due to service in the National Guard or military reserve unit shall be waived. Family and Medical Leave Act of 1993 You can continue your coverage if you take a leave governed by the Family and Medical Leave Act of 1993. If you do not continue your coverage during the governed leave, it will be reinstated at the same Benefit level you received before your leave. Uniformed Services Employment and Re-employment Rights Act of 1994 You can continue coverage for up to 24 months, if you take a leave governed by the Uniformed Services Employment and Re-employment Rights Act of 1994. If you make this election, you must submit any Premiums necessary, which may include administrative costs, to your employer. If you do not continue your coverage during a military leave, it will be reinstated at the same Benefit level you received before your leave. WHO ARE YOUR ELIGIBLE DEPENDENTS? • Your legal spouse or registered domestic partner, as defined below; • Your unmarried dependent children until their 19th birthday; • Your unmarried dependent children until their 23rd birthday if enrolled full-time in an accredited school, college or university; • An unmarried dependent child aged 19 or older who is incapable of self-support because of a physical or mental handicap that occurred before he or she turned 19, if the child is mostly dependent on you for support. Proof of this handicap must be given to Delta or your employer within 31 days, if it is requested. Proof will not be required more than once a year after the child has reached age 21. "Dependent children" also means stepchildren, adopted children, children of a registered domestic partner, children placed for adoption and foster children, provided that they are dependent upon you for support and maintenance. Registered domestic partners are defined as same sex partners, who are both at least 18 years of age and opposite sex partners when one or both partners are over the age of 62 and entitled to Social Security benefits. Registered domestic partners are required to register with the Secretary of State of the State of California a Declaration of Domestic Partnership. A registered domestic partner is subject to the same terms and conditions as any other Dependent enrolled under this Contract. Registered domestic partners are eligible for continuation of coverage under COBRA. 4 • • Dependent coverage is also extended to any child who is recognized under a Qualified Medical Child Support Order (QMCSO). No Dependent in the military service is eligible. ENROLLING YOUR DEPENDENTS A payroll deduction is required for your enrolled Dependents. Your group can only provide coverage for your Dependents if at least half of the Primary Enrollees who have Dependents enroll all of them in this plan. Your Dependents must be enrolled when you first become eligible or on the first day of the month after they become Dependents. However, Dependents who are covered under another group dental plan are not required to enroll under this Delta Dental plan. If the other coverage ends, the Dependents may enroll under this plan within 30 days of the loss of the other coverage. Proof of prior coverage is required. Dependent children up to four years of age may be enrolled at the beginning of any Contract year including the Contract year immediately following their fourth birthday. If you drop coverage for your Dependents, you may not re-enroll them in this plan. COVERAGE COSTS Your employer pays Delta Dental a monthly Premium for coverage of you and your enrolled Dependents. You do not pay for your own coverage, but a payroll deduction is made for your share of the monthly Premium required for your Dependent's coverage. Your employer can tell you how much you must contribute for the costs of dependent coverage. The amount of the Premium may change at each renewal of the Contract between your employer and Delta Dental. Premiums will not increase during the contract year unless new taxes or tax rates are imposed upon Delta Dental for this plan or unless there is an agreement between your employer and Delta Dental to change the Premiums. WHEN YOU ARE NO LONGER COVERED 1. If you stop working for your employer, your dental coverage will end on the last day of the month in which you stop working, unless you qualify for and pay for OPTIONAL CONTINUATION OF COVERAGE. Your Dependents' coverage ends when yours does, or as soon as they are no longer Dependents, unless they choose to pay for OPTIONAL CONTINUATION OF COVERAGE. 2. When the Contract between Delta Dental and your employer is discontinued or canceled, your coverage ends immediately. CANCELING THIS PLAN Delta Dental may cancel this plan only on an anniversary date (period after the plan first takes effect or at the end of each renewal period thereafter), or: 1. If your employer does not make payment to Delta Dental as required by the Contract; 2. If fewer than 10 people are reported eligible for three months or more; 3. If your employer does not give Delta Dental a list of who is eligible; 4. If your employer does not allow Delta Dental to inspect its records, if this is required by your group Contract. 5 • If you believe that this plan has been terminated or not renewed due to your health status or requirements for health care services (or that of your Dependents), you may request a review by the California Director of the Department of Managed Health Care. If the Contract is terminated for any cause, Delta Dental is not required to predetermine services beyond the termination date or to pay for services provided after the termination date, except for Single Procedures begun while the Contract was in effect which are otherwise Benefits under the Contract. If this plan is canceled, you and your Dependents have no right to renewal or reinstatement of your Benefits. YOUR BENEFITS Your dental plan covers several categories of Benefits, when the services are provided by a licensed dentist, and when they are necessary and customary under the generally accepted standards of dental practice. Delta Dental will provide payment for these services at the percentage indicated up to a Maximum of $2,000 for each Enrollee in each calendar year. Payment for Orthodontic Benefits for dependent children is limited to a lifetime Maximum of $1,000. An agreement between your employer and Delta Dental is required to change Benefits during the term of the Contract. The following Benefits are limited to the applicable percentages of dentist's fees or allowances specified below. You are required to pay the balance of any such fee or allowance, known as the "patient copayment." If the dentist discounts, waives or rebates any portion of the patient copayment to the Enrollee, Delta Dental only provides as Benefits the applicable allowances reduced by the amount that such fees or allowances are discounted, waived or rebated. I. DIAGNOSTIC AND PREVENTIVE BENEFITS 100% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Diagnostic - oral exa minations (including initial examinations, periodic examinations and emergency examinations); x-rays; diagnostic casts; examination of biopsied tissue; palliative (emergency) treatment of dental pain; specialist consultation Preventive - prophylaxis (cleaning); fluoride treatment; space maintainers II. BASIC BENEFITS 80% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Oral surgery - extractions and certain other surgical procedures, including pre- and post-operative care Restorative - amalgam, silicate or composite (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay) Endodontic - treatment of the tooth pulp Periodontic - treatment of gums and bones that support the teeth Sealants - topically applied acrylic, plastic or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay 6 • • Adjunctive General Services - general anesthesia; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post-surgical complications (unusual circumstances); limited occlusal adjustment III. CROWNS, INLAYS, ONLAYS AND CAST RESTORATION BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Crowns, Inlays, Onlays and Cast Restorations are Benefits only if they are provided to treat cavities which cannot be restored with amalgam, silicate or direct composite (resin) restorations. IV. PROSTHODONTIC BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Construction or repair of fixed bridges, partial dentures and complete dentures are Benefits if provided to replace missing, natural teeth. V. ORTHODONTIC BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Procedures using appliances or surgery to straighten or realign teeth, which otherwise would not function properly. LIMITATIONS 1. Only the first two oral examinations, including office visits for observation and specialist consultations, or combination thereof, in a calendar year are Benefits while you are eligible under any Delta Dental plan. 2. Full-mouth x-rays are Benefits once in a five-year period while you are eligible under any Delta Dental plan. 3. Bitewing x-rays are provided on request by the dentist, but no more than twice in any calendar year for children to age 18 or once in any calendar year for adults age 18 and over, while you are eligible under any Delta Dental plan. 4. Diagnostic casts are a Benefit only when made in connection with subsequent orthodontic treatment covered under this plan. 5. Only the first two cleanings, fluoride treatments, or Single Procedures which include cleaning, or combination thereof, in any calendar year are Benefits while you are eligible under any Delta Dental plan. 6. Sealant Benefits include the application of sealants only to permanent first molars through age eight and second molars through age 15 if they are without caries (decay) or restorations on the occlusal surface. Sealant Benefits do not include the repair or replacement of a sealant on any tooth within two years of its application. 7. Direct composite (resin) restorations are Benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services and Delta Dental's payment is limited to the cost of the equivalent amalgam restorations. 7 • • 8. Crowns, Inlays, Onlays and Cast Restorations are Benefits on the same tooth only once every five years, while you are a patient under any Delta Dental plan, unless Delta Dental determines that replacement is required because the restoration is unsatisfactory as a result of poor quality of care, or because the tooth involved has experience extensive loss or changes to tooth structure or supporting tissues since the replacement of the restoration. 9. Prosthodontic appliances are Benefits only once every five years, while you are eligible under any Delta Dental plan, unless Delta Dental determines that there has been such an extensive loss of remaining teeth or a change in supporting tissues that the existing appliance cannot be made satisfactory. Replacement of a prosthodontic appliance not provided under a Delta Dental plan will be made if it is unsatisfactory and cannot be made satisfactory. 10. Delta Dental will pay the applicable percentage of the dentist's fee for a standard partial or complete denture. A standard partial or complete denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth that are made from accepted materials and by conventional methods. 11. Implants (appliances inserted into bone or soft tissue in the jaw, usually to anchor a denture) are not covered by your plan. However, if implants are provided along with a revered prosthodontic appliance, Delta Dental will allow the cost of a standard partial or complete denture toward the cost of the implants and the prosthodontic appliances when the prosthetic appliance is completed. If Delta Dental makes such an allowance, we will not pay for any replacement for five years following the completion of the service. 12. If you select a more expensive plan of treatment than is customarily provided, or specialized techniques, an allowance will be made for the least expensive, professionally acceptable, alternative treatment plan. Delta Dental will pay the applicable percentage of the lesser fee for the customary or standard treatment and you are responsible for the remainder of the dentist's fee. For example: a crown where an amalgam filling would restore the tooth; or a precision denture where a standard denture would suffice. 13. Orthodontic coverage is limited to eligible dependent children. 14. If orthodontic treatment is begun before you become eligible for coverage, Delta Dental's payments will begin with the first payment due to the dentist following your eligibility date. 15. Delta Dental's orthodontics payments will stop when the first payment is due to the dentist following either a loss of eligibility, or if treatment is ended for any reason before it is completed. 16. X-rays and extractions that might be necessary for orthodontic treatment are not covered by Orthodontic Benefits, but may be covered under Diagnostic and Preventive or Basic Benefits. 17. Delta Dental will pay the applicable percentage of the Dentist's fee for a standard orthodontic treatment plan involving surgical and/or non-surgical procedures. If you select specialized orthodontic appliances or procedures chosen for aesthetic considerations an allowance will be made for the cost of a standard orthodontic treatment plan and you are responsible for the remainder of the Dentist's fee. EXCLUSIONS/SERVICES WE DO NOT COVER Delta Dental covers a wide variety of dental care expenses, but there are some services for which we do not provide Benefits. It is important for you to know what these services are before you visit your dentist. 8 • • Delta Dental does not provide benefits for: 1. Services for injuries or conditions that are covered under Workers' Compensation or Employer's Liability Laws. 2. Services that are provided to the Enrollee by any Federal or State Governmental Agency or are provided without cost to the Enrollee by any municipality, county or other political subdivision, except Medi-Cal benefits. 3. Services for cosmetic purposes or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth and teeth that are discolored or lacking enamel. 4. Services for restoring tooth structure lost from wear (abrasion, erosion, attrition, or abfraction), for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion, or for stabilizing the teeth. Exa mples of such treatment are equilibration and periodontal splinting. 5. Any Single Procedure, bridge, denture or other prosthodontic service that was started before the Enrollee was covered by this plan. 6. Prescribed drugs, or applied therapeutic drugs, premedication or analgesia. 7. Experimental procedures. 8. Charges by any hospital or other surgical or treatment facility and any additional fees charged by the Dentist for treatment in any such facility. 9. Anesthesia, except for general anesthesia given by a dentist for covered oral surgery procedures. 10. Grafting tissues from outside the mouth to tissues inside the mouth ("extraoral grafts"). 11. Implants (materials implanted into or on bone or soft tissue) or the repair or removal of implants, except as provided under LIMITATIONS. 12. Diagnosis or treatment by any method of any condition related to the temporomandibular (jaw) joints or associated muscles, nerves or tissues. 13. Replacement of existing restoration for any purpose other than active tooth decay. 14. Intravenous sedation, occlusal guards and complete occlusal adjustment. 15. Charges for replacement or repair of an orthodontic appliance paid in part or in full by this plan. OTHER CHARGES Delta Dental's co-payment for your Benefits is shown in this Evidence of Coverage under the caption titled "YOUR BENEFITS." If dental services are provided by a Delta Dental Dentist or a Delta Dental PPO Dentist, you are responsible for your co-payment only. If the dental services you receive are provided by a dentist who is not a Delta Dental Dentist or Delta Dental PPO Dentist, you are responsible for the difference between the amount Delta Dental pays and the amount charged by the non-Delta Dental dentist. COVERED FEES It is to your advantage to select a dentist who is a Delta Dental Dentist, since a lower percentage of the dentist's fees may be covered by this plan if you select a dentist who is not a Delta Dental Dentist. 9 S A list of Delta Dental Dentists (see DEFINITIONS) is available in a directory at your group benefits office, or by calling 1-800-765-6003. Payment to a Delta Dental PPO Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, the dentist's accepted Usual, Customary and Reasonable Fee on file with Delta Dental, or a fee which the dentist has contractually agreed upon with Delta Dental to.accept for treating enrollees under this plan. Payment to a Delta Dental Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the accepted fee that the dentist has on file with Delta Dental. Payment for services by a California dentist, or an out-of-state dentist, who is not a Delta Dental Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee that satisfies the majority of Delta Dental Dentists. Payment for services by a dentist located outside the United States will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee that satisfies the majority of Delta Dental dentists. CHOICE OF DENTISTS AND PROVIDERS PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Nearly 23,400 dentists in active practice in California are Delta Dental Dentists. About 12,300 of these Delta Dental Dentists are also Delta Dental PPO Dentists. You are free to choose any dentist for treatment, but it is to your advantage to choose a Delta Dental Dentist. This is because his or her'fees are approved in advance by Delta Dental. Delta Dental Dentists have treatment forms on hand and will complete and submit the forms to Delta Dental free of charge. If you choose a Delta Dental PPO Dentist, you will receive all of the advantages of going to a Delta Dental Dentist, and you may have a higher level of Benefits for certain services. If you go to a non-Delta Dental Dentist, Delta Dental cannot assure you what percentage of the charged fee may be covered. Claims for services from non-Delta Dental Dentists may be submitted to Delta Dental at P.O. Box 997330, Sacramento, CA 95899-7330. Dentists located outside the United States are not Delta Dental Dentists. Claims submitted by out-of- country dentists are translated by Delta Dental staff and the currency is converted to U.S. dollars. Claims submitted by out-of-country dentists for patients residing in California are referred to Delta Dental's Quality Review department for processing. Delta Dental may require a clinical examination to determine the quality of the services provided, and Delta Dental may decline to reimburse you for Benefits if the services are found to be unsatisfactory. A list of Delta Dental PPO Dentists and Delta Dental Dentists can be obtained by calling 1-800-765-6003. This list will identify those dentists who can provide care for individuals who have mobility impairments or have special health care needs. You can obtain specific information about Delta Dental PPO Dentists and Delta Dental Dentists by using our web site - www.deltadentalca.orq or calling the Delta Dental Customer Service department at the number listed on page 1. A printed list of the Delta Dental PPO Dentists and Delta Dental Dentists in your area is also available by calling 1-800-765-6003. Services from dental school clinics may be provided by students of dentistry or instructors who are not licensed by the state of California. Delta Dental shares the public and professional concern about the possible spread of HIV and other infectious diseases in the dental office. However, Delta Dental cannot ensure your dentist's use of precautions against the spread of such diseases, or compel your dentist to be tested for HIV or to disclose test results to Delta Dental, or to you. Delta Dental informs its panel dentists about the need for clinical 10 • • precautions as recommended by recognized health authorities on this issue. If you should have questions about your dentist's health status or use of recommended clinical precautions, you should discuss them with your dentist. CONTINUITY OF CARE Current Enrollees: Current Enrollees may have the right to the benefit of completion of care with their terminated Delta Dental Dentist for certain specified dental conditions. Please call Delta Dental's Quality Assessment Department at 415-972-8300 to see if you may be eligible for this benefit. You may request a copy of the Delta Dental's Continuity of Care Policy. You must make a specific request to continue under the care of your terminated Delta Dental Dentist. We are not required to continue your care with that dentist if you are not eligible under our policy or if we cannot reach agreement with your terminated Delta Dental Dentist on the terms regarding your care in accordance with California law. New Enrollees: A new Enrollee may have the right to the qualified benefit of completion_of care with their non-Delta Dental Dentist for certain specified dental conditions. Please call Delta Dental's Quality Assessment Department at 415-972-8300 to see if you may be eligible for this benefit. You may request a copy of the Delta Dental's Continuity of Care Policy. You must make a specific request to continue under the care of your current provider. We are not required to continue your care with that dentist if you are not eligible under our policy or if we cannot reach agreement with your non-Delta Dental Dentist on the terms regarding your care in accordance with California law. This policy does not apply to new enrollees of an individual subscriber contract. PUBLIC POLICY PARTICIPATION BY ENROLLEES Delta Dental's Board of Directors includes Enrollees who participate in establishing Delta Dental's public policy regarding Enrollees through periodic review of Delta Dental's Quality Assessment program reports and communications from Enrollees. Enrollees may submit any suggestions regarding Delta Dental's public policy in writing to: Delta Dental of California, Customer Service Department, P. O. Box 997330, Sacramento, CA 95899-7330. INTERNATIONAL DENTIST REFERRAL SERVICE You can receive your covered dental care when you are outside of the United States through a partnership between Delta Dental and International SOS Assistance, Inc. I-SOS provides referrals to 3,200 dentist or dental clinics in nearly 200 countries worldwide. English-speaking operators are available around the clock to help you find a dentist. For more information, check our web site at www.deltadentalca.org or call (800) 523-6586 from the US. Once you leave the US, you can call I-SOS at (215) 942-8226—collect. When you see an I-SOS dentist, you must pay for your treatment at the time of service and get a detailed receipt from the dentist. In addition to providing the dentist's name and address (including country), this receipt should describe the services performed by the dentist and indicate the tooth or teeth that were treated. It should also indicate whether the dentist's charges were billed in U.S. dollars or another currency. Once we receive your claim, we will reimburse you subject to the terms and conditions of your Delta Dental coverage. Reimbursement is based on the out-of-network benefit provided through your group plan. As with any dental plan, this reimbursement may not cover the entire cost of the treatment rendered. 11 • • SAVING MONEY ON YOUR DENTAL BILLS You can keep your dental expenses down by practicing the following: 1. Compare the fees of different dentists; 2. Use a Delta Dental Dentist; 3. Have your dentist obtain predetermination from Delta Dental for any treatment over $300; 4. Visit your dentist regularly for checkups; 5. Follow your dentist's advice about regular brushing and flossing; 6. Avoid putting off treatment until you have a major problem; and 7. Learn the facts about overbilling. Under this plan, you must pay the dentist your copayment share (see YOUR BENEFITS). You may hear of some dentists who offer to accept insurance payments as "full payment."—You should know that these dentists may do so by overcharging your plan and may do more work than you need, thereby increasing plan costs. You can help keep your dental Benefits intact by avoiding such schemes. YOUR FIRST APPOINTMENT During your first appointment, be sure to give your dentist the following information: 1. Your Delta Dental group number (on the front of this booklet); 2. The employer's name; 3. Primary Enrollee's social security number (which must also be used by Dependents); 4. Primary Enrollee's date of birth; 5. Any other dental coverage you may have. ACCESSIBILITY AND SERVICES FOR AFTER-HOURS AND URGENT CARE If you or a family member has special needs, you should ask your dentist about accessibility to their office or clinic at the time you call for an appointment. Your dentist will be able to tell you if their office is accessible taking into consideration the specific requirements of your needs. Routine or urgent care may be obtained from any licensed-dentist during their normal office hours. Delta Dental does not require prior authorization before seeking treatment for urgent or after-hours care. You may plan in advance, for treatment for urgent, emergency or after-hours care by asking your dentist how you can contact the dentist in the event you or a family member may need urgent care treatment or treatment after normal business hours. Many dentists have made prior arrangements with other dentists to provide care to you if treatment is immediately or urgently needed. You may also call the local dental society that is listed in your local telephone directory if your dentist is not available to refer you to another dentist for urgent, emergency or after-hours care. PREDETERMINATIONS After an examination, your dentist will talk to you about treatment you may need. The cost of treatment is something you may want to consider. If the service is extensive and involves crowns or bridges, or if the service will cost more than $300, we encourage you to ask your dentist to request a predetermination. 