triple choice - beta health association colorado triple choice proposal.pdf · our triple choice...

TRIPLE CHOICE Dental Plan

Affinity Plan Employer Proposal

Beta Health Association, Inc. “Dental Plan Specialists since 1990”

303-744-3007 or 1-800-807-0706

www.betadental.com

Affinity Program Dental Proposal Attached please find our formal dental proposal. We appreciate the opportunity you have given us to present our dental plan for your consideration. We believe in long term relationships that are a benefit to everyone involved. Our Company started in 1990 and we still represent 94% of our original clients and have over 90,000 members statewide. Our Triple Choice product line is a perfect fit for your group. Each of the employees would be able to select from three different plans. There are two network plans and an indemnity or PPO plan where they can see any dentist they wish. Our network size for the first two options is in excess of 500 dentists. This is by far the largest network of this type in the State of Colorado. The monthly costs we are willing to offer you are as follows:

Option #1 and Option #2 Option #3 Alpha and Choice Dental Securian Dental Plan Voluntary Employer Paid

Employee only coverage $11.50 $11.00 Employee and one dependent $21.50 $21.00 See Attached Rate and Employee and two dependents $29.50 $29.00 Benefit Sheet Employee and three or more dependents $35.50 $35.00 Rate guarantee: 2 years 3 years 1 year Proposed effective date: The first of the month as identified in the Securian Dental section of this proposal Rate Options:

1. If they would like to add the Orthodontic option to the Securian Dental Plan (if not already included in the attached proposal), it can be added by contacting the Beta Health Marketing Department at the number listed below.

. 2. The “Employer Paid” Option #1 and Option #2 rates above are based upon the group contributing

a minimum of the single Option #1 and Option #2 employee only rate towards the cost of all three dental plans.

We also have Spanish enrollment material for all employees as well as an interpreter to handle any potential enrollment meetings.

9725 East Hampden Avenue, Suite #400, Denver, Colorado, 80231

303-744-3007 or 1-800-807-0706

Dental Proposal Page 2 I am very confident in our company’s ability to provide all of our clients with a quality product for their employees and dependents. After all, this is what we are paid to do! Therefore, if you decide to work with us, we would be personally responsible for everything from the enrollment meetings to the continued day-to-day needs of the group. We are personally guaranteeing all parties a very high level of satisfaction. Sincerely, Beta Health Association -Marketing Department RSH/mb Please Note: The Beta Health Association, Inc. network dental plans (Alpha and Choice Dental) are discount-fee-for-service dental plans and are not considered in any way insurance. The Securian Dental Plan is not a product of Beta Health Association, Inc. but simply marketed by Beta Health Association, Inc.

Who is Beta Health Association, Inc?

We are a Colorado based company that has specialized in both voluntary (employee paid) and contributory (employer paid) dental services since 1990. We are also the only carrier in Colorado to continue to offer an individual network dental plan. Our Corporate Office is located in Denver, Colorado. Our current membership in Colorado is approximately 90,000.

Our Mission Statement

At first, our company was designed to market and administer only a singular product line…the Alpha Dental Plan. This plan is a discount fee-for-service network dental plan. Over the next 12 years our company grew to include the administration and marketing of an additional discount fee-for-service network dental plan, which is called Choice Dental Plan. We also offer an indemnity dental plan where our members can visit any dentist, which was created through a marketing alliance between Beta Health Association and Companion Life Insurance Company. These three products can be purchased separately or can be combined to create our “Triple Choice Dental Plan” option. This product line does not require any employer contribution and allows each employee in a group the choice between three different dental plan options ie… the Alpha Dental Plan, the Choice Dental Plan, or the Companion Life Dental Plan where they can see any dentist.

Throughout our history, we have remained steadfast in our focus in offering high quality products and exceptional service to all of our members. Our company is operated on a daily basis by a well-seasoned and experienced management team. Even after substantial continued large growth over the years, our company retains the feeling of a hometown, privately owned and operated business. A collection of supremely committed, qualified and conscientious dental plan experts, the Beta Health Association, Inc. team has earned the trust and respect of countless members, participating dentists, and insurance agents across Colorado. We have proven our competency and demonstrated our skills. Each employee at our company shares the same focus on delivering superior service and contributes daily to the same purpose of maintaining high quality, high value dental products for all participants. We are truly the “Dental Plan Specialists” in Colorado!

