Common use of Total Health Solutions Clause in Contracts

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Non-Surgical Periodontal Services and Periodontal Maintenance - a coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary artery disease. • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy . To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 $1,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 $150 Age 19 and older - Per Member $0 $0 Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Non-Surgical Periodontal Services and Periodontal Maintenance - a coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary artery disease. • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy pregnancy. To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 $1,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 $150 Age 19 and older - Per Member $0 $0 Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Nonnon-Surgical Periodontal Services surgical periodontal services and Periodontal Maintenance - a periodontal maintenance. A coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary the following health conditions. • Coronary artery disease. ; • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan yearDiabetes; • History of stroke; • Lupus; • Oral, members who are pregnant are also provided one (1) additional cleaning during their pregnancy head and neck cancer; • Organ transplants; • Rheumatoid arthritis; • Xxxxxxx’x disease. To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 $1,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 $150 Age 19 and older - Per Member $0 $0 Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Nonnon-Surgical Periodontal Services surgical periodontal services and Periodontal Maintenance - a periodontal maintenance. A coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary the following health conditions. • Coronary artery disease. ; • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan yearDiabetes; • History of stroke; • Lupus; • Oral, members who are pregnant are also provided one (1) additional cleaning during their pregnancy head and neck cancer; • Organ transplants; • Rheumatoid arthritis; • Xxxxxxx’x disease. To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 2,000 $1,000 2,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 25 $150 25 Age 19 and older - Per Member $0 $0 Not Applicable Not Applicable Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Non-Surgical Periodontal Services and Periodontal Maintenance - a coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary artery disease. • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy . To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 1,500 $1,000 1,500 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 25 $150 25 Age 19 and older - Per Member $0 $0 Not Applicable Not Applicable Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Non-Surgical Periodontal Services and Periodontal Maintenance - a coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary artery disease. • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy pregnancy. To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 $1,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 $150 Age 19 and older - Per Member $0 $0 Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-of- pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Non-Surgical Periodontal Services and Periodontal Maintenance - a coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary artery disease. • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan year, members who are pregnant are also provided one (1) additional cleaning during their pregnancy . To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 2,000 $1,000 2,000 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 25 $150 25 Age 19 and older - Per Member $0 $0 Not Applicable Not Applicable Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits

Total Health Solutions. Total Health Solutions is a program which allows for a more comprehensive treatment of certain health conditions by providing enhanced dental benefits for the following services: • Nonnon-Surgical Periodontal Services surgical periodontal services and Periodontal Maintenance - a periodontal maintenance. A coinsurance is not required for these services when members have been diagnosed with diabetes and/or coronary the following health conditions. • Coronary artery disease. ; • Cleanings (Prophylaxis) - besides the two (2) cleanings provided per plan yearDiabetes; • History of stroke; • Lupus; • Oral, members who are pregnant are also provided one (1) additional cleaning during their pregnancy head and neck cancer; • Organ transplants; • Rheumatoid arthritis; • Xxxxxxx’x disease. To determine if you or your enrolled dependent(s) are eligible for any of these enhanced dental benefits please contact Blue Cross Dental Customer Service or visit our website for details. Please note: Total Health Solutions enhanced benefits are not available until you have received confirmation from us. Member Age Benefit limits, the amount you pay, and whether a service is covered can differ based on whether a member is under age nineteen (19) or age nineteen (19) and older. Please see the Summary of Benefits below to understand how your benefits differ by age category. For members under age nineteen (19), benefit limits and the amount you pay, indicated in the Summary of Benefits, continue until the last day of the month in which the member turns nineteen (19). If a member turns nineteen (19) years old during the plan year and remains a member, this plan will not cover services in excess of the annual maximum benefit or benefit limits listed for members age nineteen (19) and older. Dental services previously provided, during the plan year, are taken into account to determine if the annual maximum benefit or benefit limits have been met. Members are entitled to only those benefits listed in the Summary of Benefits. Many services are covered only for members under age nineteen (19). Please be sure to review the information in the Summary of Benefits, as well as in the Exclusions section, in reference to the information about covered dental services below. Deductibles, Annual Maximum Benefits, and Maximum Out-of-Pocket Expense Deductibles, Annual Maximum Benefits and Maximum Out-of-Pocket Expense Network Dentists Non-network Dentists You Pay You Pay Annual Maximum Benefit – Per Member The annual maximum benefit amount we pay for covered dental services per member per plan year. The annual maximum benefit applies to both network dentist and non-network dentist services combined. Under age 19 Not Applicable Not Applicable Age 19 and older $1,000 1,500 $1,000 1,500 Deductible In this Summary of Benefits, the covered dental services subject to the deductible are indicated with “After deductible”. Deductible applies to both network dentist and non-network dentist services combined. Under age 19 - Per Member $150 25 $150 25 Age 19 and older - Per Member $0 $0 Not Applicable Not Applicable Maximum Out-of-Pocket Expense The coinsurance amounts apply to the maximum out-of-pocket expense. The annual maximum out-of-pocket expense applies to network dentists covered dental services only. Under age 19 - One member enrolled $350 Not Applicable Under age 19 - Two or more members enrolled $700 Not Applicable Age 19 and older Not Applicable Not Applicable Summary of Benefits