12 • • A predetermination does not guarantee payment. It is an estimate of the amount Delta Dental will pay if you are eligible and meet all the requirements of your plan at the time the treatment you have planned is completed. In order to receive predetermination, your dentist must send a claim form to us listing the proposed treatment. Delta Dental will send your dentist a Notice of Predetermination that estimates how much you will have to pay. After you review the estimate with your dentist and decide to go ahead with the treatment plan, your dentist returns the statement to us for payment when treatment has been completed. Computations are estimates only and are based on what would be payable on the date the Notice of Predetermination is issued if the patient is eligible. Payment will depend on the patient's eligibility and the remaining annual Maximum when completed services are submitted to Delta Dental. Predetermining treatment helps prevent any misunderstanding about your financial responsibilities. If you have any concerns about the predetermination, let us know before treatment begins so your questions can be answered before you incur any charges. REIMBURSEMENT PROVISIONS A Delta Dentist will file the claim for you. You do not have to file a claim or pay Delta Dental's co-payment for covered services if provided by a Delta Dental Dentist. Delta Dental of California's agreement with our Delta Dental Dentists makes sure that you will not be responsible to the dentist for any money we owe. If the covered service is provided by a dentist who is not a Delta Dental Dentist, you are responsible for filing the claims and paying your dentist. Claims should be filed with Delta Dental of California at P. O. Box 997330, Sacramento, CA 95899-7330 and Delta Dental will reimburse you. However, if for any reason we fail to pay a dentist who is not a Delta Dental Dentist, you may be liable for that portion of the cost. Payments made to you are not assignable (in other words, we will not grant requests to pay non-Delta Dental Dentists directly). Payment for claims exceeding $500 for services provided by dentists located outside the United States may, at Delta Dental's option, be conditioned upon a clinical evaluation at Delta Dental's request (see Second Opinions). Delta Dental will not pay Benefits for such services if they are found to be unsatisfactory. Delta Dental does not pay Delta Dental Dentists any incentive as an inducement to deny, reduce, limit or delay any appropriate service. If you wish to know more about the method of reimbursement to Delta Dental Dentists, you may call Delta Dental's Customer Service department for more information. Payment for any Single Procedure that is a Covered Service will only be made upon completion of that procedure. Delta Dental does not make or prorate payments for treatment in progress or incomplete procedures. The date the procedure is completed governs the calculation of any Deductible (and determines when a charge is made against any Maximum) under your plan. If there is a difference between what your dentist is charging you and what Delta Dental says your portion should be, or if you are not satisfied with the dental work you have received, contact Delta Dental's Customer Service department. We may be able to help you resolve the situation. Delta Dental may deny payment of a claim for services submitted more than 12 months after the date the services were provided. If a claim is ci?nied due to a Delta Dental Dentist's failure to make a timely submission, you shall not be liable to that dentist for the amount which would have been payable by Delta Dental (unless you failed to advise the dentist of your eligibility at the time of treatment). The process Delta Dental uses to determine or deny payment for services is distributed to all Delta Dental Dentists. It describes in detail the dental procedures covered as Benefits, the conditions under which coverage is provided, and the limitations and exclusions applicable to the plan. Claims are reviewed for 13 • • eligibility and are paid according to these processing policies. Those claims which require additional review are evaluated by Delta Dental's dentist consultants. If any claims are not covered, or if limitations or exclusions apply to services you have received from a Delta Dental Dentist, you will be notified by an adjustment notice on the Notice of Payment or Action. You may contact Delta Dental's Customer Service department for more information regarding Delta Dental's processing policies. Delta Dental uses a method called "first-in/first-out" to begin processing your claims. The date we receive your claim determines the order in which processing begins. For example, if you receive dental services in January and February, but we receive the February claim first, processing begins on the February claim first. Incomplete or missing data can affect the date the claim is paid. If all information necessary to complete claim processing has not been provided, payment could be delayed until any missing or incomplete data is received by Delta Dental. Unless the services are exempt, you are required to pay the deductible on the first claim for which processing is completed in a calendar year. Your deductible is normally paid on the first service subject to a deductible listed on a claim with multiple services. The order in which your claims are processed and paid by Delta Dental may also impact your annual maximum. For example, if a claim with a later date of service is paid and your annual maximum for the year has been reached then a claim with an earlier date of service in the same calendar year will not be paid. IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTAL DENTIST If you have questions about the services you receive from a Delta Dental Dentist, we recommend that you first discuss the matter with your dentist. If you continue to have concerns, call our Quality Review department at 1-800-765-6003. If appropriate, Delta Dental can arrange for you to be examined-by one of our consulting dentists in your area. If the consultant recommends the work be replaced or corrected, Delta Dental will intervene with the original dentist to either have the services replaced or corrected at no additional cost to you or obtain a refund. In the latter case, you are free to choose another dentist to receive your full Benefit. SECOND OPINIONS Delta Dental obtains second opinions through Regional Consultant members of its Quality Review Committee who conduct clinical examinations, prepare objective reports of dental conditions, and evaluate treatment that is proposed or has been provided. Delta Dental will authorize such an examination prior to treatment when necessary to make a Benefits determination in response to a request for a Predetermination of treatment cost by a dentist. Delta Dental will also authorize a second opinion after treatment if an Enrollee has a complaint regarding the quality of care provided. Delta Dental will notify the Enrollee and the treating dentist when a second opinion is necessary and appropriate, and direct the Enrollee to the Regional Consultant selected by Delta Dental to perform the clinical examination. When Delta Dental authorizes a second opinion through a Regional Consultant, Delta Dental will pay for all charges. Enrollees may otherwise obtain second opinions about treatment from any dentist they choose, and claims for the examination may be submitted to Delta Dental for payment. Delta Dental will pay such claims in accordance with the Benefits of the plan. This is only a summary of Delta Dental's policy on second opinions. A copy of Delta Dental's formal policy is available from Delta Dental's Customer Service department upon request. 14 • • • ORGAN AND TISSUE DONATION Donating organ and tissue provides many societal benefits. Organ and tissue donation allows recipients of transplants to go on to lead fuller and more meaningful lives. Currently, the need for organ transplants far exceeds availability. If you are interested in organ donation, please speak to your physician. Organ donation begins at the hospital when a patient is pronounced brain dead and identified as a potential organ donor. An organ procurement organization will become involved to coordinate the activities. GRIEVANCE PROCEDURE AND CLAIMS APPEAL If you have any questions about the services received from a Delta Dental Dentist, we recommend that you first discuss the matter with your Dentist. If you continue to have concerns, you may call or write us. We will provide notifications if any dental services or claims are denied, in whole or part, stating the specific reason or reasons for denial. Any questions of ineligibility should first be handled directly between you and your group. If you have any question or complaint regarding the denial of dental services or claims, the policies, procedures and operations of Delta Dental, or the quality of dental services performed by a Delta Dental Dentist, you may call us toll-free at 1-800-765-6003, contact us on our web site: www.deltadentaica.org or write us at P. O. Box 997330, Sacramento, CA 95899-7330, Attention: Customer Service Department. If your claim has been denied or modified, you may file a request for review (a grievance) with us within 180 days after receipt of the denial or modification. If in writing, the correspondence must include your group name and number, the Primary Enrollee's name and social security number, the inquirer's telephone number and any additional information that would support the claim for benefits. Your correspondence should also include a copy of the treatment form, Notice of Payment and any other relevant information. Upon request and free of charge, we will provide the Enrollee with copies of any pertinent documents that are relevant to the claim, a copy of any internal rule, guideline, protocol, and/or explanation of the scientific or clinical judgment if relied upon in denyhg or modifying the claim. Our review will take into account all information, regardless of whether such information was submitted or considered initially. Certain cases may be referred to one of our regional consultants, to a review committee of the dental society or to the state dental association for evaluation. Our review shall be conducted by a person who is neither the individual who made the original claim denial, nor the subordinate of such individual, and we will not give deference to the initial decision. If the review of a claim denial is based in whole or in part on a lack of medical necessity, experimental treatment, or a clinical judgment in applying the terms of the contract terms, we shall consult with a dentist who has appropriate training and experience. The identity of such dental consultant is available upon request. We will provide the Enrollee a written acknowledgement within five calendar days of receipt of the request for review. We will make a written decision within 30 calendar days of receipt of the request for review. We will respond, within three calendar days of receipt, to complaints involving severe pain and imminent and serious threat to a patient's health. You may file a complaint with the Department of Managed Health Care after you have completed Delta Dental's grievance procedure or after you have been involved in Delta Dental's grievance procedure for 30 calendar days. You may file a complaint with the Department immediately in an emergency situation, which is one involving severe pain and/or imminent and serious threat to the Enrollee's health. The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against Delta Dental, your health plan, you should first telephone Delta Dental at 1-800-765-6003 and use Delta Dental's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 calendar days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and 15 • • payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department's Internet Web site ittp://www.hmohelp.ca.gOV) has complaint forms, IMR application forms and instructions online. IMR has limited application to your dental program. You may request IMR only if your dental claim concerns a life-threatening or seriously debilitating condition(s) and is denied or modified because it was deemed an experimental procedure. If the group health plan is subject to the Employee Retirement Income Security Act of 1974 (ERISA), the Enrollee may contact the U.S. Department of Labor, Employee Benefits Security Administration (EBSA) for further review of the claim or if the Enrollee has questions about the rights,under ERISA. The Enrollee may also bring a civil action under section 502(a) of ERISA. The address of the U.S. Department of Labor is: U.S. Department of Labor, Employee Benefits Security Administration (EBSA), 200 Constitution Avenue, N.W. Washington, D.C. 20210. IF YOU HAVE ADDITIONAL COVERAGE It is to your advantage to let your dentist and Delta Dental know if you have dental coverage in addition to this Delta Dental plan. Most dental carriers cooperate with one another to avoid duplicate payments, but still allow you to make use of both plans - sometimes paying 100% of your dental bill. For example, you might have some fillings that cost $100. If the primary, carrier usually pays 80% for these services, it would pay $80. The secondary carrier might usually pay 50% for this service. In this case, since payment is not to exceed the entire fee charged, the secondary carrier pays the remaining $20 only. Since this method pays 100% of the bill, you have no out-of-pocket expense. Be sure to advise your dentist of all plans under which you have dental coverage and have him or her complete the dual coverage portion of the claim form, so that you will receive all benefits to which you are entitled. For further information, contact the Delta Dental Customer Service department at the number in the USING THIS BOOKLET section. OPTIONAL CONTINUATION OF COVERAGE (COBRA) Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely. The federal Consolidated Omnibus Budget Reconciliation Act (or COBRA, pertaining to certain employers having 20 or more employees) and the California Continuation Benefits Replacement Act (or Cal-COBRA, pertaining to employers with two to 19 employees), both require that continued health care coverage be made available to "Qualified Beneficiaries" who lose health care coverage under the group plan as a result of a "Qualifying Event." You may be entitled to continue coverage under this plan, at your expense, if certain conditions are met. The period of continued coverage depends on the Qualifying Event and whether you are covered under federal COBRA or Cal-COBRA. DEFINITIONS The meaning of key terms used in this section are shown below and apply to both federal and Cal-COBRA. Qualified Beneficiary means: 1. You and/or your Dependents who are enrolled in the Delta Dental plan on the day before the Qualifying Event, or 16 • S 2. A child who is born to or placed for adoption with you during the period of continued coverage, provided such child is enrolled within 30 days of birth or placement for adoption. Qualifying Event means any of the following events which, except for the election of this continued coverage, would result in a loss of coverage under the dental plan: Event 1. The termination of employment (other than termination for gross misconduct) or the • reduction in work hours, by your employer; Event 2. Your death; Event 3. Your divorce or legal separation from your spouse; Event 4. Your Dependents' loss of dependent status under the plan; and Event 5. As to your Dependents only, your entitlement to Medicare. You means the Primary Enrollee. PERIODS OF CONTINUED COVERAGE UNDER FEDERAL COBRA Qualified Beneficiaries may continue coverage for 18 months following the month in which Qualifying Event 1 occurs. This 18-month period can be extended for a total of 29 months, provided: 1. A determination is made under Title II or Title XVI of the Social Security Act that an individual is disabled on the date of the Qualifying Event or becomes disabled at any time during the first 60 days of continued coverage; and 2. Notice of the determination is given to the employer during the initial 18 months of continued coverage and within 60 days of the date of termination. This period of coverage will end on the first day of the month that begins more than 30 days after the date of the final determination that the disabled individual is no longer disabled. You must notify your employer or Delta Dental within 30 days of any such determination. If, during the 18-month continuation period resulting from Qualifying Event 1, your Dependents, who are Qualified Beneficiaries, experience Qualifying Events 2, 3, 4 or 5, they may choose to extend coverage for up to a total of 36 months (inclusive of the period continued under Qualifying Event 1). Your Dependents, who are Qualified Beneficiaries, may continue coverage for 36 months following the occurrence of Qualifying Events 2, 3, 4 or 5. When an employer has filed for bankruptcy under Title II, United States Code, Benefits may be substantially reduced or eliminated for retired employees and their Dependents, or the surviving spouse of a deceased retired employee. If this Benefit reduction or elimination occurs within one year before or one year after filing, it is considered a Qualifying Event. If the Primary Enrollee is a retiree, and has lost coverage because of this Qualifying Event, he or she may choose to continue coverage until his or her death. The Primary Enrollee's Dependents who have lost coverage because of this Qualifying Event may choose to continue coverage for up to 36 months following the Primary Enrollee's death. 17 • • PERIODS OF CONTINUED COVERAGE UNDER CAL-COBRA (groups of 2 - 19) In the case of Cal-COBRA, Delta Dental will act as the administrator. Notification and Premium payments should be made directly to Delta Dental. Notifications and payments should be delivered by first-class mail, certified mail or other reliable means of delivery. Individuals who are eligible for coverage under the federal COBRA law are not eligible for coverage under Cal-COBRA. The employer must notify Delta Dental in writing within 30 days of the date when the employer becomes subject to COBRA. Qualified Beneficiaries may continue coverage for 36 months following the month in which Qualifying Events 1, 2, 3, 4 or 5 occur. If, during the 36-month continuation period resulting from Qualifying Event 1, the Qualified Beneficiary is determined under Title II or Title XVI of the Social Security Act to be disabled on the date of the Qualifying Event or became disabled at any time during the first 60 days of continuation coverage, and notice of the determination is given to the employer during the initial period of continuation coverage and within 60 days of the date of the social security determination letter, the Qualified Beneficiary may continue coverage for a total of 36 months following the month in which Qualifying Event 1 occurs. This period of coverage will end on the first of the month that begins more than 30 days after the date of the final determination that the disabled individual is no longer disabled. The Qualified Beneficiary must notify the employer or administrator within 30 days of any such determination. If, during the 36-month continuation period resulting from Qualifying Event 1, the Qualified Beneficiary experiences Qualifying Events 2, 3, 4 or 5, he or she must notify the employer within 60 days of the second Qualifying Event and has a total of 36 months continuation coverage after the date of the first • Qualifying Event. Delta Dental shall notify the Primary Enrollee of the date his or her continued coverage will terminate. This termination notification will be sent during the 180-day period prior to the end of coverage. ELECTION OF CONTINUED COVERAGE A Qualified Beneficiary will have 60 days from a Qualifying Event to give Delta Dental written notice of the election to continue coverage. Upon written notice, Delta Dental will provide a Qualified Beneficiary with the necessary Benefits information, monthly Premium charge, enrollment forms and instructions to allow election of continued coverage. Failure to provide this written notice of election to Delta Dental within 60 days will result in the loss of the right to continue coverage. A Qualified Beneficiary has 45 days from the written election of continued coverage to pay the initial Premium to Delta Dental, which includes the Premium for each month since the loss of coverage. Failure to pay the required Premium within the 45 days will result in the loss of the right to continue coverage, and any Premiums received after that will be returned to the Qualified Beneficiary. CONTINUED COVERAGE BENEFITS The Benefits under the continued coverage will be the same as those provided to active employees and their Dependents who are still enrolled in the dental plan. If the employer changes the coverage for active employees, the continued coverage will change as well. Premiums will be adjusted to reflect the changes made. 18 • • . TERMINATION OF CONTINUED COVERAGE • A Qualified Beneficiary's coverage will terminate at the end of the month in which any of the following events first occur: 1. The allowable number of consecutive months of continued coverage is reached; 2. Failure to pay the required Premiums in a timely manner; 3. The employer ceases to provide any group dental plan to its employees; 4. The individual first obtains coverage for dental Benefits, after the date of the election of continued coverage, under another group health plan (as an employee or Dependent) which does not contain or apply any exclusion or limitation with respect to any pre-existing condition of such a person, if that pre-existing condition is covered under this plan; or 5. Entitlement to Medicare. Once continued coverage ends, it cannot be reinstated. TERMINATION OF THE EMPLOYER'S DENTAL CONTRACT If the dental contract between the employer and Delta Dental terminates prior to the time that the continuation coverage would otherwise terminate, the employer shall notify a Qualified Beneficiary either 30 days prior to the termination or when all Enrollees are notified, whichever is later, of the ability to elect continuation of coverage under the employer's subsequent dental plan, if any. The continuation coverage will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta Dental plan had such plan with the former employer not terminated. The employer shall notify the successor plan in writing of the Qualified Beneficiaries receiving continuation coverage so they may be notified of how to continue coverage. The continuation coverage will terminate if a Qualified Beneficiary fails to comply with the requirements pertaining to enrollment in and payment of Premiums to the new group benefit plan. OPEN ENROLLMENT CHANGE OF COVERAGE A Qualified Beneficiary may elect to change continuation coverage during any subsequent open enrollment period, if the employer has contracted with another plan to provide coverage to its active employees. The continuation coverage under the other plan will be provided only for the balance of the period that a Qualified Beneficiary would have remained under the Delta Dental plan. NOTICE OF PRIVACY PRACTICES: Confidentiality of your health care information THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This notice is required by law to tell you how Delta Dental of California and its affiliates ("Delta Dental") protect the confidentiality of your health care information in our possession. Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient's healthcare history; mental or physical condition; or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. Delta Dental receives, uses and discloses your PHI to administer your benefit plan or as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited. 19 • • We must follow the privacy practices that are described in this notice, but also comply with any stricter requirements under federal or state law that may apply to our administration of your benefits. However, we may change this notice and make the new notice effective for all of your PHI that we maintain. If we make any substantive changes to our privacy practices, we will promptly change this notice and redistribute to you within 60 days of the change to our practices. You may also request a copy of this notice anytime by contacting the address or phone number at the end of this notice. You should receive a copy of this notice at the time of enrollment in a Delta Dental program, and we will notify you of how you can receive a copy of this notice every three years. Permitted Uses and Disclosures of Your PHI We are permitted to use or disclose your PHI without your prior authorization for the following purposes. These permitted uses and/or disclosures include disclosures to you, uses and/or disclosures for purposes of health care treatment, payment of claims, billing of premiums, and other health care operations. If your benefit plan is sponsored by your employer or another party, we may provide PHI to your employer or that sponsor for purposes of administering your benefits. We may disclose PHI to third parties that perform services for Delta Dental in the administration of your benefits. These parties are required by law to sign a contract agreeing to protect the confidentiality of your PHI. Your PHI may te disclosed to an affiliate that performs services for Delta Dental in the administration of your benefits. These affiliates have implemented privacy policies and procedures and comply with applicable federal and state law. We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to notify or assist in notifying a family member, another person, or a personal representative of your condition, to assist in disaster relief efforts, and to report victims of abuse, neglect, or domestic violence. Other permitted uses and/or disclosures are for purposes of health oversight by government agencies, judicial, administrative, or other law enforcement purposes, information about decedents to coroners, medical examiners and funeral directors, for research purposes, for organ donation purposes, to avert a serious threat to health or safety, for specialized government functions such as military and veterans activities, for workers compensation purposes, and for use in creating summary information that can no longer be traced to you. Additionally, with certain restrictions, we are permitted to use and/or disclose your PHI for underwriting. We are also permitted to incidentally use and/or disclose your PHI during the course of a permitted use and/or disclosure, but we must attempt to keep incidental uses and/or disclosures to a minimum. We use administrative, technical, and physical safeguards to maintain the privacy of your PHI, and we must limit the use and/or disclosure of your PHI to the minimum amount necessary to accomplish the purpose of the use and/or disclosure. Examples of Uses and Disclosures of Your PHI for Treatment, Payment or Healthcare Operations Such activities may include but are not limited to: processing your claims, collecting enrollment information and premiums, reviewing the quality of health care you receive, providing customer service, resolving your grievances, and sharing payment information with other insurers. Additional examples include the following. • Uses and/or disclosures of PHI in facilitating treatment. For example, Delta Dental may use or disclose your PHI to determine eligibility for services requested by your provider. • Uses and/or disclosures of PHI for payment. For example, Delta Dental may use and disclose your PHI to bill you or your plan sponsor. • Uses and/or disclosures of PHI for health care operations. For example, Delta Dental may use and disclose your PHI to review the quality of care provided by our network of providers. 