9725 East Hampden Avenue, Suite #400, Denver, Colorado, 80231 303-744-3007 or 1-800-807-0706

“A company is known by the company it keeps”

Capco, Inc.

Weld County

Lehrer’s Flowers

The City of Greeley

Colorado Materials

Palace Construction

The Pueblo Chieftain

Union Printers Home

O’Meara Ford Center

El Pueblo Boys Ranch

Iliff School of Theology

Hospital Shared Services

Burt Automotive Network

Colorado Mountain College

Rocky Mountain Materials

Moreland Automotive Group

Columbine Health Management

Colorado Springs Health Partners

Rocky Mountain Motorists (AAA)

Lower Valley Hospital Association

11th Judicial District-District Attorney’s Office

Colorado Association of Non-Profit Organizations (CANPO)

WHAT IS THE TRIPLE CHOICE DENTAL PLAN?

The Triple Choice Dental Plan allows each employee the choice of enrolling in the Alpha Dental Plan (ADP), Choice Dental Plan (CDP) or the Securian Dental Insurance / PPO Plan. There are over 580 contracted providers in Colorado

who participate in either the Alpha or Choice Dental Plan.

There are many advantages to this flexible arrangement.

Triple Choice

Option #1 Option #2 Option #3

See Network Dentist Only No Deductibles to Satisfy Lower Co-Pays No Claim Forms to Complete Unlimited Services Orthodontics (Child & Adult) No Waiting Periods No Pre-authorizations Cosmetic Dentistry Included Low Monthly Cost Immediate Coverage for all services Save approximately 65% overall

See Network Dentist Only

No Deductibles to Satisfy Slightly Higher Co-Pays No Claim Forms to Complete Unlimited Services Orthodontics (Child & Adult) No Waiting Periods No Pre-authorizations Cosmetic Dentistry Included Low Monthly Cost Immediate Coverage for all Services Save approximately 48% overall More providers in certain areas than the Alpha Dental Plan.

Select Any Dentist or PPO Dentist

Deductibles to satisfy UCR – 80th or 90th percentile Claim Forms to Complete Calendar year Maximum applies Orthodontics (optional) Waiting Periods May Apply Authorization Suggested No Cosmetic Dentistry More Monthly Cost

Multiple plan designs for each employer to select from

Alpha Dental (ADP)

Network Plan

Discount, fee-for-service

Securian Dental (SDP)

Indemnity / PPO Plan

Choice Dental (CDP)

Network Plan

Discount, fee-for-service

Option #1 and Option #2

Plan Highlights

Cosmetic Dentistry Included

No Waiting Periods on any services

Orthodontics (braces) covered for Children and Adults

No Deductibles to satisfy

No Claim Forms to complete

No Age limits for members

No Limit on Visits

No Exclusions for Pre-Existing Conditions

No Yearly Maximum Benefit Level (Use as much as you like each year)

Guaranteed Acceptance

The following fee schedule represents the pre-negotiated discounts we have arranged in advance with the General Dentists who are participating in the plan. Simply pay these amounts directly to your participating dentist at the time services are rendered…its that easy! There are no claim forms to complete.