20 • • Disclosures Without an Authorization We are required to disclose your PHI to you or your authorized personal representative (with certain exceptions), when required by the U. S. Secretary of Health and Human Services to investigate or determine our compliance with law, and when otherwise required by law. Delta Dental may disclose your PHI without your prior authorization in response to the following: • Court order; • Order of a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority; • Subpoena in a civil action; • Investigative subpoena of a government board, commission, or agency; • Subpoena in an arbitration; • Law enforcement search warrant; or • Coroner's request during investigations Disclosures Delta Dental Makes With Your Authorization Delta Dental will not use or disclose your PHI without your prior authorization if the law requires your authorization. You can later revoke that authorization in writing to stop any future use and disclosure. The authorization will be obtained from you by Delta Dental or by a person requesting your PHI from Delta Dental. Your Rights Regarding PHI You have the right to request an inspection of and obtain a copy of your PHI. You.may access your PHI by contacting the appropriate Delta Dental office. You must include (1) your name, address, telephone number and identification number and (2) the PHI you are requesting. Delta Dental may charge a reasonable fee for providing you copies of your PHI. Delta Dental will only maintain that PHI that we obtain or utilize in providing your health care benefits. Most PHI, such as treatment records or X-rays, is returned by Delta Dental to the dentist after we have completed our review of that information. You may need to contact your health care provider to obtain PHI that Delta Dental does not possess. You may not inspect or copy PHI compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or PHI that is otherwise not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact the privacy office as noted below if you have questions about access to your PHI. You have the right to request a restriction of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. You have the right to correct or update your PHI. This means that you may request an amendment of PHI about you for as long as we maintain this information. In certain cases we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If your PHI was sent to us by another, we may refer you to that person to amend your PHI. For example, we may refer you to your dentist to amend your treatment chart or to your employer, if applicable, to amend your enrollment information. Please contact the privacy office as noted below if you have questions about amending your PHI. You have the right to request or receive confidential communications from us by alternative means or at a different address. We will agree to a reasonable request if you tell us that discbsure of your PHI could endanger you. You may be required to provide us with a statement of possible danger, a different address, another method of contact or information as to how payment will be handled. Please make this request in writing to the privacy office as noted below. 21 • • You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right does not apply to disclosures for purposes of treatment, payment, or health care operations or for information we disclosed after we received a valid authorization from you. Additionally, we do not need to account for disclosures made to you, to family members or friends involved in your care, or for notification purposes. We do not need to account for disclosures made for national security reasons or certain law enforcement purposes, disclosures made as part of a limited data set, incidental disclosures, or disclosures made prior to April 14, 2003. Please contact the privacy office as noted below if you would like to receive an accounting of disclosures or if you have questions about this right. You have the right to get this notice by e-mail. You have the right to get a copy of this notice by e- mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice. Complaints You may complain to us or to the U. S. Secretary of Health and Human Services if you believe that Delta Dental has violated your privacy rights. You may file a complaint with us by notifying the privacy office as noted below. We will not retaliate against you for filing a complaint. Contacts Delta Dental of California offers and administers fee-for-service dental programs for groups headquartered in the state of California. You may contact the Privacy Department at the address and telephone number listed below for further information about the complaint process or any of the information contained in this notice. Delta Dental Subscriber Services P.O. Box 997330 Sacramento, CA 95899-7330 (877) 335-8273 This notice is effective on and after July 1, 2006. 22 • AMENDMENT NO. 2 TO AGREEMENT RENEWAL GROUP #7809 AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2007 as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on effective date and ending on December 31, 2008 and each subsequent yearly period during which this Contract remains in effect. Paragraph 2.11 is amended to include: Coverage is reinstated on the day employment is resumed for Enrollees that are members of the National Guard or a military reserve unit absent from work due to active military duty. Any waiting period applied as a result of an Enrollee's absence from active employment due to service in the National Guard or military reserve unit shall be waived. • Paragraph 3.1 is amended to read: 3.1 Within 10 days after receipt of Delta Dental's invoice, The Contractholder agrees to pay the following monthly Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of the Contractholder's Primary Enrollees and their Dependents who are Enrollees as set forth in Article 2 of this Contract: $46.31 for each Primary Enrollee without Dependents; $77.59 for each Primary Enrollee with one enrolled Dependent; and $125.14 for each Primary Enrollee with two or more enrolled Dependents. The Contractholder agrees to bear the cost of such Premiums without withholding or otherwise charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the entire cost of coverage of their enrolled Dependents. Contractholder agrees to pay the invoiced amount. Eligibility adjustments reported to Delta Dental after the date the invoice is prepared will be reflected on the subsequent month's invoice. Such adjustments are limited to the three -month period prior to the most current month for which the Contractholder provides eligibility data. Paragraph 4.7, sections (f) is amended to read: (f) Sealant Benefits include the application of sealants only to permanent first molars through age eight and second molars through age 15 if they are without caries (decay), or restorations on the occlusal surface. Sealant Benefits do not include the repair or replacement of a sealant on any tooth within two years of its application. . • Article 8 "Other Delta Dental Obligations" is amended to include the following paragraph: 8.7 Enrollees have access to dental care when they are outside of the United States through Delta Dental's partnership with International SOS Assistance, Inc. (I -SOS). I- SOS is a worldwide network of dentists and dental clinics. English- speaking operators are available around the clock to answer questions and assist with scheduling care. Delta Dental coverage outside the United States is the same as Delta Dental coverage within the United States and is determined by the Contractholder's plan design. Claims that result from services received out -of- country are paid at the out -of- network level. Access to the 1-SOS network is offered through a partnership agreement and • will not be available if the agreement terminates. CITY OF SEAL BEACH _ Date Amendment Signed: O /Z6' ill c4 Sig ture )15s2 A& & - Printed Name I bait )')MAGI \ 1a 4 Title DATE: January 17, 2007 DELTA DENTAL OF CALIFORNIA: �;��/ Belinda Martinez Senior Vice President Sales /Marketing Kenneth E. Bernardi Vice President Underwriting & Actuarial • • AMENDMENT NO. 3 TO AGREEMENT . GROUP #7809 • AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2008 as follows: • Throughout the Contract, the term "Delta Preferred Option" is amended to read "Delta Dental PPO" and the term "DPO" is amended to read "PPO ". Paragraph 3.1 is amended to read: • 3.1 Within 10 days after 'receipt of Delta Dental's invoice, the Contractholder agrees to pay the following monthly Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of the Contractholder's Primary Enrollees and their Dependents who are Enrollees as set forth in Article 2 of this Contract: $43.99 for each Primary Enrollee without Dependents; $82.39 for each Primary Enrollee with one enrolled Dependent; and $122.41 for each Primary Enrollee with two or more enrolled Dependents. The Contractholder agrees to bear the cost of such Premiums without withholding or otherwise charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the entire cost of coverage of their enrolled Dependents. Contractholder agrees to pay the invoiced amount. Eligibility adjustments reported to Delta Dental after the date the invoice is prepared will be reflected on the subsequent month's invoice. Such adjustments are limited to the three -month period prior to the most current month for which the Contractholder provides eligibility data. Paragraph 4.2 is amended to include the following note: Note on additional Benefits during pregnancy - When an Enrollee is pregnant, Delta Dental will pay for additional services to help improve the oral health of the Enrollee during the pregnancy. The additional services each calendar year while the Enrollee is covered under this Contract include: one additional oral exam and either • one additional routine cleaning or one additional periodontal scaling and root planing per quadrant. Written confirmation of the pregnancy must be provided by the Enrollee or her dentist when the claim is submitted. Paragraph 4.5 is amended to read: 4.5 PROSTHODONTIC BENEFITS. Delta Dental agrees to pay 50% of the Dentist's Usual, Customary and Reasonable fees or the Fee Actually Charged, whichever is less, or 50% of the Delta Dental PPO Dentist's Fee for the construction or repair of fixed bridges, partial or .complete dentures to replace missing, natural teeth; for implant surgical placement and removal; and for implant supported prosthetics, including implant repair and re- cementation. (11- 05 -07) • • Sub- paragraphs (a), (e) and (i) of Paragraph 4.7 are amended to read: (a) Only the first two oral examinations, including initial, periodic, and emergency examinations, office visits for observations and specialist consultations, or combination thereof, provided to an Enrollee in a calendar year while he or she • is an Enrollee under any Delta Dental plan are Benefits under this plan. See note on additional Benefits during pregnancy. (e) A prophylaxis (cleaning) or Single Procedure that includes a prophylaxis is a Benefit twice each calendar year under any Delta Dental plan. See note on additional Benefits during pregnancy. Routine prophylaxes are covered as a Diagnostic and Preventive Benefit and periodontal prophylaxes are covered as a Basic Benefit. Periodontal scaling and root planing is a Benefit once for each quadrant each 24 -month period. See note on additional Benefits during pregnancy. Fluoride treatment is a Benefit twice each calendar year under any Delta Dental plan. (1) Prosthodontic appliances and implants that were provided under any Delta Dental plan will be replaced only after five years have passed, except when Delta Dental determines that there is such extensive loss of remaining teeth or change in supporting tissues that the existing fixed bridge, partial denture or complete denture cannot be made satisfactory. Replacement of a prosthodontic appliance or implant supported prosthesis not provided under a Delta Dental plan will be covered if it is unsatisfactory and cannot be made satisfactory. Implant removal is limited to one for each tooth during the Enrollee's lifetime whether provided under a Delta Dental or any other dental care plan. Paragraph 4.7 (k) is hereby deleted. Paragraph 4.8 (k) is hereby deleted. Sub- paragraph 6 of Paragraph 7.11 is amended to read: IMR is generally not applicable to a dental plan, unless that plan covers services related to the practice of medicine or offered pursuant to a contract with a health plan providing medical, surgical or hospital services. • (11- 05 -07) • • • • PRIVATE MEDICAL-CARE, INC. 12898 Towne Center Drive, Cerritos, California 90703 (562) 924-8311 (800) 801-7105 AMENDMENT TO APPLICATION FOR DeltaCare GROUP DENTAL SERVICE CONTRACT THIS AGREEMENT is made by and between PRIVATE MEDICAL-CARE, INC. and City of Seal Beach, DeltaCare Group #(See Appendix A), for the purpose of amending the original Group Dental Service Contract effective January 1,2006 as follows: 1. Appendix A shall be amended to include City of Seal Beach—Retirees, Group #02012-0070. 2. The term of the Contract for City of Seal Beach — Retirees shall be from January 1, 2006 through December 31,2006. 3. City of Seal Beach shall provide a list of eligible employees for Group #02012-0070 each month commencing January 1,2006. All other aspects of the Group Dental Service Contract currently in effect remain the same. IN WITNESS WHEREOF the parties have executed this Contract and have affixed their signatures on the it day of WHEREOF_ ,2006. City of Seal Beach PRIVATE MEDICAL-CARE, INC. DeltaCare Group #(See Appendix A) C By: l t1k( n � /�hL�Jj "I� By: anuary 12 2006 Signature and(Tide Signature and Date 211 8th Street Vice President, Research Address Tide Seal Beach CA 90740 City State Zip 01/13/2006 02012-0047-2AD • APPENDIX A (Effective 01/06) Group # Group Name 02012-0047 City of Seal Beach 02012-0055 City of Seal Beach— COBRA 02012-0070 City of Seal Beach—Retirees 01/11/2006 02012-0047-2.AD • • CITY OF SEAL BEACH GROUP NUMBER #7809 Date Amendment Signed: 01 / l' Jo caw By: Si nature N2D cmtemy Printed Name ilAdAG fr Title DATE: November 5, 2007 DELTA DENTAL OF CALIFORNIA: Belinda Martinez Senior Vice President Sales /Marketing Kenneth E. Bernardi Vice President Underwriting & Actuarial (11- 05 -07) a • • AMENDMENT NO. 4 TO AGREEMENT RENEWAL GROUP #7809 REVISED AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2009, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on January 1, 2009, and ending on December 31, 2010 and each subsequent yearly period during which this Contract remains in effect. Sub - paragraph 1 of Paragraph 3.1 is amended to read: 3.1 Within 10 days after receipt of Delta Dental's invoice, the Contractholder agrees to pay the following monthly Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of the Contractholder's Primary Enrollees and their Dependents who are Enrollees as set forth in Article 2 of this Contract: $46.59 for each Primary Enrollee without Dependents; $87.25 for each Primary Enrollee with one enrolled Dependent; and $129.63 for each Primary Enrollee with two or more enrolled Dependents. The Contractholder agrees to bear the cost of such Premiums without withholding or otherwise charging Primary Enrollees for their coverage. Primary Enrollees agree to bear the entire cost of coverage of their enrolled Dependents. Paragraph 9.3 is amended to read: 9.3 A party choosing to terminate this Contract at the end of a Contract Term must give at least 60 days written notice of termination to the other party. If Delta Dental wants to change the Premiums or Benefits effective at the beginning of the next Contract Term, Delta Dental will give at least 120 days advance written notice of such changes to the Contractholder. Such an advance notice will have the effect of a notice of termination as of the end of the Contract Term, unless the Contractholder agrees to the new Contract provisions. 755067 i • • CITY OF SEAL BEACH DELTA DENTAL GROUP #7809 Date Amendment Signed: )/../.4,--t-t G-""j �D ?-009 By: Signa e A.)t Ls Printed Name 7/4/4-704-6- ,t4 -� r If r Title DATE: December 3, 2008 DELTA DENTAL OF CALIFORNIA Belinda Martinez Senior Vice President Sales /Marketing Kenneth E. Bernardi Vice President Underwriting & Actuarial 755067 . • APPENDIX B CODE ON DENTAL PROCEDURES AND NOMENCLATURE NOTE: All the listed procedures may not be benefits under the terms of your contract. Refer to your contract for your specific benefits. DO10O - DO999 DIAGNOSTIC Clinical oral evaluations D0120 Periodic oral evaluation - established patient D0140 Limited oral evaluation — problem focused DO145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation — new or established patient D0160 Detailed and extensive oral evaluation — problem focused, by report D0170 Re-evaluation — limited, problem focused (established patient; not post-operative visit) D0180 Comprehensive periodontal evaluation — new or established patient Radiographs/diagnostic imaging (including interpretation) D0210 Intraoral — complete series (including bitewings) D0220 Intraoral — periapical first film D0230 Intraoral — periapical each additional film D0240 Intraoral — occlusal film D0250 Extraoral — first film D0260 Extraoral — each additional film D0270 Bitewing — single film D0272 Bitewings — two films DO273 Bitewings - three films D0274 Bitewings — four films D0277 Vertical bitewings — 7 to 8 films D0290 Posterior — anterior or lateral skull and facial bone survey film D0310 Sialography D0320 Temporomandibular joint arthrogram, including injection D0321 Other temporomandibular joint films, by report D0322 Tomographic survey D0330 Panoramic film D0340 Cephalometric film D0350 Oral/facial photographic images D0360 Cone beam ct - craniofacial data capture D0362 Cone beam - two-dimensional image reconstruction using existing data, includes multiple images D0363 Cone beam - three-dimensional image reconstruction using existing data, includes multiple images Tests and examinations D0415 Collection of microorganisms for culture and sensitivity D0416 Viral culture D0421 Genetic test for susceptibility to oral diseases D0425 Caries susceptibility tests D0431 Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures D0460 Pulp vitality tests D0470 Diagnostic casts CDT2011 (Eff. 01-O1-11) • S Oral pathology laboratory D0472 Accession of tissue, gross examination, preparation and transmission of written report D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report D0474 Accession of tissue, gross and microscopic examination, including assessment of surgical margins for presence of disease, preparation and transmission of written report D0475 Decalcification procedure D0476 Special stains for microorganisms D0477 Special stains, not for microorganisms D0478 Immunohistochemical stains D0479 Tissue in-situ hybridization, including interpretation D0480 Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission of written report D0481 Electron microscopy - diagnostic D0482 Direct immunofluorescence D0483 Indirect immunofluorescence D0484 Consultation on slides prepared elsewhere D0485 Consultation, including preparation of slides from biopsy material supplied by referring source D0486 Accession of brush biopsy sample, microscopic examination, preparation and transmission of written report D0502 Other oral pathology procedures, by report D0999 Unspecified diagnostic procedure, by report D1000 - D1999 PREVENTIVE Dental prophylaxis D1110 Prophylaxis — adult D1120 Prophylaxis — child through age 13 Topical fluoride treatment (office procedure) D1203 Topical application of fluoride (prophylaxis not included) — child through age 13 D1204 Topical application of fluoride (prophylaxis not included) — adult D1206 Topical fluoride varnish; therapeutic application for moderate to high caries risk patients Other preventive services D1310 Nutritional counseling for control of dental disease D1320 Tobacco counseling for the control and prevention of oral disease D1330 Oral hygiene instructions D1351 Sealant — per tooth D1352 Preventive resin restoration in a moderate to high caries risk patient - permanent tooth Space maintenance (passive appliances) D1510 Space maintainer — fixed — unilateral D1515 Space maintainer — fixed — bilateral D1520 Space maintainer — removable — unilateral D1525 Space maintainer — removable — bilateral D1550 Recementation of space maintainer D1555 Removal of fixed space maintainer D2000 - D2999 RESTORATIVE Amalgam restorations (including polishing) D2140 Amalgam — one surface, primary or permanent D2150 Amalgam — two surfaces, primary or permanent D2160 Amalgam — three surfaces, primary or permanent D2161 Amalgam — four or more surfaces, primary or permanent • CDT2011 (Eff. 01-01-11) e Resin-based composite restorations-direct D2330 Resin-based composite — one surface, anterior D2331 Resin-based composite — two surfaces, anterior D2332 Resin-based composite — three surfaces, anterior D2335 Resin-based composite — four or more surfaces or involving incisal angle (anterior) D2390 Resin-based composite crown, anterior D2391 Resin-based composite — one surface, posterior D2392 Resin-based composite — two surfaces, posterior D2393 Resin-based composite — three surfaces, posterior D2394 Resin-based composite — four or more surfaces, posterior Gold foil restorations D2410 Gold foil — one surface D2420 Gold foil — two surfaces D2430 Gold foil — three surfaces Inlay/onlay restorations D2510 Inlay — metallic — one surface D2520 Inlay — metallic — two surfaces D2530 Inlay — metallic — three or more surfaces D2542 Onlay — metallic — two surfaces D2543 Onlay — metallic — three surfaces D2544 Onlay — metallic — four or more surfaces D2610 Inlay — porcelain/ceramic — one surface D2620 Inlay — porcelain/ceramic — two surfaces D2630 Inlay — porcelain/ceramic — three or more surfaces D2642 Onlay — porcelain/ceramic — two surfaces D2643 Onlay — porcelain/ceramic — three surfaces D2644 Onlay — porcelain/ceramic — four or more surfaces D2650 Inlay — resin-based composite — one surface D2651 Inlay — resin-based composite — two surfaces D2652 Inlay — resin-based composite — three or more surfaces D2662 Onlay — resin-based composite — two surfaces D2663 Onlay — resin-based composite — three surfaces D2664 Onlay — resin-based composite — four or more surfaces Crowns — single restorations only D2710 Crown — resin-based composite (indirect) D2712 Crown — 3/4 resin-based composite (indirect) D2720 Crown — resin with high noble metal D2721 Crown — resin with predominantly base metal D2722 Crown — resin with noble metal D2740 Crown — porcelain/ceramic substrate D2750 Crown — porcelain fused to high noble metal D2751 Crown — porcelain fused to predominantly base metal D2752 Crown — porcelain fused to noble metal D2780 Crown — 3/4 cast high noble metal D2781 Crown — 3/4 cast predominantly base metal D2782 Crown — 3/4 cast noble metal D2783 Crown — 3/4 porcelain/ceramic D2790 Crown — full cast high noble metal D2791 Crown — full cast predominantly base metal D2792 Crown — full cast noble metal D2794 Crown — titanium D2799 Provisional crown CDT2011 (Eff. 01-01-11) . • Other restorative services D2910 Recement inlay, onlay, or partial coverage restoration D2915 Recement cast or prefabricated post and core D2920 Recement crown D2930 Prefabricated stainless steel crown — primary tooth D2931 Prefabricated stainless steel crown — permanent tooth D2932 Prefabricated resin crown D2933 Prefabricated stainless steel crown with resin window D2934 Prefabricated esthetic coated stainless steel crown — primary tooth D2940 Sedative filling D2950 Core buildup, including any pins D2951 Pin retention — per tooth, in addition to restoration D2952 Post and core in addition to crown, indirectly fabricated D2953 Each additional indirectly fabricated post — same tooth D2954 Prefabricated post and core in addition to crown D2955 Post removal (not in conjunction with endodontic therapy) D2957 Each additional prefabricated post — same tooth D2960 Labial veneer (resin laminate) — chairside D2961 Labial veneer (resin laminate) — laboratory D2962 Labial veneer (porcelain laminate) — laboratory D2970 Temporary crown (fractured tooth) D2971 Additional procedures to construct new crown under existing partial denture framework D2975 Coping D2980 Crown repair, by report D2999 Unspecified restorative procedure, by report D3000 - D3999 ENDODONTICS Pulp capping D3110 Pulp cap — direct (excluding final restoration) D3120 Pulp cap — indirect (excluding final restoration) Pulpotomy D3220 Therapeutic pulpotomy (excluding final restoration) — removal of pulp corona) to the dentinocemental junction and application of medicament D3221 Pulpal debridement, primary and permanent teeth D3222 Partial pulpotomy for apexogenesis-permanent tooth with incomplete root development D3230 Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration) D3240 Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration) Endodontic therapy on primary teeth (including treatment plan, clinical procedures and follow- up care) D3310 Endodontic therapy, anterior tooth (excluding final restoration) D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) D3330 Endodontic therapy, molar tooth (excluding final restoration) D3331 Treatment of root canal obstruction; non-surgical access D3332 Incomplete endodontic therapy; inoperable, unrestorable or fractured tooth D3333 Internal root repair of perforation defects Endodontic retreatment D3346 Retreatment of previous root canal therapy — anterior D3347 Retreatment of previous root canal therapy — bicuspid D3348 Retreatment of previous root canal therapy — molar CDT2011 (Eff. 01-01-11) • • Apexification/recalcification procedures D3351 Apexification/recalcification/pupal regeneration — initial visit (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) D3352 Apexifcation/recalcification/pulpal regeneration — interim medication replacement (apical closure/calcific repair of perforations, root resorption, pulpal space disinfection, etc.) D3353 Apexification/recalcification — final visit (includes completed root canal therapy — apical closure/calcific repair of perforations, root resorption, etc.) Apicoectomy/periradicular services D3410 Apicoectomy/periradicular surgery — anterior D3421 Apicoectomy/periradicular surgery — bicuspid (first root) D3425 Apicoectomy/periradicular surgery — molar (first root) D3426 Apicoectomy/periradicular surgery (each additional root) D3430 Retrograde filling — per root D3450 Root amputation — per root D3460 Endodontic endosseous implant D3470 Intentional reimplantation (including necessary splinting) Other endodontic procedures D3910 Surgical procedure for isolation of tooth with rubber dam D3920 Hemisection (including any root removal), not including root canal therapy D3950 Canal preparation and fitting of preformed dowel or post D3999 Unspecified endodontic procedure, by report D4000 - D4999 PERIODONTICS Surgical services (including usual post-operative care) D4210 Gingivectomy or gingivoplasty — four or more contiguous teeth or bounded teeth spaces per quadrant D4211 Gingivectomy or gingivoplasty — one to three contiguous teeth or bounded teeth spaces per quadrant D4230 Anatomical crown exposure - four or more contiguous teeth per quadrant D4231 Anatomical crown exposure - one to three teeth per quadrant D4240 Gingival flap procedure, including root planing — four or more contiguous teeth or bounded teeth spaces per quadrant D4241 Gingival flap procedure, including root planing — one to three contiguous teeth or bounded teeth spaces per quadrant D4245 Apically positioned flap D4249 Clinical crown lengthening — hard tissue D4260 Osseous surgery (including flap entry and closure) — four or more contiguous teeth or bounded teeth spaces per quadrant D4261 Osseous surgery (including flap entry and closure) — one to three contiguous teeth or bounded teeth spaces per quadrant D4263 Bone replacement graft — first site in quadrant D4264 Bone replacement graft — each additional site in quadrant D4265 Biologic materials to aid in soft and osseous tissue regeneration D4266 Guided tissue regeneration — resorbable barrier, per site D4267 Guided tissue regeneration — nonresorbable barrier, per site (includes membrane removal) D4268 Surgical revision procedure, per tooth D4270 Pedicle soft tissue graft procedure D4271 Free soft tissue graft procedure (including donor site surgery) D4273 Subepithelial connective tissue graft procedures, per tooth D4274 Distal or proximal wedge procedure (when not performed in conjunction with surgical procedures in the same anatomical area) D4275 Soft tissue allograft D4276 Combined connective tissue and double pedicle graft, per tooth CDT2011 (Eff. 01-01-11) • • Non-surgical periodontal service D4320 Provisional splinting — intracoronal D4321 Provisional splinting — extracoronal D4341 Periodontal scaling and root planing — four or more teeth per quadrant D4342 Periodontal scaling and root planing, — one to three teeth, per quadrant D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report Other periodontal services D4910 Periodontal maintenance D4920 Unscheduled dressing change (by someone other than treating dentist) D4999 Unspecified periodontal procedure, by report D5000 - D5899 PROSTHODONTICS (REMOVABLE) Complete dentures (including routine post-delivery care) D5110 Complete denture — maxillary D5120 Complete denture — mandibular D5130 Immediate denture — maxillary D5140 Immediate denture — mandibular Partial dentures (including routine post-delivery care) D5211 Maxillary partial denture — resin base (including any conventional clasps, rests and teeth) D5212 Mandibular partial denture — resin base (including any conventional clasps, rests and teeth) D5213 Maxillary partial denture — cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5214 Mandibular partial denture — cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5225 Maxillary partial denture — flexible base (including any clasps, rests and teeth) D5226 Mandibular partial denture — flexible base (including any clasps, rests and teeth) D5281 Removable unilateral partial denture — one piece cast metal (including clasps and teeth) Adjustments to dentures D5410 Adjust complete denture — maxillary D5411 Adjust complete denture — mandibular D5421 Adjust partial denture — maxillary D5422 Adjust partial denture — mandibular Repairs to complete dentures D5510 Repair broken complete denture base D5520 Replace missing or broken teeth — complete denture (each tooth) Repairs to partial dentures D5610 Repair resin denture base D5620 Repair cast framework D5630 Repair or replace broken clasp D5640 Replace broken teeth — per tooth D5650 Add tooth to existing partial denture D5660 Add clasp to existing partial denture D5670 Replace all teeth and acrylic on cast metal framework (maxillary) D5671 Replace all teeth and acrylic on cast metal framework (mandibular) Denture rebase procedures D5710 Rebase complete maxillary denture D5711 Rebase complete mandibular denture D5720 Rebase maxillary partial denture D5721 Rebase mandibular partial denture CDT2011 (Eff. 01-01-11) • • Denture reline procedures D5730 Reline complete maxillary denture (chairside) D5731 Reline complete mandibular denture (chairside) D5740 Reline maxillary partial denture (chairside) D5741 Reline mandibular partial denture (chairside) D5750 Reline complete maxillary denture (laboratory) D5751 Reline complete mandibular denture (laboratory) D5760 Reline maxillary partial denture (laboratory) D5761 Reline mandibular partial denture (laboratory) Interim prosthesis D5810 Interim complete denture (maxillary) D5811 Interim complete denture (mandibular) D5820 Interim partial denture (maxillary) D5821 Interim partial denture (mandibular) Other removable prosthetic services D5850 Tissue conditioning — maxillary D5851 Tissue conditioning — mandibular D5860 Overdenture — complete, by report D5861 Overdenture — partial, by report D5862 Precision attachment, by report D5867 Replacement of replaceable part of semi-precision or precision attachment (male or female component) D5875 Modification of removable prosthesis following implant surgery D5899 Unspecified removable prosthodontic procedure, by report D5900 – D5999 MAXILLOFACIAL PROSTHETICS D5911 Facial moulage (sectional) D5912 Facial moulage (complete) D5913 Nasal prosthesis D5914 Auricular prosthesis D5915 Orbital prosthesis D5916 Ocular prosthesis D5919 Facial prosthesis D5922 Nasal septal prosthesis D5923 Ocular prosthesis, interim D5924 Cranial prosthesis D5925 Facial augmentation implant prosthesis D5926 Nasal prosthesis, replacement D5927 Auricular prosthesis, replacement D5928 Orbital prosthesis, replacement D5929 Facial prosthesis, replacement D5931 Obturator prosthesis, surgical D5932 Obturator prosthesis, definitive D5933 Obturator prosthesis, modification D5934 Mandibular resection prosthesis with guide flange D5935 Mandibular resection prosthesis without guide flange D5936 Obturator prosthesis, interim D5937 Trismus appliance (not for TMD treatment) D5951 Feeding aid D5952 Speech aid prosthesis, pediatric D5953 Speech aid prosthesis, adult D5954 Palatal augmentation prosthesis D5955 Palatal lift prosthesis, definitive D5958 Palatal lift prosthesis, interim CDT2011 (Eff. 01-01-11) D5959 Palatal lift prosthesis, modification D5960 Speech aid prosthesis, modification D5982 Surgical stent D5983 Radiation carrier D5984 Radiation shield D5985 Radiation cone locator D5986 Fluoride gel carrier D5987 Commissure splint D5988 Surgical splint D5999 Unspecified maxillofacial prosthesis, by report D6000 — D6199 IMPLANT SERVICES D6010 Surgical placement of implant body: endosteal implant D6012 Surgical placement of interim implant body for transitional prosthesis: endosteal implant D6040 Surgical placement: eposteal implant D6050 Surgical placement: transosteal implant Implant supported prosthetics D6053 Implant/abutment supported removable denture for completely edentulous arch D6054 Implant/abutment supported removable denture for partially edentulous arch D6055 Dental implant supported connecting bar D6056 Prefabricated abutment — includes placement D6057 Custom abutment — includes placement D6058 Abutment supported porcelain/ceramic crown D6059 Abutment supported porcelain fused to metal crown (high noble metal) D6060 Abutment supported porcelain fused to metal crown (predominantly base metal) D6061 Abutment supported porcelain fused to metal crown (noble metal) D6062 Abutment supported cast metal crown (high noble metal) D6063 Abutment supported cast metal crown (predominantly base metal) D6064 Abutment supported cast metal crown (noble metal) D6065 Implant supported porcelain/ceramic crown D6066 Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) D6068 Abutment supported retainer for porcelain/ceramic FPD D6069 Abutment supported retainer for porcelain fused to metal FPD (high noble metal) D6070 Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) D6071 Abutment supported retainer for porcelain fused to metal FPD (noble metal) D6072 Abutment supported retainer for cast metal FPD (high noble metal) D6073 Abutment supported retainer for cast metal FPD (predominantly base metal) D6074 Abutment supported retainer for cast metal FPD (noble metal) D6075 Implant supported retainer for ceramic FPD D6076 Implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal) D6077 Implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal) D6078 Implant/abutment supported fixed denture for completely edentulous arch D6079 Implant/abutment supported fixed denture for partially edentulous arch Other implant services D6080 Implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis D6090 Repair implant supported prosthesis, by report D6091 Replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment D6092 Recement implant/abutment supported crown D6094 Abutment supported crown — (titanium) CDT2011 (Eff. 01-01-11) • • D6095 Repair implant abutment, by report D6100 Implant removal, by report D6190 Radiographic/surgical implant index, by Report D6093 Recement implant/abutment supported fixed partial denture D6194 Abutment supported retainer crown for FPD — (titanium) D6199 Unspecified implant procedure, by report D6200 — D6999 PROSTHODONTICS, FIXED (Each retainer and each pontic constitutes a unit in a fixed partial denture) Fixed partial denture pontics D6205 Pontic — indirect resin based composite D6210 Pontic — cast high noble metal D6211 Pontic — cast predominantly base metal D6212 Pontic — cast noble metal D6214 Pontic — titanium D6240 Pontic — porcelain fused to high noble metal D6241 Pontic — porcelain fused to predominantly base metal D6242 Pontic — porcelain fused to noble metal D6245 Pontic — porcelain/ceramic D6250 Pontic — resin with high noble metal D6251 Pontic — resin with predominantly base metal D6252 Pontic — resin with noble metal D6253 Provisional pontic Fixed partial denture retainers — inlays/ onlays D6545 Retainer — cast metal for resin bonded fixed prosthesis D6548 Retainer — porcelain/ceramic for resin bonded fixed prosthesis D6600 Inlay — porcelain/ceramic, two surfaces D6601 Inlay — porcelain/ceramic, three or more surfaces D6602 Inlay — cast high metal, two surfaces D6603 Inlay — cast high metal, three or more surfaces D6604 Inlay — cast predominantly base metal, two surfaces D6605 Inlay — cast predominantly base metal, three or more surfaces D6606 Inlay — cast noble metal, two surfaces D6607 Inlay — cast noble metal, three or more surfaces D6608 Onlay — porcelain/ceramic, two surfaces D6609 Onlay — porcelain/ceramic, three or more surfaces D6610 Onlay — cast high noble metal, two surfaces D6611 Onlay — cast high noble metal, three or more surfaces D6612 Onlay — cast predominantly base metal, two surfaces D6613 Onlay — cast predominantly base metal, three or more surfaces D6614 Onlay — cast noble metal, two surfaces D6615 Onlay — cast noble metal, three or more surfaces D6624 Inlay — titanium D6634 Onlay — titanium Fixed partial denture retainers — crowns D6710 Crown — indirect resin based composite D6720 Crown — resin with high noble metal D6721 Crown — resin with predominantly base metal D6722 Crown — resin with noble metal D6740 Crown — porcelain/ceramic D6750 Crown — porcelain fused to high noble metal D6751 Crown — porcelain fused to predominantly base metal D6752 Crown — porcelain fused to noble metal D6780 Crown — 3/4 cast high noble metal CDT2011 (Elf. 01-01-11) • • D6781 Crown — 3/4 cast predominantly base metal D6782 Crown — 3/4 cast noble metal D6783 Crown — 3/4 porcelain/ceramic D6790 Crown — full cast high noble metal D6791 Crown — full cast predominantly base metal D6792 Crown — full cast noble metal D6793 Provisional retainer crown D6794 Crown — titanium Other fixed partial denture services D6920 Connector bar D6930 Recement fixed partial denture D6940 Stress breaker D6950 Precision attachment D6970 Post and core in addition to fixed partial denture retainer, indirectly fabricated D6972 Prefabricated post and core in addition to fixed partial denture retainer D6973 Core buildup for retainer, including any pins D6975 Coping — metal D6976 Each additional indirectly fabricated post — same tooth D6977 Each additional prefabricated post — same tooth D6980 Fixed partial denture repair, by report D6985 Pediatric partial denture, fixed D6999 Unspecified, fixed prosthodontic procedure, by report D7000 - D7999 ORAL AND MAXILLOFACIAL SURGERY Extractions (includes local anesthesia, suturing, if needed, and routine postoperative care) D7111 Extraction, coronal remnants — deciduous tooth 07140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) Surgical extractions (includes local anesthesia, suturing, if needed, and routine postoperative care) D7210 Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D7220 Removal of impacted tooth — soft tissue D7230 Removal of impacted tooth — partially bony D7240 Removal of impacted tooth — completely bony D7241 Removal of impacted tooth — completely bony, with unusual surgical complications D7250 Surgical removal of residual tooth roots (cutting procedure) Other surgical procedures D7260 Oroantral fistual closure D7261 Primary closure of a sinus perforation D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth D7272 Tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization) D7280 Surgical access of an unerupted tooth D7282 Mobilization of erupted or malpositioned tooth to aid eruption D7283 Placement of device to facilitate eruption of impacted tooth D7285 Biopsy of oral tissue — hard (bone, tooth) D7286 Biopsy of oral tissue — soft D7287 Exfoliative cytological sample collection D7288 Brush biopsy — transepithelial sample collection D7290 Surgical repositioning of teeth D7291 Transseptal fiberotomy/supra crestal fiberotomy, by report D7292 Surgical placement: temporary anchorage device [screw retained plate] requiring surgical flap CDT2011 (Eff. 01-01-11) • • D7293 Surgical placement: temporary anchorage device requiring surgical flap D7294 Surgical placement: temporary anchorage device without surgical flap Alveoloplasty — surgical preparation of ridge for dentures D7310 Alveoloplasty in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7311 Alveoloplastyin.conjunction with extractions — one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions — one to three teeth or tooth spaces, per quadrant Vestibuloplasty D7340 Vestibuloplasty — ridge extension (secondary epithelialization) D7350 Vestibuloplasty — ridge extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) Surgical excision of of soft tissue lesions D7410 Excision of benign lesion up to 1.25 cm D7411 Excision of benign lesion greater than 1.25 cm D7412 Excision of benign lesion, complicated D7413 Excision of malignant lesion up to 1.25 cm D7414 Excision of malignant lesion greater than 1.25 cm D7415 Excision of malignant lesion complicated D7465 Destruction of lesion(s) by physical or chemical method, by report Surgical excision of intra-osseous lesions D7440 Excision of malignant tumor — lesion diameter up to 1.25 cm D7441 Excision of malignant tumor — lesion diameter greater than 1.25 cm D7450 Removal of benign odontogenic cyst or tumor — lesion diameter up to 1.25 cm D7451 Removal of benign odontogenic cyst or tumor — lesion diameter greater than 1.25 cm D7460 Removal of benign nonodontogenic cyst or tumor — lesion diameter up to 1.25 cm D7461 Removal of benign nonodontogenic cyst or tumor — lesion diameter greater than 1.25 cm Excision of bone tissue D7471 Removal of lateral exostosis (maxilla or mandible) D7472 Removal of torus palatinus D7473 Removal of torus manibularis D7485 Surgical reduction of osseous tuberosity D7490 Radical resection of maxilla or mandible Surgical incision D7510 Incision and drainage of abscess — intraoral soft tissue D7511 Incision and drainage of abscess — intraoral soft tissue — complicated (includes drainage of multiple fascial spaces) D7520 Incision and drainage of abscess — extraoral soft tissue D7521 Incision and drainage of abscess — extraoral soft tissue — complicated (includes drainage of multiple fascial spaces) D7530 Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue D7540 Removal of reaction-producing foreign bodies, musculoskeletal system D7550 Partial ostectomy/sequestrectomy for removal of non-vital bone D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body CDT2011 (Eff. 01-01-11) • Treatment of fractures — simple D7610 Maxilla — open reduction (teeth immobilized, if present) D7620 Maxilla — closed reduction (teeth immobilized, if present) D7630 Mandible — open reduction (teeth immobilized, if present) D7640 Mandible — closed reduction (teeth immobilized, if present) D7650 Malar and/or zygomatic arch — open reduction D7660 Malar and/or zygomatic arch — closed reduction D7670 Alveolus — closed reduction, may include stabilization of teeth D7671 Alveolus — open reduction, may include stabilization of teeth D7680 Facial bones — complicated reduction with fixation and multiple surgical approaches Treatment of fractures — compound D7710 Maxilla — open reduction D7720 Maxilla — closed reduction D7730 Mandible — open reduction D7740 Mandible — closed reduction D7750 Malar and/or zygomatic arch — open reduction D7760 Malar and/or zygomatic arch — closed reduction D7770 Alveolus — open reduction splinting stabilization of teeth D7771 Alveolus — closed reduction stabilization of teeth D7780 Facial bones — complicated reduction with fixation and multiple surgical approaches Reduction of dislocation and management of other temporomandibular joint dysfunctions D7810 Open reduction of dislocation D7820 Closed reduction of dislocation D7830 Manipulation under anesthesia D7840 Condylectomy D7850 Surgical discectomy, with/without implant D7852 Disc repair D7854 Synovectomy D7856 Myotomy D7858 Joint reconstruction D7860 Arthrotomy D7865 Arthroplasty D7870 Arthrocentesis D7871 Non-arthroscopic lysis and lavage D7872 Arthroscopy — diagnosis, with or without biopsy D7873 Arthroscopy — surgical: lavage and lysis of adhesions D7874 Arthroscopy — surgical: disc repositioning and stabilization D7875 Arthroscopy — surgical: synovectomy D7876 Arthroscopy — surgical: discectomy D7877 Arthroscopy — surgical: debridement D7880 Occlusal orthotic device, by report D7899 Unspecified TMD therapy, by report Repair of traumatic wounds D7910 Suture of recent small wounds up to 5 cm Complicated suturing (reconstruction requiring delicate handling of tissues and wide undermining for meticulous closure) D7911 Complicated suture — up to 5 cm D7912 Complicated suture — greater than 5 cm Other repair procedures D7920 Skin graft (identify defect covered, location and type of graft) D7940 Osteoplasty — for orthognathic deformities CDT2011 (Eff. 01-01-11) • • D7941 Osteotomy — mandibular rami D7943 Osteotomy — mandibular rami with bone graft; includes obtaining the graft D7944 Osteotomy — segmented or subapical D7945 Osteotomy — body of mandible D7946 LeFort I (maxilla — total) D7947 LeFort I (maxilla — segmented) D7948 LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) — without bone graft D7949 LeFort II or LeFort III — with bone graft D7950 Osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report D7951 Sinus augmentation with bone or bone substitutes D7953 Bone replacement graft for ridge preservation — per site D7955 Repair of maxillofacial soft and/or hard tissue defect D7960 Frenulectomy - also known as frenectomy or frenotomy — separate procedure not incidental to another procedure D7963 Frenuloplasty D7970 Excision of hyperplastic tissue — per arch D7971 Excision of pericoronal gingiva D7972 Surgical reduction of fibrous tuberosity D7980 Sialolithotomy D7981 Excision of salivary gland, by report D7982 Sialodochoplasty D7983 Closure of salivary fistula D7990 Emergency tracheotomy D7991 Coronoidectomy D7995 Synthetic graft — mandible or facial bones, by report D7996 Implant — mandible for augmentation purposes (excluding alveolar ridge), by report D7997 Appliance removal (not by dentist who placed appliance), includes removal of archbar D7998 Intraoral placement of a fixation device not in conjunction with a fracture D7999 Unspecified oral surgery procedure, by report D8000 - D8999 ORTHODONTICS Limited orthodontic treatment D8010 Limited orthodontic treatment of the primary dentition D8020 Limited orthodontic treatment of the transitional dentition D8030 Limited orthodontic treatment of the adolescent dentition D8040 Limited orthodontic treatment of the adult dentition Interceptive orthodontic treatment D8050 Interceptive orthodontic treatment of the primary dentition D8060 Interceptive orthodontic treatment of the transitional dentition Comprehensive orthodontic treatment D8070 Comprehensive orthodontic treatment of the transitional dentition D8080 Comprehensive orthodontic treatment of the adolescent dentition D8090 Comprehensive orthodontic treatment of the adult dentition Minor treatment to control harmful habits D8210 Removable appliance therapy D8220 Fixed appliance therapy Other orthodontic services D8660 Pre-orthodontic treatment visit D8670 Periodic orthodontic treatment visit (as part of contract) D8680 Orthodontic retention (removal of appliances, construction and placement of retainer[s]) CDT2011 (Eff. 01-01-11) • • D8690 Orthodontic treatment (alternative billing to a contract fee) D8691 Repair of orthodontic appliance D8692 Replacement of lost or broken retainer D8693 Rebonding or recementing; and/or repaid, as required, of fixed retainers D8999 Unspecified orthodontic procedure, by report D9OOO - D9999 ADJUNCTIVE GENERAL SERVICES Unclassified treatment D9110 Palliative (emergency) treatment of dental pain — minor procedure D9120 Fixed partial denture sectioning Anesthesia D9210 Local anesthesia not in conjunction with operative or surgical procedures D9211 Regional block anesthesia D9212 Trigeminal division block anesthesia D9215 Local anesthesia D9220 Deep sedation/general anesthesia — first 30 minutes D9221 Deep sedation/general anesthesia — each additional 15 minutes D9230 Analgesia, anxiolysis, inhalation of nitrous oxide D9241 Intravenous conscious sedation/ analgesia — first 30 minutes D9242 Intravenous conscious sedation/ analgesia — each additional 15 minutes D9248 Non-intravenous conscious sedation Professional consultation D9310 Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician Professional visits D9410 House/extended care facility call D9420 Hospital call D9430 Office visit for observation (during regularly scheduled hours) — no other services performed D9440 Office visit — after regularly scheduled hours D9450 Case presentation, detailed and extensive treatment planning Drugs D9610 Therapeutic parenteral drug, single administration D9612 Therapeutic parenteral drugs, two or more administrations, different medications D9630 Other drugs and/or medicaments, by report Miscellaneous services D9910 Application of desensitizing medicament D9911 Application of desensitizing resin for cervical and/or root surface, per tooth D9920 Behavior management, by report D9930 Treatment of complications (post-surgical) — unusual circumstances, by report D9940 Occlusal guard, by report D9941 Fabrication of athletic mouthguard D9942 Repair and/or reline of occlusal guard D9950 Occlusion analysis — mounted case D9951 Occlusal adjustment — limited D9952 Occlusal adjustment — complete D9970 Enamel microabrasion D9971 Odontoplasty 1-2 teeth; includes removal of enamel projections CDT2011 (Eff. 01-01-11) D9972 External bleaching — per arch D9973 External bleaching — per tooth D9974 Internal bleaching — per tooth D9999 Unspecified adjunctive procedure, by report Note: This Appendix represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect at the date of this printing. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Appendix, Delta Dental's administration of Benefits, Limitations and Exclusions under this Contract will at all times be based on the then-current version of CDT whether or not a revised Appendix B is provided. CDT2011 (Eff. 01-01-11) • • ,e R 11e 4 � _ p ; 'ti b pJt omt" O tI�Ha f Gl°I 1,g, „r..a}t ^a. + s dd' X .•+ r n F yn ;n d DN "E dt:ay Hp F. }:jic }a',TE 1IEli7 .' �`" N#:•d Y 'd Ft" cNED° ,cg Viz„r ry ll . e tsi VE RA :z Y, }i :, � 4 �� �h w ` O ' mk - �i$i +r' d TR i � t $ . 0 i. '1 n � ( ." j f R ::: { 'p�1`3g P‘ : ..0 5 $ ;41 Y Fes ^ 4 s '! s k n..a:,rJ w_. ._, ,..,;:.::31:Q4,:4;,-1 • of }, Delta Dental PPO Plan For Employees of CITY OF SEAL BEACH Group No. 7809 Effective Date: January 1, 2008 • • USING THIS BOOKLET This booklet has been written with you in mind. It is designed to help you make the most of your Delta Dental plan. This combined Evidence of Coverage/Disclosure form discloses the terms and conditions of your coverage. The Combined Evidence of Coverage/Disclosure form should be read completely and carefully and individuals with special health care needs should read carefully those sections that apply to them (see CHOICE OF DENTISTS AND PROVIDERS section). You have a right to review it prior to your enrollment. Please read the "DEFINITIONS" section. It will explain to you any words that have special or technical meanings under your group Contract. A copy of the Contract will be furnished upon request. Please read this summary of your dental Benefits carefully. Keep in mind that YOU means the ENROLLEES whom Delta Dental covers. WE, US and OUR always refers to Delta Dental of California (Delta Dental). If you have any questions about your coverage that are not answered here, please check with your personnel office, or with Delta Dental. DELTA DENTAL OF CALIFORNIA 100 First Street San Francisco, CA 94105 For claims, eligibility and benefits inquiries, or additional information, call Delta Dental's Customer Service department toll-free at: 800-765-6003 or contact us on our web site: www.deltadentalca.org A STATEMENT DESCRIBING OUR POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST This Combined Evidence of Coverage/Disclosure Form constitutes only a summary of the dental plan. The dental Contract must be consulted to determine the exact terms and conditions of coverage. 