ADA CODE DENTAL PROCEDURE/ADA CODE DESCRIPTION

NORMAL FEE

WITH ALPHA

WITH CHOICE

999 ROUTINE OFFICE VISIT 35$ 5$ 5$ 120 PERIODIC ORAL EVALUATION 47$ No Cost 26$ 140 LIMITED ORAL EVALUATION-PROBLEM FOCUSED 69$ 13$ 40$ 150 COMPREHENSIVE ORAL EVALUATION-NEW OR ESTABLISHED PATIENT 85$ 11$ 41$ 210 X-RAY INTRAORAL COMPLETE SERIES INC. BITEWINGS 116$ 25$ 73$ 220 X-RAY INTRAORAL-PERIAPICAL-FIRST FILM 26$ 5$ 14$ 230 X-RAY INTRAORAL PERIAPICAL EACH ADDITIONAL FILM 21$ 4$ 12$ 240 X-RAY INTRA ORAL-OCCLUSAL FILM 42$ 4$ 20$ 250 X-RAY EXTRAORAL-FIRST FILM 66$ 4$ 30$ 260 X-RAY EXTRAORAL-EACH ADDITIONAL FILM 53$ 4$ 16$ 270 X-RAY BITEWING-SINGLE FILM 26$ No Cost 12$ 272 X-RAY BITEWING-2 FILMS 41$ No Cost 25$ 274 X-RAY BITEWING-4 FILMS 59$ No Cost 34$ 330 X-RAY PANORAMIC FILM 101$ 43$ 60$ 340 CEPHALOMETRIC FILM 116$ 51$ 54$ 460 PULP VITALITY TEST 54$ No Cost 28$ 470 DIAGNOSTIC CASTS 101$ 40$ 59$ 999 EMERGENCY VISIT (SAME DAY) 90$ 25$ 55$

1110 PROPHYLAXIS-ADULT CLEANING (EVERY 6 MONTHS) 77$ 15$ 57$ 1120 PROPHYLAXIS-CHILD CLEANING (EVERY 6 MONTHS) 59$ 15$ 39$ 1203 TOPICAL APPLICATION OF FLUORIDE NOT INCL/PROPHY-CHILD 35$ 10$ 20$ 1330 ORAL HYGIENE INSTRUCTIONS 53$ No Cost 22$ 1351 SEALANT PER TOOTH 50$ 10$ 31$ 1510 SPACE MAINTAINER FIXED UNILATERAL 307$ 157$ 188$ 1515 SPACE MAINTAINER FIXED BILATERAL 422$ 229$ 286$ 1520 SPACE MAINTAINER-REMOVABLE-UNILATERAL 370$ 189$ 150$ 1525 SPACE MAINTAINER-REMOVABLE-BILATERAL 462$ 217$ 252$ 1550 RE-CEMENTATION OF SPACE MAINTAINER 78$ 15$ 37$ 1999 ADDITIONAL PROPHY (FOR PERIO MAINTENANCE) 77$ 33$ 57$

2140 AMALGAM-1 SURFACE (PRIMARY OR PERMANENT) 122$ 27$ 85$ 2150 AMALGAM-2 SURFACES (PRIMARY OR PERMANENT) 159$ 36$ 110$ 2160 AMALGAM-3 SURFACES (PRIMARY OR PERMANENT) 190$ 44$ 130$ 2161 AMALGAM-4 OR MORE SURFACES (PRIMARY OR PERMANENT) 224$ 52$ 153$ 2330 RESIN BASED COMPOSITE 1 SURFACE (ANTERIOR) 148$ 39$ 90$ 2331 RESIN BASED COMPOSITE 2 SURFACES (ANTERIOR) 181$ 50$ 114$ 2332 RESIN BASED COMPOSITE 3 SURFACES (ANTERIOR) 226$ 66$ 136$ 2335 RESIN 4 OR MORE SURFACES OR INVOLVING INCISAL ANGLE (ANTERIOR) 283$ 107$ 168$ 2390 RESIN BASED COMPOSITE CROWN ( ANTERIOR) 423$ 233$ 213$ 2391 RESIN BASED COMPOSITE ONE SURFACE (POSTERIOR) 164$ 86$ 102$ 2392 RESIN BASED COMPOSITE TWO SURFACE (POSTERIOR) 211$ 118$ 135$ 2393 RESIN BASED COMPOSITE THREE SURFACE (POSTERIOR) 265$ 149$ 170$ 2394 RESIN BASED COMPOSITE FOUR OR MORE SURFACES (POSTERIOR) 315$ 163$ 194$ 2510 INLAY-METALLIC-ONE SURFACE 794$ 262$ 383$ 2520 INLAY-METALLIC-TWO SURFACE 796$ 262$ 445$ 2530 INLAY-METALLIC-THREE OR MORE SURFACES 874$ 288$ 501$ 2542 ONLAY-METALLIC-TWO SURFACES 900$ 297$ 573$ 2543 ONLAY-METALLIC-THREE SURFACES 940$ 311$ 584$ 2544 ONLAY-METALLIC-FOUR OR MORE SURFACES 960$ 317$ 615$ 2610 INLAY-PORCELAIN/CERAMIC-ONE SURFACE 829$ 273$ 553$ 2650 INLAY-RESIN BASED COMPOSITE-ONE SURFACE 794$ 262$ 436$ 2651 INLAY-RESIN BASED COMPOSITE-TWO SURFACES 837$ 276$ 500$ 2652 INLAY-RESIN BASED COMPOSITE-THREE OR MORE SURFACES 868$ 286$ 512$