1 • • TABLE OF CONTENTS DEFINITIONS 3 WHO IS COVERED? 4 WHO ARE YOUR ELIGIBLE DEPENDENTS? 4 ENROLLING YOUR DEPENDENTS 5 COVERAGE COSTS 5 WHEN YOU ARE NO LONGER COVERED 5 CANCELING THIS PLAN 5 YOUR BENEFITS 6 LIMITATIONS 7 EXCLUSIONS/SERVICES WE DO NOT COVER 9 OTHER CHARGES 10 COVERED FEES 10 CHOICE OF DENTISTS AND PROVIDERS 10 CONTINUITY OF CARE 11 PUBLIC POLICY PARTICIPATION BY ENROLLEES 11 INTERNATIONAL DENTIST REFERRAL SERVICE 11 SAVING MONEY ON YOUR DENTAL BILLS 12 YOUR FIRST APPOINTMENT 12 ACCESSIBILITY AND SERVICES FOR AFTER-HOURS AND URGENT CARE 12 PREDETERMINATIONS 13 REIMBURSEMENT PROVISIONS 13 IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTAL DENTIST 14 SECOND OPINIONS 14 ORGAN AND TISSUE DONATION 15 GRIEVANCE PROCEDURE AND CLAIMS APPEAL 15 IF YOU HAVE ADDITIONAL COVERAGE 16 OPTIONAL CONTINUATION OF COVERAGE (COBRA) 16 NOTICE OF PRIVACY PRACTICES: CONFIDENTIALITY OF YOUR HEALTH CARE INFORMATION 19 2 • • DEFINITIONS Certain words that you will see in this booklet have specific meanings. These definitions should make your dental plan easier to understand. Benefits - those dental services available under the Contract and which are described in this booklet. Contract - the written agreement between your employer or sponsoring group and Delta Dental to provide dental Benefits. The Contract, together with this booklet, forms the terms and conditions of the Benefits you are provided. Covered Services - those dental services to which Delta Dental will apply Benefit payments, according to the Contract. Delta Dental PPO Dentist - a Dentist with whom Delta Dental has a written agreement to provide services at the in-network level for Enrollees in this Delta Dental PPO Plan. Delta Dental Dentist - a Dentist who has signed an agreement with Delta Dental or a Participating Plan, agreeing to provide services under the terms and conditions established by Delta Dental or the Participating Plan. Dependent - a Primary Enrollee's Dependent who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Effective Date - the date this plan starts. Enrollee - A Primary Enrollee or Dependent enrolled to receive Benefits or a person who chooses to pay for OPTIONAL CONTINUATION OF COVERAGE. Maximum - the greatest dollar amount Delta Dental will pay for covered procedures in any calendar year and lifetime for Orthodontic Benefits. Participating Plan - Delta Dental and any other member of the Delta Dental Plans Association with whom Delta Dental contracts for assistance in administering your Benefits. Premiums - the money paid to Delta Dental each month for you and your Dependents' dental coverage. Primary Enrollee - any group member or employee who is eligible to enroll for Benefits in accordance with the conditions of eligibility outlined in this booklet. Single Procedure - a dental procedure to which a separate Procedure Number has been assigned by the American Dental Association in the current version of Common Dental Terminology (CDT). Usual, Customary and Reasonable (UCR) - A Usual fee is the amount which an individual dentist regularly charges and receives for a given service or the fee actually charged, whichever is less. A Customary fee is within the range of usual fees charged and received for a particular service by dentists of similar training in the same geographic area. A Reasonable fee schedule is reasonable if it is Usual and Customary. Additionally, a specific fee to a specific patient is reasonable if it is justifiable considering special circumstances, or extraordinary difficulty, of the case in question. 3 • • WHO IS COVERED? All regular employees are required to enroll and will become eligible to receive Benefits on the first day of the month following 30 days of continuous full-time employment. Retirees residing out of state are eligible for this plan and will received the Delta Dental PPO in-network level of Benefits. You are not eligible if you are not reporting to work on a regular basis and are not actively employed. Coverage resumes on the first day of the month after you return to active employment, report to work regularly and amounts due to Delta Dental for coverage have been paid. But, coverage can continue without interruption if your employer continues to report you as a Primary Enrollee and amounts due Delta Dental for your coverage continue to be paid. Coverage is reinstated on the day employment is resumed for Enrollees that are members of the National Guard or a military reserve unit absent from work due to active military duty. Any waiting period applied as a result of ai Enrollee's absence from active employment due to service in the National Guard or military reserve unit shall be waived. Family and Medical Leave Act of 1993 You can continue your coverage if you take a leave governed by the Family and Medical Leave Act of 1993. If you do not continue your coverage during the governed leave, it will be reinstated at the same Benefit level you received before your leave. Uniformed Services Employment and Re-employment Rights Act of 1994 You can continue coverage for up to 24 months, if you take a leave governed by the Uniformed Services Employment and Re-employment Rights Act of 1994. If you rrake this election, you must submit any Premiums necessary, which may include administrative costs, to your employer. If you do not continue your coverage during a military leave, it will be reinstated at the same Benefit level you received before your leave. WHO ARE YOUR ELIGIBLE DEPENDENTS? • Your legal spouse or registered domestic partner, as defined below; • Your unmarried dependent children until their 19th birthday; • Your unmarried dependent children until their 23rd birthday if enrolled full-time in an accredited school, college or university; • An unmarried dependent child aged 19 or older who is incapable of self-support because of a physical or mental handicap that occurred before he or she turned 19, if the child is mostly dependent on you for support. Proof of this handicap must be given to Delta Dental or your employer within 31 days, if it is requested. Proof will not be required more than once a year after the child has reached age 21. "Dependent children" also means stepchildren, adopted children, children of a registered domestic partner, children placed for adoption and foster children, provided that they are dependent upon you for support and maintenance. Registered domestic partners are defined as same sex partners, who are both at least 18 years of age and opposite sex partners when one or both partners are over the age of 62 and entitled to Social Security benefits. Registered domestic partners are required to register with the Secretary of State of the State of California a Declaration of Domestic Partnership. A registered domestic partner is subject to the same terms and conditions as any other Dependent enrolled under this Contract. Registered domestic partners are eligible for continuation of coverage under COBRA. 4 • • Dependent coverage is also extended to any child who is recognized under a Qualified Medical Child Support Order (QMCSO). No Dependent in the military service is eligible. ENROLLING YOUR DEPENDENTS A payroll deduction is required for your enrolled Dependents. Your group can only provide coverage for your Dependents if at least half of the Primary Enrollees who have Dependents enroll all of them in this plan. Your Dependents must be enrolled when you first become eligible or on the first day of the month after they become Dependents. However, Dependents who are covered under another group dental plan are not required to enroll under this Delta Dental plan. If the other coverage ends, the Dependents may enroll under this plan within 30 days of the loss of the other coverage. Proof of prior coverage is required. Dependent children up to four years of age may be enrolled at the beginning of any Contract year including the Contract year immediately following their fourth birthday. If you drop coverage for your Dependents, you may not re-enroll them in this plan. COVERAGE COSTS Your employer pays Delta Dental a monthly Premium for coverage of you and your enrolled Dependents. You do not pay for your own coverage, but a payroll deduction is made for your share of the monthly Premium required for your Dependent's coverage. Your employer can tell you how much you must contribute for the costs of dependent coverage. The amount of the Premium may change at each renewal of the Contract between your employer and Delta Dental. Premiums will not increase during the contract year unless new taxes or tax rates are imposed upon Delta Dental for this plan or unless there is an agreement between your employer and Delta Dental to change the Premiums. WHEN YOU ARE NO LONGER COVERED 1. If you stop working for your employer, your dental coverage will end on the last day of the month in which you stop working, unless you qualify for and pay for OPTIONAL CONTINUATION OF COVERAGE. Your Dependents' coverage ends when yours does, or as soon as they are m longer Dependents, unless they choose to pay for OPTIONAL CONTINUATION OF COVERAGE. 2. When the Contract between Delta Dental and your employer is discontinued or canceled, your coverage ends immediately. CANCELING THIS PLAN Delta Dental may cancel this plan only on an anniversary date (period after the plan first takes effect or at the end of each renewal period thereafter), or: 1. If your employer does not make payment to Delta Dental as required by the Contract; 2. If fewer than 10 people are reported eligible for three months or more; 3. If your employer does not give Delta Dental a list of who is eligible; 4. If your employer does not allow Delta Dental to inspect its records, if this is required by your group Contract. 5 • • If you believe that this plan has been terminated or not renewed due to your health status or requirements for health care services (or that of your Dependents), you may request a review by the California Director of the Department of Managed Health Care. If the Contract is terminated for any cause, Delta Dental is not required to predetermine services beyond the termination date or to pay for services provided after the termination date, except for Single Procedures begun while the Contract was in effect which are otherwise Benefits under the Contract. If this plan is canceled, you and your Dependents have no right to renewal or reinstatement of your Benefits. YOUR BENEFITS Your dental plan covers several categories of Benefits, when the services are provided by a licensed dentist, and when they are necessary and customary under the generally accepted standards of dental practice. Delta Dental will provide payment for these services at the percentage indicated up to a Maximum of $2,000 for each Enrollee in each calendar year. Payment for Orthodontic Benefits for dependent children is limited to a lifetime Maximum of $1,000. An agreement between your employer and Delta Dental is required to change Benefits during the term of the Contract. The following Benefits are limited to the applicable percentages of dentist's fees or allowances specified below. You are required to pay the balance of any such fee or allowance, known as the "patient copayment." If the dentist discounts, waives or rebates any portion of the patient copayment to the Enrollee, Delta Dental only provides as Benefits the applicable allowances reduced by the amount that such fees or allowances are discounted, waived or rebated. I. DIAGNOSTIC AND PREVENTIVE BENEFITS 100% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Diagnostic - oral exa minations (including initial examinations, periodic examinations and emergency examinations); x-rays; diagnostic casts; examination of biopsied tissue; palliative (emergency) treatment of dental pain; specialist consultation Preventive - prophylaxis (cleaning); fluoride treatment; space maintainers Note on additional Benefits during pregnancy. If you are pregnant, Delta Dental will pay for additional services to help improve your oral health during pregnancy. The additional services each calendar year while you are eligible in this Delta Dental plan include: one additional oral examination and either one additional routine cleaning or one additional periodontal scaling and root planing per quadrant. Written confirmation of your pregnancy must be provided by you or your dentist when the claim is submitted. II. BASIC BENEFITS 80% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Oral surgery - extractions and certain other surgical procedures, including pre- and post-operative care 6 • • Restorative - amalgam, silicate or composite (resin) restorations (fillings) for treatment of carious lesions (visible destruction of hard tooth structure resulting from the process of dental decay) Endodontic - treatment of the tooth pulp Periodontic - treatment of gums and bones that support the teeth Sealants - topically applied acrylic, plastic or composite material used to seal developmental grooves and pits in teeth for the purpose of preventing dental decay • Adjunctive General Services - general anesthesia; office visit for observation; office visit after regularly scheduled hours; therapeutic drug injection; treatment of post-surgical complications (unusual circumstances); limited occlusal adjustment III. CROWNS, INLAYS, ONLAYS AND CAST RESTORATION BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Crowns, Inlays, Onlays and Cast Restorations are Benefits only if they are provided to treat cavities which cannot be restored with amalgam, silicate or direct composite (resin) restorations. IV. PROSTHODONTIC BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Construction or repair of fixed bridges, partial dentures and complete dentures are Benefits if provided to replace missing, natural teeth. Implant surgical placement and removal and for implant supported prosthetics, including implant repair and re-cementation. V. ORTHODONTIC BENEFITS 50% if provided by a Delta Dental PPO Dentist 50% if provided by other dentists Procedures using appliances or surgery to straighten or realign teeth, which otherwise would not function properly. LIMITATIONS 1. Only the first two oral examinations, including office visits for observation and specialist consultations, or combination thereof, in a calendar year are Benefits while you are eligible under any Delta Dental plan. See Note on additional Benefits during pregnancy. 2. Full-mouth x-rays are Benefits once in a five-year period while you are eligible under any Delta Dental plan. 3. Bitewing x-rays are provided on request by the dentist, but no more than twice in any calendar year for children to age 18 or once in any calendar year for adults age 18 and over, while you are eligible under any Delta Dental plan. 4. Diagnostic casts are a Benefit only when made in connection with subsequent orthodontic treatment covered under this plan. 7 • • 5, We pay for two cleanings or a dental procedure that includes a cleaning each calendar year under any Delta Dental plan. If you are pregnant during this time, we may pay for an additional cleaning. See Note on additional Benefits during pregnancy. Routine prophylaxes are covered as a Diagnostic and Preventive Benefit and periodontal prophylaxes are covered as a Basic Benefit. 6. Fluoride treatments are covered twice each calendar year under any Delta Dental plan. 7. Periodontal scaling and root planing is a Benefit once for each quadrant each 24-month period. See note on additional Benefits during pregnancy. 8. Sealant Benefits include the application of sealants only to permanent first molars through age eight and second molars through age 15 if they are without caries (decay) or restorations on the occlusal surface. Sealant Benefits do not include the repair or replacement of a sealant on any tooth within two years of its application. 9. Direct composite (resin) restorations are Benefits on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services and Delta Dental's payment is limited to the cost of the equivalent amalgam restorations. 10. Crowns, Inlays, Onlays and Cast Restorations are Benefits on the same tooth only once every five years, while you are a patient under any Delta Dental plan, unless Delta Dental determines that replacement is required because the restoration is unsatisfactory as a result of poor quality of care, or because the tooth involved has experience extensive loss or changes to tooth structure or supporting tissues since the replacement of the restoration. 11. Prosthodontic appliances and implants are Benefits only once every five years, while you are eligible under any Delta Dental plan, unless Delta Dental determines that there has been such an extensive loss of remaining teeth or a change in supporting tissues that the existing appliance cannot be made satisfactory. Replacement of a prosthodontic appliance not provided under a Delta Dental plan will be made if it is unsatisfactory and cannot be made satisfactory. Delta Dental will replace an implant, a prosthodontic appliance or an implant supported prosthesis you received under another dental plan if we determine it is unsatisfactory and cannot be made satisfactory. We will pay for the removal of an implant once for each tooth during the Enrollee's lifetime. 12 Delta Dental will pay the applicable percentage ff the dentist's fee for a standard partial or complete denture. A standard partial or complete denture is defined as a removable prosthetic appliance provided to replace missing natural, permanent teeth that are made from accepted materials and by conventional methods. 13. If you select a more expensive plan of treatment than is customarily provided, or specialized techniques, an allowance will be made for the least expensive, professionally acceptable, alternative treatment plan. Delta Dental will pay the applicable percentage of the lesser fee for the customary or standard treatment and you are responsible for the remainder of the dentist's fee. For example: a crown where an amalgam filling would restore the tooth; or a precision denture where a standard denture would suffice. 14. Orthodontic coverage is limited to eligible dependent children. 15. If orthodontic treatment is begun before you become eligible for coverage, Delta Dental's payments will begin with the first payment due to the dentist following your eligibility date. 8 • • 16. Delta Dental's orthodontics payments will stop when the first payment is due to the dentist following either a loss of eligibility, or if treatment is ended for any reason before it is completed. 17. X-rays and extractions that might be necessary for orthodontic treatment are not covered by Orthodontic Benefits, but may be covered under Diagnostic and Preventive or Basic Benefits. 18. Delta Dental will pay the applicable percentage of the Dentist's fee for a standard orthodontic treatment plan involving surgical and/or non-surgical procedures. If you select specialized orthodontic appliances or procedures chosen for aesthetic considerations an allowance will be made for the cost of a standard orthodontic treatment plan and you are responsible for the remainder of the Dentist's fee. EXCLUSIONS/SERVICES WE DO NOT COVER Delta Dental covers a wide variety of dental care expenses, but there are some services for which we do not provide Benefits. It is important for you to know what these services are before you visit your dentist. Delta Dental does not provide benefits for: 1. Services for injuries or conditions that are covered under Workers' Compensation or Employer's Liability Laws. 2. Services that are provided to the Enrollee by any Federal or State Governmental Agency or are provided without cost to the Enrollee by any municipality, county or other political subdivision, except Medi-Cal benefits. 3. Services for cosmetic purposes or for conditions that are a result of hereditary or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth and teeth that are discolored or lacking enamel. 4. Services for restoring tooth structure lost from wear (abrasion, erosion, attrition, or abfraction), for rebuilding or maintaining chewing surfaces due to teeth out of alignment or occlusion, or for stabilizing the teeth. Examples of such treatment are equilibration and periodontal splinting. 5. Any Single Procedure, bridge, denture or other prosthodontic service that was started before the Enrollee was covered by this plan. 6. Prescribed drugs, or applied therapeutic drugs, premedication or analgesia. 7. Experimental procedures. 8. Charges by any hospital or other surgical or treatment facility and any additional fees charged by the Dentist for treatment in any such facility. 9. Anesthesia, except for general anesthesia given by a dentist for covered oral surgery procedures. 10. Grafting tissues from outside the mouth to tissues inside the mouth ("extraoral grafts"). 11. Diagnosis or treatment by any method of any condition related to the temporomandibular (jaw) joints or associated muscles, nerves or tissues. 12. Replacement of existing restoration for any purpose other than active tooth decay. 13. Intravenous sedation, occlusal guards and complete occlusal adjustment. 14. Charges for replacement or repair of an orthodontic appliance paid in part or in full by this plan. 9 OTHER CHARGES Delta Dental's co-payment for your Benefits is shown in this Evidence of Coverage under the caption titled "YOUR BENEFITS." If dental services are provided by a Delta Dental Dentist or a Delta Dental PPO Dentist, you are responsible for your co-payment only. If the dental services you receive are provided by a dentist who is not a Delta Dental Dentist or Delta Dental PPO Dentist, you are responsible for the difference between the amount Delta Dental pays and the amount charged by the non-Delta Dental dentist. COVERED FEES It is to your advantage to select a dentist who is a Delta Dental Dentist, since a lower percentage of the dentist's fees may be covered by this plan if you select a dentist who is not a Delta Dental Dentist. A list of Delta Dental Dentists (see DEFINITIONS) is available in a directory at your group benefits office, or by calling 800-765-6003. Payment to a Delta Dental PPO Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, the dentist's accepted Usual, Customary and Reasonable Fee on file with Delta Dental, or a fee which the dentist has contractually agreed upon with Delta Dental to accept for treating enrollees under this plan. Payment to a Delta Dental Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the accepted fee that the dentist has on file with Delta Dental. Payment for services by a California dentist, or an out-of-state dentist, who is not a Delta Dental Dentist will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee that satisfies the majority of Delta Dental Dentists. Payment for services by a dentist located outside the United States will be based on the applicable percentage of the lesser of the Fee Actually Charged, or the fee that satisfies the majority of Delta Dental dentists. CHOICE OF DENTISTS AND PROVIDERS PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. Nearly 27,000 dentists in active practice in California are Delta Dental Dentists. About 16,000 of these Delta Dental Dentists are also Delta Dental PPO Dentists. You are free to choose any dentist for treatment, but it is to your advantage to choose a Delta Dental Dentist. This is because his or her fees are approved in advance by Delta Dental. Delta Dental Dentists have treatment forms on hand and will complete and submit the forms to Delta Dental free of charge. If you choose a Delta Dental PPO Dentist, you will receive all of the advantages of going to a Delta Dental Dentist, and you may have a higher level of Benefits for certain services. If you go to a non-Delta Dental Dentist, Delta Dental cannot assure you what percentage of the charged fee may be covered. Claims for services from non-Delta Dental Dentists may be submitted to Delta Dental at P.O. Box 997330, Sacramento, CA 95899-7330. Dentists located outside the United States are not Delta Dental Dentists. Claims submitted by out-of- country dentists are translated by Delta Dental staff and the currency is converted to U.S. dollars. Claims submitted by out-of-country dentists for patients residing in California are referred to Delta Dental's Quality Review department for processing. Delta Dental may require a clinical examination to determine the quality of the services provided, and Delta Dental may decline to reimburse you for Benefits if the services are found to be unsatisfactory. 10 • • A list of Delta Dental PPO Dentists and Delta Dental Dentists can be obtained by calling 800-765-6003. This list will identify those dentists who can provide care for individuals who have mobility impairments or have special health care needs. You can obtain specific information about Delta Dental PPO Dentists and Delta Dental Dentists by using our web site - www.deltadentalca.orq or calling the Delta Dental Customer Service department at the number listed on page 1. A printed list of the Delta Dental PPO Dentists and Delta Dental Dentists in your area is also available by calling 800-765-6003. Services from dental school clinics may be provided by students of dentistry or instructors who are not licensed by the state of California. Delta Dental shares the public and professional concern about the possible spread of HIV and other infectious diseases in the dental office. However, Delta Dental cannot ensure your dentist's use of precautions against the spread of such diseases, or compel your dentist to be tested for HIV or to disclose test results to Delta Dental, or to you. Delta Dental informs its panel dentists about the need for clinical precautions as recommended by recognized health authorities on this issue. If you should have questions about your dentist's health status or use of recommended clinical precautions, you should discuss them with your dentist. CONTINUITY OF CARE Current Enrollees: Current Enrollees Tray have the right to the benefit of completion of care with their terminated Delta Dental Dentist for certain specified dental conditions. Please call Delta Dental's Quality Assessment Department at 415-972-8300 to see if you may be eligible for this benefit. You may request a copy of the Delta Dental's Continuity of Care Policy. You must make a specific request to continue under the care of your terminated Delta Dental Dentist. We are not required to continue your care with that dentist if you are not eligible under our policy or if we cannot reach agreement with your terminated Delta Dental Dentist on the terms regarding your care in accordance with California law. New Enrollees: A new Enrollee may have the right to the qualified benefit of completion of care with their non-Delta Dental Dentist for certain specified dental conditions. Please call Delta Dental's Quality Assessment Department at 415-972-8300 to see if you may be eligible for this benefit. You may request a copy of the Delta Dental's Continuity of Care Policy. You must make a specific request to continue under the care of your current provider. We are not required to continue your care with that dentist if you are not eligible under our policy or if we cannot reach agreement with your non-Delta Dental Dentist on the terms regarding your care in accordance with California law. This policy does not apply to new enrollees of an individual subscriber contract. PUBLIC POLICY PARTICIPATION BY ENROLLEES Delta Dental's Board of Directors includes Enrollees who participate in establishing Delta Dental's public policy regarding Enrollees through periodic review of Delta Dental's Quality Assessment program reports and communications from Enrollees. Enrollees may submit any suggestions regarding Delta Dental's public policy in writing to: Delta Dental of California, Customer Service Department, P. O. Box 997330, Sacramento, CA 95899-7330. INTERNATIONAL DENTIST REFERRAL SERVICE You can receive your covered dental care when you are outside of the United States through a partnership between Delta Dental and International SOS Assistance, Inc. I-SOS provides referrals to 3,200 dentist or dental clinics in nearly 200 countries worldwide. English-speaking operators are available around the clock to help you find a dentist. For more information, check our web site at www.deltadentalca.org or call (800) 523-6586 from the US. Once you leave the US, you can call I-SOS at (215) 942-8226—collect. 11 • • When you see an I-SOS dentist, you must pay for your treatment at the time of service and get a detailed receipt from the dentist. In addition to providing the dentist's name and address (including country), this receipt should describe the services performed by the dentist and indicate the tooth or teeth that were treated. It should also indicate whether the dentist's charges were billed in U.S. dollars or another currency. Once we receive your claim, we will reimburse you subject to the terms and conditions of your Delta Dental coverage. Reimbursement is based on the out-of-network benefit provided through your group plan. As with any dental plan, this reimbursement may not cover the entire cost of the treatment rendered. • SAVING MONEY ON YOUR DENTAL BILLS You can keep your dental expenses down by practicing the following: 1. Compare the fees of different dentists; 2. Use a Delta Dental Dentist; 3. Have your dentist obtain predetermination from Delta Dental for any treatment over $300; 4. Visit your dentist regularly for checkups; 5. Follow your dentist's advice about regular brushing and flossing; 6. Avoid putting off treatment until you have a major problem; and 7. Learn the facts about overbilling. Under this plan, you must pay the dentist your copayment share (see YOUR BENEFITS). You may hear of some dentists who offer to accept insurance payments as "full payment." You should know that these dentists may do so by overcharging your plan and may do more work than you need, thereby increasing plan costs. You can help keep your dental Benefits intact by avoiding such schemes. YOUR FIRST APPOINTMENT During your first appointment, be sure to give your dentist the following information: 1. Your Delta Dental group number (on the front of this booklet); 2. The employer's name; 3. Primary Enrollee's ID number (which must also be used by Dependents); 4. Primary Enrollee's date of birth; 5. Any other dental coverage you may have. ACCESSIBILITY AND SERVICES FOR AFTER-HOURS AND URGENT CARE If you or a family member has special needs, you should ask your dentist about accessibility to their office or clinic at the time you call for an appointment. Your dentist will be able to tell you if their office is accessible taking into consideration the specific requirements of your needs. Routine or urgent care may be obtained from any licensed dentist during their normal office hours. Delta Dental does not require prior authorization before seeking treatment for urgent or after-hours care. You may plan in advance, for treatment for urgent, emergency or after-hours care by asking your dentist how 12 • • you can contact the dentist in the event you or a family member may need urgent care treatment or treatment after normal business hours. Many dentists have made prior arrangements with other dentists to provide care to you if treatment is immediately or urgently needed. You may also call the local dental society that is listed in your local telephone directory if your dentist is not available to refer you to another dentist for urgent, emergency or after-hours care. PREDETERMINATIONS After an examination, your dentist will talk to you about treatment you may need. The cost of treatment is something you may want to consider. If the service is extensive and involves crowns or bridges, or if the service will cost more than $300, we encourage you to ask your dentist to request a predetermination. A predetermination does not guarantee payment. It is an estimate of the amount Delta Dental will pay if you are eligible and meet all the requirements of your plan at the time the treatment you have planned is completed. In order to receive predetermination, your dentist must send a claim form to us listing the proposed treatment. Delta Dental will send your dentist a Notice of Predetermination that estimates how much you will have to pay. After you review the estimate with your dentist and decide to go ahead with the treatment plan, your dentist returns the statement to us for payment when treatment has been completed. Computations are estimates only and are based on what would be payable on the date the Notice of Predetermination is issued if the patient is eligible. Payment will depend on the patient's eligibility and the remaining annual Maximum when completed services are submitted to Delta Dental. Predetermining treatment helps prevent any misunderstanding about your financial responsibilities. If you have any concerns about the predetermination, let us know before treatment begins so your questions can be answered before you incur any charges. REIMBURSEMENT PROVISIONS A Delta Dentist will file the claim for you. You do not have to file a claim or pay Delta Dental's co-payment for covered services if provided by a Delta Dental Dentist. Delta Dental of California's agreement with our Delta Dental Dentists makes sure that you will not be responsible to the dentist for any money we owe. If the covered service is provided by a dentist who is not a Delta Dental Dentist, you are responsible for filing the claims and paying your dentist. Claims should be filed with Delta Dental of California at P. O. Box 997330, Sacramento, CA 95899-7330 and Delta Dental will reimburse you. However, if for any reason we fail to pay a dentist who is not a Delta Dental Dentist, you may be liable for that portion of the cost. Payments made to you are not assignable (in other words, we will not grant requests to pay non-Delta Dental Dentists directly). Payment for claims exceeding $500 for services provided by dentists located outside the United States may, at Delta Dental's option, be conditioned upon a clinical evaluation at Delta Dental's request (see Second Opinions). Delta Dental will not pay Benefits for such services if they are found to be unsatisfactory. Delta Dental does not pay Delta Dental Dentists any incentive as an inducement to deny, reduce, limit or delay any appropriate service. If you wish to know more about the method of reimbursement to Delta Dental Dentists, you may call Delta Dental's Customer Service department for more information. Payment for any Single Procedure that is a Covered Service will only be made upon completion of that procedure. Delta Dental does not make or prorate payments for treatment in progress or incomplete procedures. The date the procedure is completed governs the calculation of any Deductible (and determines when a charge is made against any Maximum) under your plan. 13 • • If there is a difference between what your dentist is charging you and what Delta Dental says your portion should be, or if you are not satisfied with the dental work you have received, contact Delta Dental's Customer Service department. We may be able to help you resolve the situation. Delta Dental may deny payment of a claim for services submitted more than 12 months after the date the services were provided. If a claim is denied due to a Delta Dental Dentist's failure to make a timely submission, you shall not be liable to that dentist for the amount which would have been payable by Delta Dental (unless you failed to advise the dentist of your eligibility at the time of treatment). The process Delta Dental uses to determine or deny payment for services is distributed to all Delta Dental Dentists. It describes in detail the dental procedures covered as Benefits, the conditions under which coverage is provided, and the limitations and exclusions applicable to the plan. Claims are reviewed for eligibility and are paid according to these processing policies. Those claims which require additional review are evaluated by Delta Dental's dentist consultants. If any claims are not covered, or if limitations or exclusions apply to services you have received from a Delta Dental Dentist, you will be notified by an adjustment notice on the Notice of Payment or Action. You may contact Delta Dental's Customer Service department for more information regarding Delta Dental's processing policies. Delta Dental uses a method called "first-in/first-out" to begin processing your claims. The date we receive your claim determines the order in which processing begins. For example, if you receive dental services in January and February, but we receive the February claim first, processing begins on the February claim first. Incomplete or missing data can affect the date the claim is paid. If all information necessary to complete claim processing has not been provided, payment could be delayed until any missing or incomplete data is received by Delta Dental. The order in which your claims are processed and paid by Delta Dental may also impact your annual maximum. For example, if a claim with a later date of service is paid and your annual maximum for the year has been reached then a claim with an earlier date of service in the same calendar year will not be paid. IF YOU HAVE QUESTIONS ABOUT SERVICES FROM A DELTA DENTAL DENTIST If you have questions about the services you receive from a Delta Dental Dentist, we recommend that you first discuss the matter with your dentist. If you continue to have concerns, call our Quality Review department at 800-765-6003. If appropriate, Delta Dental can arrange for you to be examined by one of our consulting dentists in your area. If the consultant recommends the work be replaced or corrected, Delta Dental will intervene with the original dentist to either have the services replaced or corrected at no additional cost to you or obtain a refund. In the latter case, you are free to choose another dentist to receive your full Benefit. SECOND OPINIONS Delta Dental obtains second opinions through Regional Consultant members of its Quality Review Committee who conduct clinical examinations, prepare objective reports of dental conditions, and evaluate treatment that is proposed or has been provided. Delta Dental will authorize such an examination prior to treatment when necessary to make a Benefits determination in response to a request for a Predetermination of treatment cost by a dentist. Delta Dental will also authorize a second opinion after treatment if an Enrollee has a complaint regarding the quality of care provided. Delta Dental will notify the Enrollee and the treating dentist when a second opinion is necessary and appropriate, and direct the Enrollee to the Regional Consultant selected by Delta Dental to perform the clinical examination. When Delta Dental authorizes a second opinion through a Regional Consultant, Delta Dental will pay for all charges. 14 • • Enrollees may otherwise obtain second opinions about treatment from any dentist they choose, and claims for the examination may be submitted to Delta Dental for payment. Delta Dental will pay such claims in accordance with the Benefits of the plan. This is only a summary of Delta Dental's policy on second opinions. A copy of Delta Dental's formal policy is available from Delta Dental's Customer Service department upon request. ORGAN AND TISSUE DONATION Donating organ and tissue provides many societal benefits. Organ and tissue donation allows recipients of transplants to go on to lead fuller and more meaningful lives. Currently, the need for organ transplants far exceeds availability. If you are interested in organ donation, please speak to your physician. Organ donation begins at the hospital when a patient is pronounced brain dead and identified as a potential organ donor. An organ procurement organization will become involved to coordinate the activities. GRIEVANCE PROCEDURE AND CLAIMS APPEAL If you have any questions about the services received from a Delta Dental Dentist, we recommend that you first discuss the matter with your Dentist. If you continue to have concerns, you may call or write us. We will provide notifications if any dental services or claims are denied, in whole or part, stating the specific reason or reasons for denial. Any questions of ineligibility should first be handled directly between you and your group. If you have any question or complaint regarding the denial of dental services or claims, the policies, procedures and operations of Delta Dental, or the quality of dental services performed by a Delta Dental Dentist, you may call us toll-free at 800-765-6003, contact us on our web site: www.deltadentalca.org or write us at P. O. Box 997330, Sacramento, CA 95899-7330, Attention: Customer Service Department. If your claim has been denied or modified, you may file a request for review (a grievance) with us within 180 days after receipt of the denial or modification. If in writing, the correspondence must include your group name and number, the Primary Enrollee's name and ID number, the inquirer's telephone number and any additional information that would support the claim for benefits. Your correspondence should also include a copy of the treatment form, Notice of Payment and any other relevant information. Upon request and free of charge, we will provide the Enrollee with copies of any pertinent documents that are relevant to the claim, a copy of any internal rule, guideline, protocol, and/or explanation of the scientific or clinical judgment if relied upon in denying or modifying the claim. Our review will take into account all information, regardless of whether such information was submitted or considered initially. Certain cases may be referred to one of our regional consultants, to a review committee of the dental society or to the state dental association for evaluation. Our review shall be conducted by a person who is neither the individual who made the original claim denial, nor the subordinate of such individual, and we will not give deference to the initial decision. If the review of a claim denial is based in whole or in part on a lack of medical necessity, experimental treatment, or a clinical judgment in applying the terms of the contract terms, we shall consult with a dentist who has appropriate training and experience. The identity of such dental consultant is available upon request. We will provide the Enrollee a written acknowledgement within five calendar days of receipt of the request for review. We will make a written decision within 30 calendar days of receipt of the request for review. We will respond, within three calendar days of receipt, to complaints involving severe pain and imminent and serious threat to a patient's health. You may file a complaint with the Department of Managed Health Care after you have completed Delta Dental's grievance procedure or after you have been involved in Delta Dental's grievance procedure for 30 calendar days. You may file a complaint with the Department immediately in an emergency situation, which is one involving severe pain and/or imminent and serious threat to the Enrollee's health. 15 • • The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against Delta Dental, your health plan, you should first telephone Delta Dental at 800-765-6003 and use Delta Dental's grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 calendar days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (888- HMO-2219) and a TDD line (877-688-9891) for the hearing and speech impaired. The department's Internet Web site (http://www.hmohelp.ca.gov) has complaint forms, IMR application forms and instructions online. IMR is generally not applicable to a dental plan, unless that dental plan covers services related to the practice of medicine or offered pursuant to a contract with a health plan providing medical, surgical or hospital services. If the group health plan is subject to the Employee Retirement Income Security Act of 1974 (ERISA), the Enrollee may contact the U.S. Department of Labor, Employee Benefits Security Administration (EBSA) for further review of the claim or if the Enrollee has questions about the rights under ERISA. The Enrollee may also bring a civil action under section 502(a) of ERISA. The address of the U.S. Department of Labor is: U.S. Department of Labor, Employee Benefits Security Administration (EBSA), 200 Constitution Avenue, N.W. Washington, D.C. 20210. IF YOU HAVE ADDITIONAL COVERAGE It is to your advantage to let your dentist and Delta Dental know if you have dental coverage in addition to this Delta Dental plan. Most dental carriers cooperate with one another to avoid duplicate payments, but still allow you to make use of both plans - sometimes paying 100% of your dental bill. For example, you might have some fillings that cost $100. If the primary carrier usually pays 80% for these services, it would pay $80. The secondary carrier might usually pay 50% for this service. In this case, since payment is not to exceed the entire fee charged, the secondary carrier pays the remaining $20 only. Since this method pays 100% of the bill, you have no out-of-pocket expense. Be sure to advise your dentist of all plans under which you have dental coverage and have him or her complete the dual coverage portion of the claim form, so that you will receive all benefits to which you are entitled. For further information, contact the Delta Dental Customer Service department at the number in the USING THIS BOOKLET section. OPTIONAL CONTINUATION OF COVERAGE (COBRA) Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely. The federal Consolidated Omnibus Budget Reconciliation Act (or COBRA, pertaining to certain employers having 20 or more employees) and the California Continuation Benefits Replacement Act (or Cal-COBRA, • pertaining to employers with two to 19 employees), both require that continued health care coverage be made available to "Qualified Beneficiaries" who lose health care coverage under the group plan as a result of a "Qualifying Event." You may be entitled to continue coverage under this plan, at your expense, if certain conditions are met. The period of continued coverage depends on the Qualifying Event and whether you are covered under federal COBRA or Cal-COBRA. 16 • • DEFINITIONS • The meaning of key terms used in this section are shown below and apply to both federal and Cal-COBRA. Qualified Beneficiary means: 1. You and/or your Dependents who are enrolled in the Delta Dental plan on the day before the Qualifying Event, or 2. A child who is born to or placed for adoption with you during the period of continued coverage, provided such child is enrolled within 30 days of birth or placement for adoption. Qualifying Event means any of the following events which, except for the election of this continued coverage, would result in a loss of coverage under the dental plan: Event 1. The termination of employment (other than termination for gross misconduct) or the reduction in work hours, by your employer; Event 2. Your death; Event 3. Your divorce or legal separation from your spouse; Event 4. Your Dependents' loss of dependent status under the plan; and Event 5. As to your Dependents only, your entitlement to Medicare. You means the Primary Enrollee. PERIODS OF CONTINUED COVERAGE UNDER FEDERAL COBRA Qualified Beneficiaries may continue coverage for 18 months following the month in which Qualifying Event 1 occurs. This 18-month period can be extended for a total of 29 months, provided: 1. A determination is made under Title II or Title XVI of the Social Security Act that an individual is disabled on the date of the Qualifying Event or becomes disabled at any time during the first 60 days of continued coverage; and • 2. Notice of the determination is given to the employer during the initial 18 months of continued coverage and within 60 days of the date of termination. This period of coverage will end on the first day of the month that begins more than 30 days after the date of the final determination that the disabled individual is no longer disabled. You must notify your employer or Delta Dental within 30 days of any such determination. If, during the 18-month continuation period resulting from Qualifying Event 1, your Dependents, who are Qualified Beneficiaries, experience Qualifying Events 2, 3, 4 or 5, they may choose to extend coverage for up to a total of 36 months (inclusive of the period continued under Qualifying Event 1). Your Dependents, who are Qualified Beneficiaries, may continue coverage for 36 months following the occurrence of Qualifying Events 2, 3, 4 or 5. 17 • • When an employer has filed for bankruptcy under Title II, United States Code, Benefits may be substantially reduced or eliminated for retired employees and their Dependents, or the surviving spouse of a deceased retired employee. If this Benefit reduction or elimination occurs within one year before or one year after filing, it is considered a Qualifying Event. If the Primary Enrollee is a retiree, and has lost coverage because of this Qualifying Event, he or she may choose to continue coverage until his or her death. The Primary Enrollee's Dependents who have lost coverage because of this Qualifying Event may choose to continue coverage for up to 36 months following the Primary Enrollee's death. PERIODS OF CONTINUED COVERAGE UNDER CAL-COBRA (groups of 2 - 19) In the case of Cal-COBRA, Delta Dental will act as the administrator. Notification and Premium payments should be made directly to Delta Dental. Notifications and payments should be delivered by first-class mail, certified mail or other reliable means of delivery. Individuals who are eligible for coverage under the federal COBRA law are not eligible for coverage under Cal-COBRA. The employer must notify Delta Dental in writing within 30 days of the date when the employer becomes subject to COBRA. Qualified Beneficiaries may continue coverage for 36 months following the month in which Qualifying Events 1, 2, 3, 4 or 5 occur. If, during the 36-month continuation period resulting from Qualifying Event 1, the Qualified Beneficiary is determined under Title II or Title XVI of the Social Security Act to be disabled on the date of the Qualifying Event or became disabled at any time during the first 60 days of continuation coverage, and notice of the determination is given to the employer during the initial period of continuation coverage and within 60 days of the date of the social security determination letter, the Qualified Beneficiary may continue coverage for a total of 36 months following the month in which Qualifying Event 1 occurs. This period of coverage will end on the first of the month that begins more than 30 days after the date of the final determination that the disabled individual is no longer disabled. The Qualified Beneficiary must notify the employer or administrator within 30 days of any such determination. If, during the 36-month continuation period resulting from Qualifying Event 1, the Qualified Beneficiary experiences Qualifying Events 2, 3, 4 or 5, he or she must notify the employer within 60 days of the second Qualifying Event and has a total of 36 months continuation coverage after the date of the first Qualifying Event. Delta Dental shall notify the Primary Enrollee of the date his or her continued coverage will terminate. This termination notification will be sent during the 180-day period prior to the end of coverage. ELECTION OF CONTINUED COVERAGE A Qualified Beneficiary will have 60 days from a Qualifying Event to give Delta Dental written notice of the election to continue coverage. Upon written notice, Delta Dental will provide a Qualified Beneficiary with the necessary Benefits information, monthly Premium charge, enrollment forms and instructions to allow election of continued coverage. Failure to provide this written notice of election to Delta Dental within 60 days will result in the loss of the right to continue coverage. A Qualified Beneficiary has 45 days from the written election of continued coverage to pay the initial Premium to Delta Dental, which includes the Premium for each month since the loss of coverage. Failure to pay the required Premium within the 45 days will result in the loss of the right to continue coverage, and any Premiums received after that will be returned to the Qualified Beneficiary. 