*2710 CROWN-RESIN BASED COMPOSITE (INDIRECT) 836$ 277$ 337$ *2720 CROWN-RESIN WITH HIGH NOBLE METAL 960$ 316$ 446$ *2721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 901$ 297$ 307$ *2722 CROWN RESIN WITH NOBLE METAL 925$ 306$ 396$ *2740 CROWN PORCELAIN/CERAMIC SUBSTRATE 1,032$ 341$ 525$ *2750 CROWN PORCELAIN FUSED TO HIGH NOBLE METAL 1,005$ 331$ 501$ *2751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 929$ 278$ 418$ *2752 CROWN-PORCELAIN FUSED TO NOBLE METAL 965$ 327$ 478$

Diagnostic Services (Exams and X-rays)

Preventive Services (Cleanings)

Restorative Services (Fillings, Crowns, Inlays and Onlays)

Beta Health Association Inc.Marketing Plan 19 and Plan 20 Fee Schedule

(7105)

Current Dental Terminology © American Dental Association


NORMAL FEE

WITH ALPHA

WITH CHOICE

*2790 CROWN FULL CAST HIGH NOBLE METAL 986$ 312$ 501$ *2791 CROWN FULL CAST PREDOMINANTLY BASE METAL 904$ 280$ 396$ *2792 CROWN FULL CAST NOBLE METAL 949$ 310$ 472$ 2910 RECEMENT INLAY, ONLAY, OR PARTIAL COVERAGE RESTORATION 101$ 13$ 44$ 2920 RECEMENT CROWN 102$ 27$ 53$ 2930 PREFAB. STAINLESS STEEL CROWN-PRIMARY 261$ 91$ 161$ 2931 PREFAB STAINLESS STEEL CROWN-PERMANENT 311$ 108$ 173$ 2932 PREFAB. RESIN CROWN 328$ 137$ 173$ 2933 PREFAB. STAINLESS STEEL CROWN WITH RESIN WINDOW 341$ 153$ 216$ 2940 SEDATIVE FILLING 106$ 30$ 56$ 2950 CORE BUILDUP INCLUDING ANY PINS 257$ 73$ 150$ 2951 PIN RETENTION PER TOOTH IN ADD. TO RESTORATION 69$ 20$ 34$ 2952 CAST POST & CORE IN ADDITION TO CROWN 407$ 119$ 217$ 2954 PREFAB POST & CORE IN ADDITION TO CROWN 314$ 92$ 177$ 2955 POST REMOVAL (NOT IN CONJUNCTION WITH ENDODONTIC THERAPY) 279$ 123$ 117$ 2960 LABIAL VENEER RESIN LAMINATE (CHAIRSIDE) 621$ 162$ 368$ 2999 BLEACHING (PER ARCH) 250$ 150$ 170$ 2999 $125 ADDTL.CHARGE P/UNIT FOR MULTIPLE CROWN UNITS/COMPLEX REHABILITATION

3110 PULP CAP DIRECT EXCLUDING FINAL RESTORATION 79$ 22$ 33$ 3120 PULP CAP INDIRECT EXCLUDING FINAL RESTORATION 80$ 23$ 43$ 3220 THERAPEUTIC PULPOTOMY EXCLUDING FINAL RESTORATION 190$ 63$ 98$ 3230 PULPAL THERAPY ANTERIOR, PRIMARY TOOTH EXCLUDING REST. 268$ 83$ 150$ 3240 PULPAL THERAPY POSTERIOR, PRIMARY TOOTH EXCLUDING REST 311$ 95$ 168$ 3310 ROOT CANAL THERAPY 1 CANAL (EXCLUDING FINAL RESTORATION) 650$ 230$ 445$ 3320 ROOT CANAL THERAPY 2 CANALS (EXCLUDING FINAL RESTORATION) 767$ 281$ 515$ 3330 ROOT CANAL THERAPY 3 CANALS OR MORE 931$ 352$ 647$ 3410 APICOECTOMY/PERIRADICULAR SURGERY-ANTERIOR 645$ 286$ 422$ 3421 APICOECTOMY/PERIRADICULAR SURGERY-BICUSPID (FIRST ROOT) 694$ 316$ 475$ 3425 APICOECTOMY/PERIRADICULAR SURGERY-MOLAR (FIRST ROOT) 846$ 378$ 568$ 3426 APICOECTOMY/PERIRADICULAR SURGERY-EACH ADDITIONAL ROOT 387$ 138$ 144$ 3430 RETROGRADE FILLING-PER ROOT 266$ 98$ 122$ 3910 SURGICAL PROCEDURE FOR ISOLATION OF TOOTH WITH RUBBER DAM 241$ 56$ 160$

4210 GINGIVOPLASY OR GIGIVECTOMY-4+ CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 609$ 288$ 234$ 4211 GINGIVECTOMY OR GINGIVOPLASTY1 TO 3 CONTIGUOUS OR BOUNDED SP. TEETH P/QUAD 238$ 131$ 78$ 4240 GINGIVAL FLAP PROCEDURE, INCL.ROOT PLNG -4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 713$ 306$ 311$ 4260 OSSEOUS SURG. INCL. FLAP ENTRY & CLOSURE-4+ CONTIG. OR BOUNDED SP. TEETH P/QUAD 1,005$ 460$ 667$ 4320 PROVISIONAL SPLINTING-INTRACORNIAL 494$ 231$ 144$ 4321 PROVISIONAL SPLINTING-EXTRACORNIAL 455$ 213$ 125$ 4341 PERIODONTAL SCALING & ROOT PLNG- 4+ TEETH PER QUAD 233$ 98$ 139$ 4355 FULL MOUTH DEBRIDEMENT TO ENABLE COMP.EVAL. & DIAGNOSIS 175$ 79$ 97$ 4910 PERIODONTAL MAINTENANCE 132$ 51$ 79$ 4999 PERIO SCREENING AND SCORING 30$ 10$ 20$

5110 COMPLETE DENTURE-MAXILLARY 1,587$ 470$ 925$ 5120 COMPLETE DENTURE-MANDIBULAR 1,587$ 470$ 925$ 5130 IMMEDIATE DENTURE-MAXILLARY 1,693$ 673$ 948$ 5140 IMMEDIATE DENTURE-MANDIBULAR 1,693$ 673$ 948$ 5211 MAXILLARY PART. DENTURE-RESIN BASE (INCL. CLASPS & TEETH) 1,244$ 390$ 624$ 5212 MANDIBULAR PARTIAL DENTURE-RESIN BASE (INCL. CLASPS & TEETH) 1,270$ 388$ 624$ 5213 MAXILLARY PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) 1,639$ 475$ 910$ 5214 MANDIBULAR PART. DENT.-CST MTL FRMEWRK W/RESIN DENT. BASE (INCL/CLASPS & TEETH) 1,635$ 472$ 910$ 5410 ADJUST COMPLETE DENTURE-MAXILLARY 83$ 31$ 31$ 5411 ADJUST COMPLETE DENTURE-MANDIBULAR 83$ 31$ 37$ 5421 ADJUST PARTIAL DENTURE-MAXILLARY 81$ 30$ 37$ 5422 ADJUST PARTIAL DENTURE-MANDIBULAR 83$ 31$ 37$ 5510 REPAIR BROKEN COMPLETE DENTURE BASE 195$ 74$ 106$ 5520 REPLACE MISSING OF BROKEN TEETH-COMP.DENTURE-EACH TOOTH 168$ 53$ 90$ 5610 REPAIR RESIN DENTURE BASE 187$ 68$ 87$ 5620 REPAIR CAST FRAMEWORK 272$ 121$ 120$ 5630 REPAIR OR REPLACE BROKEN CLASP 249$ 91$ 130$ 5640 REPLACE BROKEN TEETH-PER TOOTH 169$ 58$ 90$ 5650 ADD TOOTH TO EXISTING PARTIAL DENTURE 205$ 79$ 92$ 5660 ADD CLASP TO EXISTING PARTIAL DENTURE 255$ 105$ 117$