18 • • CONTINUED COVERAGE BENEFITS The Benefits under the continued coverage will be the same as those provided to active employees and their Dependents who are still enrolled in the dental plan. If the employer changes the coverage for active employees, the continued coverage will change as well. Premiums will be adjusted to reflect the changes made. TERMINATION OF CONTINUED COVERAGE A Qualified Beneficiary's coverage will terminate at the end of the month in which any of the following events first occur: 1. The allowable number of consecutive months of continued coverage is reached; 2. Failure to pay the required Premiums in a timely manner; 3. The employer ceases to provide any group dental plan to its employees; 4. The individual first obtains coverage for dental Benefits, after the date of the election of continued coverage, under another group health plan (as an employee or Dependent) which does not contain or apply any exclusion or limitation with respect to any pre-existing condition of such a person, if that pre-existing condition is covered under this plan; or 5. Entitlement to Medicare. Once continued coverage ends, it cannot be reinstated. TERMINATION OF THE EMPLOYER'S DENTAL CONTRACT If the dental contract between the employer and Delta Dental terminates prior to the time that the continuation coverage would otherwise terminate, the employer shall notify a Qualified Beneficiary either 30 days prior to the termination or when all Enrollees are notified, whichever is later, of the ability to elect continuation of coverage under the employer's subsequent dental plan, if any. The continuation coverage will be provided only for the balance of the period that a Qualified Beneficiary would have remained covered under the Delta Dental plan had such plan with the former employer not terminated. The employer shall notify the successor plan in writing of the Qualified Beneficiaries receiving continuation coverage so they may be notified of how to continue coverage. The continuation coverage will terminate if a Qualified Beneficiary fails to comply with the requirements pertaining to enrollment in and payment of Premiums to the new group benefit plan. OPEN ENROLLMENT CHANGE OF COVERAGE A Qualified Beneficiary may elect to change continuation coverage during any subsequent open enrollment period, if the employer has contracted with another plan to provide coverage to its active employees. The continuation coverage under the other plan will be provided only for the balance of the period that a Qualified Beneficiary would have remained under the Delta Dental plan. NOTICE OF PRIVACY PRACTICES: CONFIDENTIALITY OF YOUR HEALTH CARE INFORMATION THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 19 • • This notice is required by law to tell you how Delta Dental of California and its affiliates ("Delta Dental") protect the confidentiality of your health care information in our possession. Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient's healthcare history; mental or physical condition; or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. Delta Dental receives, uses and discloses your PHI to administer your benefit plan or as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited. We must follow the privacy practices that are described in this notice, but also comply with any stricter requirements under federal or state law that may apply to our administration of your benefits. However, we may change this notice-and make the new notice effective for all of your PHI that we maintain. If we make any substantive changes to our privacy practices, we will promptly change this notice and redistribute to you within 60 days of the change to our practices. You may also request a copy of this notice anytime by contacting the address or phone number at the end of this notice. You should receive a copy of this notice at the time of enrollment in a Delta Dental program, and we will notify you of how you can receive a copy of this notice every three years. Permitted Uses and Disclosures of Your PHI We are permitted to use or disclose your PHI without your prior authorization for the following purposes. These permitted uses and/or disclosures include disclosures to you, uses and/or disclosures for purposes of health care treatment, payment of claims, billing of premiums, and other health care operations. If your benefit plan is sponsored by your employer or another party, we may provide PHI to your employer or that sponsor for purposes of administering your benefits. We may disclose PHI to third parties that perform services for Delta Dental in the administration of your benefits. These parties are required by law to sign a contract agreeing to protect the confidentiality of your PHI. Your PHI may be disclosed to an affiliate that performs services for Delta Dental in the administration of your benefits. These affiliates have implemented privacy policies and procedures and comply with applicable federal and state law. We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to notify or assist in notifying a family member, another person, or a personal representative of your condition, to assist in disaster relief efforts, and to report victims of abuse, neglect, or domestic violence. Other permitted uses and/or disclosures are for purposes of health oversight by government agencies, judicial, administrative, or other law enforcement purposes, information about decedents to coroners, medical examiners and funeral directors, for research purposes, for organ donation purposes, to avert a serious threat to health or safety, for specialized government functions such as military and veterans activities, for workers compensation purposes, and for use in creating summary information that can no longer be traced to you. Additionally, with certain restrictions, we are permitted to use and/or disclose your PHI for underwriting. We are also permitted to incidentally use and/or disclose your PHI during the course of a permitted use and/or disclosure, but we must attempt to keep incidental uses and/or disclosures to a minimum. We use administrative, technical, and physical safeguards to maintain the privacy of your PHI, and we must limit the use and/or disclosure of your PHI to the minimum amount necessary to accomplish the purpose of the use and/or disclosure. Examples of Uses and Disclosures of Your PHI for Treatment, Payment or Healthcare Operations Such activities may include but are not limited to: processing your claims, collecting enrollment information and premiums, reviewing the quality of health care you receive, providing customer service, resolving your grievances, and sharing payment information with other insurers. Additional examples • include the following. • Uses and/or disclosures of PHI in facilitating treatment. For example, Delta Dental may use or disclose your PHI to determine eligibility for services requested by your provider. 20 • • • Uses and/or disclosures of PHI for payment. For example, Delta Dental may use and disclose your PHI to bill you or your plan sponsor. • Uses and/or disclosures of PHI for health care operations. For example, Delta Dental may use and disclose your PHI to review the quality of care provided by our network of providers. Disclosures Without an Authorization We are required to disclose your PHI to you or your authorized personal representative (with certain exceptions), when required by the U. S. Secretary of Health and Human Services to investigate or determine our compliance with law, and when otherwise required by law. Delta Dental may disclose your PHI without your prior authorization in response to the following: • Court order; • Order of a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority; • Subpoena in a civil action; • Investigative subpoena of a government board, commission, or agency; • Subpoena in an arbitration; • Law enforcement search warrant; or • Coroner's request during investigations Disclosures Delta Dental Makes With Your Authorization Delta Dental will not use or disclose your PHI without your prior authorization if the law requires your authorization. You can later revoke that authorization in writing to stop any future use and disclosure. The authorization will be obtained from you by Delta Dental or by a person requesting your PHI from Delta Dental. Your Rights Regarding PHI You have the right to request an inspection of and obtain a copy of your PHI. You may access your PHI by contacting the appropriate Delta Dental office. You must include (1) your name, address, telephone number and identification number and (2) the PHI you are requesting. Delta Dental may charge a reasonable fee for providing you copies of your PHI. Delta Dental will only maintain that PHI that we obtain or utilize in providing your health care benefits. Most PHI, such as treatment records or X-rays, is returned by Delta Dental to the dentist after we have completed our review of that information. You may need to contact your health care provider to obtain PHI that Delta Dental does not possess. You may not inspect or copy PHI compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or PHI that is otherwise not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact the privacy office as noted below if you have questions about access to your PHI. You have the right to request a restriction of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. You have the right to correct or update your PHI. This means that you may request an amendment of PHI about you for as long as we maintain this information. In certain cases we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. 21 If your PHI was sent to us by another, we may refer you to that person to amend your PHI. For example, we may refer you to your dentist to amend your treatment chart or to your employer, if applicable, to amend your enrollment information. Please contact the privacy office as noted below if you have questions about amending your PHI. You have the right to request or receive confidential communications from us by alternative means or at a different address. We will agree to a reasonable request if you tell us that disclosure of your PHI could endanger you. You may be required to provide us with a statement of possible danger, a different address, another method of contact or information as to how payment will be handled. Please make this request in writing to the privacy office as noted below. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right does not apply to disclosures for purposes of treatment, payment, or health care operations or for information we disclosed after we received a valid authorization from you. Additionally, we do not need to account for disclosures made to you, to family members or friends involved in your care, or for notification purposes. We do not need to account for disclosures made for national security reasons or certain law enforcement purposes, disclosures made as part of a limited data set, incidental disclosures, or disclosures made prior to April 14, 2003. Please contact the privacy office as noted below if you would like to receive an accounting of disclosures or if you have questions about this right. You have the right to get this notice by e-mail. You have the right to get a copy of this notice by e- mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice. • Complaints You may complain to us or to the U. S. Secretary of Health and Human Services if you believe that Delta Dental has violated your privacy rights. You may file a complaint with us by notifying the privacy office as noted below. We will not retaliate against you for filing a complaint. Contacts Delta Dental of California offers and administers fee-for-service dental programs for groups headquartered in the state of California. You may contact the Privacy Department at the address and telephone number listed below for further information about the complaint process or any of the information contained in this notice. Delta Dental Subscriber Services P.O. Box 997330 Sacramento, CA 95899-7330 (877) 335-8273 This notice is effective on and after July 1, 2006. 11-07 VT 22 • • AMENDMENT NO. 5 TO AGREEMENT RENEWAL GROUP #7809 AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2010, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on January 1, 2010, and ending on December 31, 2010 and each subsequent yearly period during which this Contract remains in effect. Sub - paragraph 1 of Paragraph 3.1 is amended to read: 3.1 Within 10 days after receipt of Delta Dental's invoice, the Contractholder agrees to pay the following monthly Premiums to Delta Dental, at the address shown on the first page of this Contract, for all of the Contractholder's Primary Enrollees and their Dependents who are Enrollees as set forth in Article 2 of this Contract: $49.03 for each Primary Enrollee without Dependents; $91.83 for each Primary Enrollee with one enrolled Dependent; and $136.44 for each Primary Enrollee with two or more enrolled Dependents. Paragraph 8.7 is hereby deleted. URF #933629 1 CITY OF SEAL BEACH DELTA DENTAL GROUP #7809 Date Amendment Signed: &'i i By: GLZt 4 /<'- cc,A Cl Signature /OA N e Y &A- 1.5 Printed Name ,1/?-,o4 & 7''2 7 / -, ),4 - Y5 % Title DATE: October 26, 2009 DELTA DENTAL OF CALIFORNIA 111#1144 Belinda Martinez Senior Vice President Sales /Marketing Kenneth E. Bernardi Vice President Underwriting & Actuarial URF #933629 2 • • CITY OF SEAL BEACH DELTA DENTAL GROUP #7809 Date Amendment Signed: i2_C-1-1 X11 a o / o By: // "Lc ` CJ Signature N f N e / /C_i4 LS nt-Al Printed Name , 134-&-& m ax7> n-.-/4 L YS % Title DATE: October 26, 2009 DELTA DENTAL-OF CALIFORNIA A Belinda Martinez Senior Vice President Sales/Marketing 47, Kenneth E. Bernardi Vice President Underwriting & Actuarial URF#933629 2 . . AMENDMENT NO. 6 TO AGREEMENT RENEWAL GROUP #7809 AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2011, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on January 1, 2011, and ending on December 31, 2011 and each subsequent yearly period during which this Contract remains in effect. Sub - paragraph 2 of Paragraph 3.1 is amended to read: $51.37 for each Primary Enrollee with no enrolled Dependents; $96.22 for each Primary Enrollee with one enrolled Dependent; and $142.96 for each Primary Enrollee with two or more enrolled Dependents. Sub - paragraph 7 of paragraph 4.3, Adjunctive General Services, is amended to include: I.V. Sedation Paragraphs 4.7 (b) is amended to read: (b) Delta Dental pays for full -mouth x -rays only after five years have elapsed since any prior set of full -mouth x -rays was provided under any Delta Dental plan. Delta Dental pays for a panoramic x -ray provided as an individual service only after five years have elapsed since any prior panoramic x -ray was provided under any Delta Dental plan. Paragraph 4.8 (i) is amended to read: (i) Charges for anesthesia, other than general anesthesia or I.V. sedation administered by a licensed Dentist in connection with covered Oral Surgery services and select Endodontic and Periodontic procedures. Paragraph 4.8 (n) is amended to read: (n) Occlusal guards and complete occlusal adjustment. Appendix B, CODE ON DENTAL PROCEDURES AND NOMENCLATURE, attached hereto, is hereby amended. #1163635 i • • CITY OF SEAL BEACH DELTA DENTAL GROUP #7809 Date Amendment Signed: 424ff) 1/) )-12/7 By: / Za Signature /VA-Aid-7 'C 6-9 r77J Printed Name /'2-t u4-6-6/4'LL7U% /1-A JA-c-75- Title DATE: March 30, 2011 DELTA DENTAL OF CALIFORNIA Belinda Martinez Senior Vice President Sales/Marketing r ((el' Kevin Jackson Group Vice President Underwriting & Actuarial #1163635 1� APPENDIX B CODE ON DENTAL PROCEDURES AND NOMENCLATURE NOTE: All the listed procedures may not be benefits under the terms of your contract. Refer to your contract for your specific benefits. DO100 - D0999 DIAGNOSTIC • Clinical oral evaluations D0120 Periodic oral evaluation - established patient D0140 Limited oral evaluation — problem focused D0145 Oral evaluation for a patient under three years of age and counseling with primary caregiver D0150 Comprehensive oral evaluation — new or established patient D0160 Detailed and extensive oral evaluation — problem focused, by report D0170 Re-evaluation — limited, problem focused (established patient; not post-operative visit) D0180 Comprehensive periodontal evaluation — new or established patient Radiographs/diagnostic imaging (including interpretation) D0210 Intraoral — complete series (including bitewings) D0220 Intraoral — periapical first film D0230 Intraoral — periapical each additional film D0240 Intraoral — occlusal film D0250 Extraoral — first film 00260 Extraoral — each additional film D0270 Bitewing — single film D0272 Bitewings — two films 00273 Bitewings - three films 00274 Bitewings — four films D0277 Vertical bitewings — 7 to 8 films D0290 Posterior — anterior or lateral skull and facial bone survey film 00310 Sialography D0320 Temporomandibular joint arthrogram, including injection D0321 Other temporomandibular joint films, by report D0322 Tomographic survey D0330 Panoramic film D0340 Cephalometric film 00350 Oral/facial photographic images 00360 Cone beam ct - craniofacial data capture D0362 Cone beam - two-dimensional image reconstruction using existing data, includes multiple images D0363 Cone beam - three-dimensional image reconstruction using existing data, includes multiple images Tests and examinations D0415 Collection of microorganisms for culture and sensitivity D0416 Viral culture D0421 Genetic test for susceptibility to oral diseases D0425 Caries susceptibility tests D0431 Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and malignant lesions, not to include cytology or biopsy procedures D0460 Pulp vitality tests D0470 Diagnostic casts CDT2011 (Eff. 01-01-11) Oral pathology laboratory D0472 Accession of tissue, gross examination, preparation and transmission of written report D0473 Accession of tissue, gross and microscopic examination, preparation and transmission of written report D0474 Accession of tissue, gross and microscopic examination; including assessment of surgical margins for presence of disease, preparation and transmission of written report D0475 Decalcification procedure D0476 Special stains for microorganisms D0477 Special stains, not for microorganisms D0478 Immunohistochemical stains D0479 Tissue in-situ hybridization, including interpretation 00480 Accession of exfoliative cytologic smears, microscopic examination, preparation and transmission of written report D0481 Electron microscopy - diagnostic D0482 Direct immunofluorescence D0483 Indirect immunofluorescence D0484 Consultation on slides prepared elsewhere 00485 Consultation, including preparation of slides from biopsy material supplied by referring source D0486 Accession of brush biopsy sample, microscopic examination, preparation and transmission of written report D0502 Other oral pathology procedures, by report D0999 Unspecified diagnostic procedure, by report D1000 - D1999 PREVENTIVE Dental prophylaxis D1110 Prophylaxis — adult D1120 Prophylaxis — child through age 13 Topical fluoride treatment (office procedure) D1203 Topical application of fluoride (prophylaxis not included) — child through age 13 D1204 Topical application of fluoride (prophylaxis not included) — adult D1206 Topical fluoride varnish; therapeutic application for moderate to high caries risk patients Other preventive services D1310 Nutritional counseling for control of dental disease D1320 Tobacco counseling for the control and prevention of oral disease D1330 Oral hygiene instructions D1351 Sealant — per tooth D1352 Preventive resin restoration in a moderate to high caries risk patient - permanent tooth Space maintenance (passive appliances) D1510 Space maintainer — fixed — unilateral D1515 Space maintainer — fixed — bilateral D1520 Space maintainer — removable — unilateral D1525 Space maintainer — removable — bilateral D1550 Recementation of space maintainer D1555 Removal of fixed space maintainer D2000 - D2999 RESTORATIVE Amalgam restorations (including polishing) D2140 Amalgam — one surface, primary or permanent D2150 Amalgam — two surfaces, primary or permanent D2160 Amalgam — three surfaces, primary or permanent D2161 Amalgam — four or more surfaces, primary or permanent • CDT2011 (Eff. 01-01-11) Resin-based composite restorations-direct D2330 Resin-based composite — one surface, anterior D2331 Resin-based composite — two surfaces, anterior D2332 Resin-based composite — three surfaces, anterior D2335 Resin-based composite — four or more surfaces or involving incisal angle (anterior) D2390 Resin-based composite crown, anterior D2391 Resin-based composite — one surface, posterior D2392 Resin-based composite — two surfaces, posterior D2393 Resin-based composite — three surfaces, posterior D2394 Resin-based composite — four or more surfaces, posterior Gold foil restorations D2410 Gold foil — one surface D2420 Gold foil — two surfaces D2430 Gold foil — three surfaces Inlay/onlay restorations D2510 Inlay — metallic — one surface D2520 Inlay — metallic — two surfaces D2530 Inlay — metallic — three or more surfaces D2542 Onlay — metallic — two surfaces D2543 Onlay — metallic — three surfaces D2544 Onlay — metallic — four or more surfaces D2610 Inlay — porcelain/ceramic — one surface D2620 Inlay — porcelain/ceramic — two surfaces D2630 Inlay — porcelain/ceramic — three or more surfaces D2642 Onlay — porcelain/ceramic — two surfaces D2643 Onlay — porcelain/ceramic — three surfaces D2644 Onlay — porcelain/ceramic — four or more surfaces D2650 Inlay — resin-based composite — one surface D2651 Inlay — resin-based composite — two surfaces D2652 Inlay — resin-based composite — three or more surfaces D2662 Onlay — resin-based composite — two surfaces D2663 Onlay — resin-based composite — three surfaces D2664 Onlay — resin-based composite — four or more surfaces Crowns — single restorations only D2710 Crown — resin-based composite (indirect) D2712 Crown — 3/4 resin-based composite (indirect) D2720 Crown — resin with high noble metal D2721 Crown — resin with predominantly base metal D2722 Crown — resin with noble metal D2740 Crown — porcelain/ceramic substrate D2750 Crown — porcelain fused to high noble metal D2751 Crown — porcelain fused to predominantly base metal D2752 Crown — porcelain fused to noble metal • D2780 Crown — 3/4 cast high noble metal D2781 Crown — 3/4 cast predominantly base metal D2782 Crown — 3/4 cast noble metal D2783 Crown — 3/4 porcelain/ceramic D2790 Crown — full cast high noble metal D2791 Crown — full cast predominantly base metal D2792 Crown — full cast noble metal D2794 Crown — titanium D2799 Provisional crown CDT2011 (Eff. 01-01-n) Other restorative services D2910 Recement inlay, onlay, or partial coverage restoration D2915 Recement cast or prefabricated post and core D2920 Recement crown D2930 Prefabricated stainless steel crown — primary tooth D2931 Prefabricated stainless steel crown — permanent tooth D2932 Prefabricated resin crown D2933 Prefabricated stainless steel crown with resin window D2934 Prefabricated esthetic coated stainless steel crown — primary tooth D2940 Sedative filling D2950 Core buildup, including any pins D2951 Pin retention — per tooth, in addition to restoration D2952 Post and core in addition to crown, indirectly fabricated D2953 Each additional indirectly fabricated post — same tooth D2954 Prefabricated post and core in addition to crown D2955 Post removal (not in conjunction with endodontic therapy) D2957 Each additional prefabricated post — same tooth D2960 Labial veneer (resin laminate) — chairside D2961 Labial veneer (resin laminate) — laboratory D2962 Labial veneer (porcelain laminate) — laboratory D2970 Temporary crown (fractured tooth) D2971 Additional procedures to construct new crown under existing partial denture framework D2975 Coping D2980 Crown repair, by report • D2999 Unspecified restorative procedure, by report D3000 - D3999 ENDODONTICS Pulp capping D3110 Pulp cap — direct (excluding final restoration) D3120 Pulp cap — indirect (excluding final restoration) Pulpotomy D3220 Therapeutic pulpotomy (excluding final restoration) — removal of pulp coronal to the dentinocemental junction and application of medicament D3221 Pulpal debridement, primary and permanent teeth D3222 Partial pulpotomy for apexogenesis-permanent tooth with incomplete root development D3230 Pulpal therapy (resorbable filling) — anterior, primary tooth (excluding final restoration) D3240 Pulpal therapy (resorbable filling) — posterior, primary tooth (excluding final restoration) Endodontic therapy on primary teeth (including treatment plan, clinical procedures and follow- up tare) D3310 Endodontic therapy, anterior tooth (excluding final restoration) D3320 Endodontic therapy, bicuspid tooth (excluding final restoration) D3330 Endodontic therapy, molar tooth (excluding final restoration) D3331 Treatment of root canal obstruction; non-surgical access D3332 Incomplete endodontic therapy; inoperable; unrestorable or fractured tooth D3333 Internal root repair of perforation defects Endodontic retreatment D3346 Retreatment of previous root canal therapy — anterior D3347 Retreatment of previous root canal therapy — bicuspid D3348 Retreatment of previous root canal therapy — molar CDT2011 (Eff. 01-01-11) Apexification/recalcification procedures D3351 Apexification/recalcification/pupal regeneration — initial visit (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) D3352 Apexification/recalcification/pulpal regeneration — interim medication replacement (apical closure/calcific repair of perforations, root resorption, pulpal space disinfection, etc.) D3353 Apexification/recalcification — final visit (includes completed root canal therapy — apical closure/calcific repair of perforations, root resorption, etc.) Apicoectomy/periradicular services D3410 Apicoectomy/periradicular surgery — anterior D3421 Apicoectomy/periradicular surgery — bicuspid (first root) D3425 Apicoectomy/periradicular surgery — molar (first root) D3426 Apicoectomy/periradicular surgery (each additional root) D3430 Retrograde filling — per root D3450 Root amputation — per root D3460 Endodontic endosseous implant D3470 Intentional reimplantation (including necessary splinting) Other endodontic procedures D3910 Surgical procedure for isolation of tooth with rubber dam D3920 Hemisection (including any root removal), not including root canal therapy D3950 Canal preparation and fitting of preformed dowel or post D3999 Unspecified endodontic procedure, by report D4000 — D4999 PERIODONTICS Surgical services (including usual post-operative care) D4210 Gingivectomy or gingivoplasty — four or more contiguous teeth or bounded teeth spaces per quadrant D4211 Gingivectomy or gingivoplasty — one to three contiguous teeth or bounded teeth spaces per quadrant D4230 Anatomical crown exposure - four or more contiguous teeth per quadrant D4231 Anatomical crown exposure - one to three teeth per quadrant D4240 Gingival flap procedure, including root planing — four or more contiguous teeth or bounded teeth spaces per quadrant D4241 Gingival flap procedure, including root planing — one to three contiguous teeth or bounded teeth spaces per quadrant D4245 Apically positioned flap • D4249 Clinical crown lengthening — hard tissue D4260 Osseous surgery (including flap entry and closure) — four or more contiguous teeth or bounded teeth spaces per quadrant • D4261 Osseous surgery (including flap entry and closure) — one to three contiguous teeth or bounded teeth spaces per quadrant D4263 Bone replacement graft — first site in quadrant D4264 Bone replacement graft — each additional site in quadrant D4265 Biologic materials to aid in soft and osseous tissue regeneration D4266 Guided tissue regeneration — resorbable barrier, per site D4267 Guided tissue regeneration — nonresorbable barrier, per site (includes membrane removal) D4268 Surgical revision procedure, per tooth D4270 Pedicle soft tissue graft procedure D4271 Free soft tissue graft procedure (including donor site surgery) D4273 Subepithelial connective tissue graft procedures, per tooth D4274 Distal or proximal wedge procedure (when not performed in conjunction with surgical procedures in the same anatomical area) D4275 Soft tissue allograft D4276 Combined connective tissue and double pedicle graft, per tooth CDT2011 (Eff. 01-01-11) Non-surgical periodontal service D4320 Provisional splinting — intracoronal D4321 Provisional splinting — extracoronal D4341 Periodontal scaling and root planing — four or more teeth per quadrant D4342 Periodontal scaling and root planing, — one to three teeth, per quadrant D4355 Full mouth debridement to enable comprehensive evaluation and diagnosis D4381 Localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth, by report Other periodontal services D4910 Periodontal maintenance D4920 Unscheduled dressing change (by someone other than treating dentist) D4999 Unspecified periodontal procedure, by report D5000 — D5899 PROSTHODONTICS (REMOVABLE) Complete dentures (including routine post-delivery care) D5110 Complete denture — maxillary D5120 Complete denture — mandibular D5130 Immediate denture — maxillary 05140 Immediate denture — mandibular Partial dentures (including routine post-delivery care) D5211 Maxillary partial denture — resin base (including any conventional clasps, rests and teeth) D5212 Mandibular partial denture — resin base (including any conventional clasps, rests and teeth) D5213 Maxillary partial denture — cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5214 Mandibular partial denture — cast metal framework with resin denture bases (including any conventional clasps, rests and teeth) D5225 Maxillary partial denture — flexible base (including any clasps, rests and teeth) D5226 Mandibular partial denture — flexible base (including any clasps, rests and teeth) D5281 Removable unilateral partial denture — one piece cast metal (including clasps and teeth) Adjustments to dentures D5410 Adjust complete denture — maxillary D5411 Adjust complete denture — mandibular D5421 Adjust partial denture — maxillary D5422 Adjust partial denture — mandibular Repairs to complete dentures D5510 Repair broken complete denture base D5520 Replace missing or broken teeth — complete denture (each tooth) Repairs to partial dentures D5610 Repair resin denture base D5620 Repair cast framework D5630 Repair or replace broken clasp D5640 Replace broken teeth — per tooth D5650 Add tooth to existing partial denture D5660 Add clasp to existing partial denture D5670 Replace all teeth and acrylic on cast metal framework (maxillary) D5671 Replace all teeth and acrylic on cast metal framework (mandibular) Denture rebase procedures D5710 Rebase complete maxillary denture D5711 Rebase complete mandibular denture D5720 Rebase maxillary partial denture D5721 Rebase mandibular partial denture CDT2011 (Eff. 01-01-11) • Denture reline procedures D5730 Reline complete maxillary denture (chairside) D5731 Reline complete mandibular denture (chairside) D5740 Reline maxillary partial denture (chairside) D5741 Reline mandibular partial denture (chairside) D5750 Reline complete maxillary denture (laboratory) D5751 Reline complete mandibular denture (laboratory) D5760 Reline maxillary partial denture (laboratory) D5761 Reline mandibular partial denture (laboratory) Interim prosthesis D5810 Interim complete denture (maxillary) 05811 Interim complete denture (mandibular) D5820 Interim partial denture (maxillary) D5821 Interim partial denture (mandibular) Other removable prosthetic services D5850 Tissue conditioning — maxillary D5851 Tissue conditioning — mandibular D5860 Overdenture — complete, by report D5861 Overdenture — partial, by report D5862 Precision attachment, by report D5867 Replacement of replaceable part of semi-precision or precision attachment (male or female component) D5875 Modification of removable prosthesis following implant surgery D5899 Unspecified removable prosthodontic procedure, by report D5900 — D5999 MAXILLOFACIAL PROSTHETICS D5911 Facial moulage (sectional) D5912 Facial moulage (complete) D5913 Nasal prosthesis D5914 Auricular prosthesis D5915 Orbital prosthesis D5916 Ocular prosthesis D5919 Facial prosthesis D5922 Nasal septal prosthesis D5923 Ocular prosthesis, interim D5924 Cranial prosthesis D5925 Facial augmentation implant prosthesis D5926 Nasal prosthesis, replacement D5927 Auricular prosthesis, replacement D5928 Orbital prosthesis, replacement D5929 Facial prosthesis, replacement D5931 Obturator prosthesis, surgical D5932 Obturator prosthesis, definitive D5933 Obturator prosthesis, modification D5934 Mandibular resection prosthesis with guide flange D5935 Mandibular resection prosthesis without guide flange D5936 Obturator prosthesis, interim D5937 Trismus appliance (not for TMD treatment) D5951 Feeding aid D5952 Speech aid prosthesis, pediatric D5953 Speech aid prosthesis, adult D5954 Palatal augmentation prosthesis D5955 Palatal lift prosthesis, definitive D5958 Palatal lift prosthesis, interim CDT2011 (Eff. 01-01-11) D5959 Palatal lift prosthesis, modification D5960 Speech aid prosthesis, modification D5982 Surgical stent D5983 Radiation carrier D5984 Radiation shield D5985 Radiation cone locator D5986 Fluoride gel carrier D5987 Commissure splint D5988 Surgical splint D5999 Unspecified maxillofacial prosthesis, by report D6000 – D6199 IMPLANT SERVICES D6010 Surgical placement of implant body: endosteal implant D6012 Surgical placement of interim implant body for transitional prosthesis: endosteal implant D6040 Surgical placement: eposteal implant D6050 Surgical placement: transosteal implant Implant supported prosthetics D6053 Implant/abutment supported removable denture for completely edentulous arch D6054 Implant/abutment supported removable denture for partially edentulous arch D6055 Dental implant supported connecting bar D6056 Prefabricated abutment — includes placement D6057 Custom abutment — includes placement D6058 Abutment supported porcelain/ceramic crown D6059 Abutment supported porcelain fused to metal crown (high noble metal) D6060 Abutment supported porcelain fused to metal crown (predominantly base metal) D6061 Abutment supported porcelain fused to metal crown (noble metal) D6062 Abutment supported cast metal crown (high noble metal) D6063 Abutment supported cast metal crown (predominantly base metal) D6064 Abutment supported cast metal crown (noble metal) D6065 Implant supported porcelain/ceramic crown D6066 Implant supported porcelain fused to metal crown (titanium, titanium alloy, high noble metal) D6067 Implant supported metal crown (titanium, titanium alloy, high noble metal) 06068 Abutment supported retainer for porcelain/ceramic FPD D6069 Abutment supported retainer for porcelain fused to metal FPD (high noble metal) D6070 Abutment supported retainer for porcelain fused to metal FPD (predominantly base metal) D6071 Abutment supported retainer for porcelain fused to metal FPD (noble metal) D6072 Abutment supported retainer for cast metal FPD (high noble metal) D6073 Abutment supported retainer for cast metal FPD (predominantly base metal) D6074 Abutment supported retainer for cast metal FPD (noble metal) D6075 Implant supported retainer for ceramic FPD D6076 Implant supported retainer for porcelain fused to metal FPD (titanium, titanium alloy, or high noble metal) D6077 Implant supported retainer for cast metal FPD (titanium, titanium alloy, or high noble metal) D6078 Implant/abutment supported fixed denture for completely edentulous arch D6079 Implant/abutment supported fixed denture for partially edentulous arch Other implant services D6080 Implant maintenance procedures, including removal of prosthesis, cleansing of prosthesis and abutments and reinsertion of prosthesis D6090 Repair implant supported prosthesis, by report D6091 Replacement of semi-precision or precision attachment (male or female component) of implant/abutment supported prosthesis, per attachment D6092 Recement implant/abutment supported crown D6094 Abutment supported crown — (titanium) CDT2011 (Eff. 01-01-11) D6095 Repair implant abutment, by report D6100 Implant removal, by report D6190 Radiographic/surgical implant index, by Report D6093 Recement implant/abutment supported fixed partial denture D6194 Abutment supported retainer crown for FPD — (titanium) D6199 Unspecified implant procedure, by report D6200 m D6999 PROSTHODONTICS, FIXED (Each retainer and each pontic constitutes a unit in a fixed partial denture) Fixed partial denture pontics D6205 Pontic — indirect resin based composite D6210 Pontic — cast high noble metal D6211 Pontic — cast predominantly base metal D6212 Pontic — cast noble metal D6214 Pontic — titanium D6240 Pontic — porcelain fused to high noble metal D6241 Pontic — porcelain fused to predominantly base metal D6242 Pontic — porcelain fused to noble metal D6245 Pontic — porcelain/ceramic D6250 Pontic — resin with high noble metal D6251 Pontic — resin with predominantly base metal D6252 Pontic — resin with noble metal D6253 Provisional pontic Fixed partial denture retainers — inlays/ onlays D6545 Retainer — cast metal for resin bonded fixed prosthesis D6548 Retainer — porcelain/ceramic for resin bonded fixed prosthesis D6600 Inlay — porcelain/ceramic, two surfaces D6601 Inlay — porcelain/ceramic, three or more surfaces D6602 Inlay — cast high metal, two surfaces D6603 Inlay — cast high.metal, three or more surfaces D6604 Inlay — cast predominantly base metal, two surfaces 06605 Inlay — cast predominantly base metal, three or more surfaces D6606 Inlay — cast noble metal, two surfaces D6607 Inlay — cast noble metal, three or more surfaces D6608 Onlay — porcelain/ceramic, two surfaces D6609 Onlay — porcelain/ceramic, three or more surfaces D6610 Onlay — cast high noble metal, two surfaces D6611 Onlay — cast high noble metal, three or more surfaces D6612 Onlay — cast predominantly base metal, two surfaces D6613 Onlay — cast predominantly base metal, three or more surfaces D6614 Onlay — cast noble metal, two surfaces D6615 Onlay — cast noble metal, three or more surfaces D6624 Inlay — titanium D6634 Onlay — titanium Fixed partial denture retainers — crowns D6710 Crown — indirect resin based composite D6720 Crown — resin with high noble metal D6721 Crown — resin with predominantly base metal D6722 Crown — resin with noble metal D6740 Crown — porcelain/ceramic D6750 Crown — porcelain fused to high noble metal D6751 Crown — porcelain fused to predominantly base metal D6752 Crown — porcelain fused to noble metal 06780 Crown — 3/4 cast high noble metal CDT2011 (Eff. 01-01-11) D6781 Crown — 3/4 cast predominantly base metal D6782 Crown — 3/4 cast noble metal D6783 Crown — 3/4 porcelain/ceramic D6790 Crown — full cast high noble metal D6791 Crown — full cast predominantly base metal D6792 Crown — full cast noble metal D6793 Provisional retainer crown D6794 Crown — titanium Other fixed partial denture services D6920 Connector bar D6930 Recement fixed partial denture D6940 Stress breaker D6950 Precision attachment D6970 Post and core in addition to fixed partial denture retainer, indirectly fabricated D6972 Prefabricated post and core in addition to fixed partial denture retainer D6973 Core buildup for retainer, including any pins D6975 Coping — metal D6976 Each additional indirectly fabricated post — same tooth D6977 Each additional prefabricated post — same tooth D6980 Fixed partial denture repair, by report D6985 Pediatric partial denture, fixed D6999 Unspecified, fixed prosthodontic procedure, by report D7000 — D7999 ORAL AND MAXILLOFACIAL SURGERY Extractions (includes local anesthesia, suturing, if needed, and routine postoperative care) D7111 Extraction, coronal remnants — deciduous tooth 07140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) Surgical extractions (includes local anesthesia, suturing, if needed, and routine postoperative care) D7210 Surgical removal of erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated D7220 Removal of impacted tooth — soft tissue D7230 Removal of impacted tooth — partially bony D7240 Removal of impacted tooth — completely bony D7241 Removal of impacted tooth — completely bony, with unusual surgical complications D7250 Surgical removal of residual tooth roots (cutting procedure) Other surgical procedures D7260 Oroantral fistual closure D7261 Primary closure of a sinus perforation D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth D7272 Tooth transplantation (includes reimplantation from one site to another and splinting and/or stabilization) D7280 Surgical access of an unerupted tooth D7282 Mobilization of erupted or malpositioned tooth to aid eruption D7283 Placement of device to facilitate eruption of impacted tooth D7285 Biopsy of oral tissue — hard (bone, tooth) D7286 Biopsy of oral tissue — soft D7287 Exfoliative cytological sample collection D7288 Brush biopsy — transepithelial sample collection 07290 Surgical repositioning of teeth D7291 Transseptal fiberotomy/supra crestal fiberotomy, by report D7292 Surgical placement: temporary anchorage device [screw retained plate] requiring surgical flap CDT2011 (Eff. 01-01-11) D7293 Surgical placement: temporary anchorage device requiring surgical flap D7294 Surgical placement: temporary anchorage device without surgical flap Alveoloplasty — surgical preparation of ridge fordentures • D7310 Alveoloplasty in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7311 Alveoloplasty in conjunction with extractions — one to three teeth or tooth spaces, per quadrant D7320 Alveoloplasty not in conjunction with extractions — four or more teeth or tooth spaces, per quadrant D7321 Alveoloplasty not in conjunction with extractions — one to three teeth or tooth spaces, per quadrant Vestibuloplasty D7340 Vestibuloplasty — ridge extension (secondary epithelialization) D7350 Vestibuloplasty — ridge extension (including soft tissue grafts, muscle reattachment, revision of soft tissue attachment and management of hypertrophied and hyperplastic tissue) Surgical excision of of soft tissue lesions D7410 Excision of benign lesion up to 1.25 cm D7411 Excision of benign lesion greater than 1.25 cm D7412 Excision of benign lesion, complicated D7413 Excision of malignant lesion up to 1.25 cm D7414 Excision of malignant lesion greater than 1.25 cm D7415 Excision of malignant lesion complicated D7465 Destruction of lesion(s) by physical or chemical method, by report Surgical excision of intra-osseous lesions D7440 Excision of malignant tumor — lesion diameter up to 1.25 cm D7441 Excision of malignant tumor — lesion diameter greater than 1.25 cm D7450 Removal of benign odontogenic cyst or tumor — lesion diameter up to 1.25 cm D7451 Removal of benign odontogenic cyst or tumor — lesion diameter greater than 1.25 cm D7460 Removal of benign nonodontogenic cyst or tumor — lesion diameter up to 1.25 cm D7461 Removal of benign nonodontogenic cyst or tumor — lesion diameter greater than 1.25 cm Excision of bone tissue D7471 Removal of lateral exostosis (maxilla or mandible) D7472 Removal of torus palatinus D7473 Removal of torus manibularis D7485 Surgical reduction of osseous tuberosity D7490 Radical resection of maxilla or mandible Surgical incision D7510 Incision and drainage of abscess — intraoral soft tissue D7511 Incision and drainage of abscess — intraoral soft tissue — complicated (includes drainage of multiple fascial spaces) D7520 Incision and drainage of abscess — extraoral soft tissue D7521 Incision and drainage of abscess — extraoral soft tissue — complicated (includes drainage of multiple fascial spaces) D7530 Removal of foreign body from mucosa, skin or subcutaneous alveolar tissue D7540 Removal of reaction-producing foreign bodies, musculoskeletal system D7550 Partial ostectomy/sequestrectomy for removal of non-vital bone D7560 Maxillary sinusotomy for removal of tooth fragment or foreign body CDT2011 (Eff. 01-01-11) Treatment of fractures — simple D7610 Maxilla — open reduction (teeth immobilized, if present) D7620 Maxilla — closed reduction (teeth immobilized, if present) D7630 Mandible — open reduction (teeth immobilized, if present) D7640 Mandible — closed reduction (teeth immobilized, if present) D7650 Malar and/or zygomatic arch — open reduction D7660 Malar and/or zygomatic arch — closed reduction D7670 Alveolus — closed reduction, may include stabilization of teeth D7671 Alveolus — open reduction, may include stabilization of teeth D7680 Facial bones — complicated reduction with fixation and multiple surgical approaches Treatment of fractures — compound 07710 Maxilla — open reduction D7720 Maxilla — closed reduction D7730 Mandible — open reduction D7740 Mandible — closed reduction D7750 Malar and/or zygomatic arch — open reduction 07760 Malar and/or zygomatic arch — closed reduction D7770 Alveolus — open reduction splinting stabilization of teeth D7771 Alveolus — closed reduction stabilization of teeth D7780 Facial bones — complicated reduction with fixation and multiple surgical approaches Reduction of dislocation and management of other temporomandibular joint dysfunctions D7810 Open reduction of dislocation D7820 Closed reduction of dislocation D7830 Manipulation under anesthesia D7840 Condylectomy D7850 Surgical discectomy, with/without implant D7852 Disc repair D7854 Synovectomy D7856 Myotomy D7858 Joint reconstruction D7860 Arthrotomy D7865 Arthroplasty D7870 Arthrocentesis D7871 Non-arthroscopic lysis and lavage D7872 Arthroscopy — diagnosis, with or without biopsy D7873 Arthroscopy — surgical: lavage and lysis of adhesions D7874 Arthroscopy — surgical: disc repositioning and stabilization D7875 Arthroscopy — surgical: synovectomy D7876 Arthroscopy — surgical: discectomy D7877 Arthroscopy — surgical: debridement D7880 Occlusal orthotic device, by report D7899 Unspecified TMD therapy, by report Repair of traumatic wounds D7910 Suture of recent small wounds up to 5 cm Complicated suturing (reconstruction requiring delicate handling of tissues and wide undermining for meticulous closure) D7911 Complicated suture — up to 5 cm D7912 Complicated suture — greater than 5 cm Other repair procedures D7920 Skin graft (identify defect covered, location and type of graft) D7940 Osteoplasty — for orthognathic deformities • CDT2011 (Eff. 01-01-11) D7941 Osteotomy — mandibular rami D7943 Osteotomy — mandibular rami with bone graft; includes obtaining the graft D7944 Osteotomy — segmented or subapical D7945 Osteotomy — body of mandible D7946 LeFort I (maxilla — total) D7947 LeFort I (maxilla — segmented) • D7948 LeFort II or LeFort III (osteoplasty of facial bones for rnidface hypoplasia or retrusion) — without bone graft D7949 LeFort II or LeFort III — with bone graft D7950 Osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report D7951 Sinus augmentation with bone or bone substitutes D7953 Bone replacement graft for ridge preservation — per site D7955 Repair of maxillofacial soft and/or hard tissue defect D7960 Frenulectomy - also known as frenectomy or frenotomy — separate procedure not incidental to another procedure D7963 Frenuloplasty D7970 Excision of hyperplastic tissue — per arch D7971 Excision of pericoronal gingiva D7972 Surgical reduction of fibrous tuberosity D7980 Sialolithotomy D7981 Excision of salivary gland, by report D7982 Sialodochoplasty D7983 Closure of salivary fistula D7990 Emergency tracheotomy D7991 Coronoidectomy D7995 Synthetic graft — mandible or facial bones, by report D7996 Implant — mandible for augmentation purposes (excluding alveolar ridge), by report D7997 Appliance removal (not by dentist who placed appliance), includes removal of archbar D7998 Intraoral placement of a fixation device not in conjunction with a fracture D7999 Unspecified oral surgery procedure, by report D8000 - D8999 ORTHODONTICS Limited orthodontic treatment D8010 Limited orthodontic treatment of the primary dentition D8020 Limited orthodontic treatment of the transitional dentition D8030 Limited orthodontic treatment of the adolescent dentition D8040 Limited orthodontic treatment of the adult dentition Interceptive orthodontic treatment D8050 Interceptive orthodontic treatment of the primary dentition 08060 Interceptive orthodontic treatment of the transitional dentition Comprehensive orthodontic treatment D8070 Comprehensive orthodontic treatment of the transitional dentition D8080 Comprehensive orthodontic treatment of the adolescent dentition D8090 Comprehensive orthodontic treatment of the adult dentition Minor treatment to control harmful habits D8210 Removable appliance therapy D8220 Fixed appliance therapy Other orthodontic services D8660_ Pre-orthodontic treatment visit D8670 Periodic orthodontic treatment visit (as part of contract) D8680 Orthodontic retention (removal of appliances, construction and placement of retainer[s]) CDT2011 (Eff. 01-01-11) D8690 Orthodontic treatment (alternative billing to a contract fee) D8691 Repair of orthodontic appliance D8692 Replacement of lost or broken retainer D8693 Rebonding or recementing; and/or repaid, as required, of fixed retainers D8999 Unspecified orthodontic procedure, by report D9O0O — D9999 ADJUNCTIVE GENERAL SERVICES Unclassified treatment D9110 Palliative (emergency) treatment of dental pain — minor procedure D9120 Fixed partial denture sectioning Anesthesia D9210 Local anesthesia not in conjunction with operative or surgical procedures D9211 Regional block anesthesia D9212 Trigeminal division block anesthesia D9215 Local anesthesia D9220 Deep sedation/general anesthesia — first 30 minutes D9221 Deep sedation/general anesthesia — each additional 15 minutes D9230 Analgesia, anxiolysis, inhalation of nitrous oxide D9241 Intravenous conscious sedation/ analgesia — first 30 minutes D9242 Intravenous conscious sedation/ analgesia — each additional 15 minutes D9248 Non-intravenous conscious sedation Professional consultation D9310 Consultation (diagnostic service provided by dentist or physician other than requesting dentist or physician Professional visits D9410 House/extended care facility call D9420 Hospital call D9430 Office visit for observation (during regularly scheduled hours) — no other services performed D9440 Office visit — after regularly scheduled hours D9450 Case presentation, detailed and extensive treatment planning Drugs D9610 Therapeutic parenteral drug, single administration D9612 Therapeutic parenteral drugs, two or more administrations, different medications D9630 Other drugs and/or medicaments, by report Miscellaneous services • D9910 Application of desensitizing medicament D9911 Application of desensitizing resin for cervical and/or root surface, per tooth D9920 Behavior management, by report D9930 Treatment of complications (post-surgical) — unusual circumstances, by report D9940 Occlusal guard, by report D9941 Fabrication of athletic mouthguard D9942 Repair and/or reline of occlusal guard D9950 Occlusion analysis — mounted case D9951 Occlusal adjustment — limited D9952 Occlusal adjustment — complete D9970 Enamel microabrasion D9971 Odontoplasty 1-2 teeth; includes removal of enamel projections CDT2011 (Eff. 01-01-11) D9972 External bleaching — per arch D9973 External bleaching — per tooth D9974 Internal bleaching — per tooth D9999 Unspecified adjunctive procedure, by report • Note: This Appendix represents codes and nomenclature excerpted from the version of Current Dental Terminology (CDT) in effect at the date of this printing. CDT coding and nomenclature are the copyright of the American Dental Association, and have been accepted as the standard for data transmission purposes under federal Administrative Simplification regulations. For the purposes of this Appendix, Delta Dental's administration of Benefits, Limitations and Exclusions under this Contract will at all times be based on the then-current version of CDT whether or not a revised Appendix B is provided. • cDT2n11 (Eff. 01-01-11) • • CITY OF SEAL BEACH DELTA DENTAL GROUP #7809 Date Amendment Signed: 47,1.;11 /1 / d-°// By: 1L6441 4-6 " Signature /V,' - j loft -S !--) Printed Name 144 A M t &_7U i /17UA -t- r5 T Title DATE: March 30, 2011 DELTA DENTAL OF CALIFORNIA Belinda Martinez Senior Vice President Sales /Marketing ' Kevin Jackson Group Vice President Underwriting & Actuarial #1163635 AMENDMENT NO. 7 TO AGREEMENT RENEWAL GROUP #07809 AGREEMENT dated January 1, 2005, as amended, between CITY OF SEAL BEACH and DELTA DENTAL OF CALIFORNIA "Delta Dental," is hereby further amended, effective January 1, 2012, as follows: Paragraph 1.4 is amended to read: 1.4 "Contract Term" means the period beginning on January 1, 2012, and ending on December 31, 2012 and each subsequent yearly period during which this Contract remains in effect. CITY OF SEAL BEACH DELTA DENTAL GROUP #07809 Date Amendment Signed: ? a 42t el-0/.2- By: “F--- Signature N4NGY 444- �� Printed Name 14-70 j---xteO A-c. VsT- Title DATE: February 15, 2012 DELTA DENTAL OF CALIFORNIA ,---- -404- /ot `41.1 Belinda Martinez Senior Vice President Sales/Marketing C 2 • Kevin Jackson Group Vice President Underwriting & Actuarial