*These co-payments do not include an allowable $138 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the savings are from your Usual and Customary fees. Temporary crowns are included with permanent crown preparation.

Endodontic Services (Root Canals)

Periodontic Services (Gum Disease)

Prosthodontics (Removable)/Complete Dentures, etc.)

Restorative Services (Fillings, Crowns, Inlays and Inlays) Cont.



NORMAL FEE

WITH ALPHA

WITH CHOICE

5710 REBASE COMPLETE MAXILLARY DENTURE 547$ 240$ 278$ 5711 REBASE COMPLETE MANDIBULAR DENTURE 529$ 232$ 278$ 5720 REBASE MAXILLARY PARTIAL DENTURE 523$ 198$ 267$ 5721 REBASE MANDIBULAR PARTIAL DENTURE 521$ 197$ 267$ 5730 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) 351$ 153$ 129$ 5731 RELINE COMPLETE MANDIBULAR DENTURE (CHAIRSIDE) 351$ 153$ 129$ 5740 RELINE MAXILLARY PARTIAL DENTURE (CHAIRSIDE) 343$ 144$ 138$ 5741 RELINE MANDIBULAR PARTIAL DENTURE (CHAIRSIDE) 344$ 143$ 138$ 5750 RELINE COMPLETE MAXILLARY DENTURE (LABORATORY) 439$ 135$ 229$ 5751 RELINE COMPLETE MANDIBULAR DENTURE (LABORATORY) 437$ 134$ 229$ 5760 RELINE MAXILLARY PARTIAL DENTURE (LABORATORY) 434$ 137$ 216$ 5761 RELINE MANDIBULAR PARTIAL DENTURE (LABORATORY) 434$ 136$ 216$ 5850 TISSUE CONDITIONING MAXILLARY 196$ 56$ 77$ 5851 TISSUE CONDITIONING MANDIBULAR 196$ 55$ 77$

*6210 PONTIC-CAST HIGH NOBLE METAL 979$ 310$ 471$ *6211 PONTIC-CAST PREDOMINANTLY BASE METAL 926$ 271$ 390$ *6212 PONTIC-CAST NOBLE METAL 952$ 284$ 407$ *6240 PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL 998$ 329$ 482$ *6241 PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 930$ 274$ 422$ *6242 PONTIC-PORCELAIN FUSED TO NOBLE METAL 954$ 291$ 452$ *6250 PONTIC-RESIN WITH HIGH NOBLE METAL 952$ 302$ 456$ *6251 PONTIC-RESIN WITH PREDOMINANTLY BASE METAL 932$ 289$ 496$ *6252 PONTIC-RESIN WITH NOBLE METAL 950$ 296$ 446$ *6720 CROWN-RESIN WITH HIGH NOBLE METAL 979$ 323$ 446$ *6721 CROWN-RESIN WITH PREDOMINANTLY BASE METAL 921$ 304$ 274$ *6722 CROWN-RESIN WITH NOBLE METAL 952$ 314$ 356$ *6750 CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL 1,005$ 331$ 489$ *6751 CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL 932$ 279$ 424$ *6752 CROWN-PORCELAIN FUSED TO NOBLE METAL 970$ 301$ 461$ *6790 CROWN-FULL CAST HIGH NOBLE METAL 990$ 314$ 478$ *6791 CROWN-FULL CAST PREDOMINANTLY BASE METAL 922$ 286$ 405$ *6792 CROWN-FULL CAST NOBLE METAL 954$ 290$ 466$ 6930 RECEMENT FIXED PARTIAL DENTURE 159$ 59$ 78$

7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) 153$ 38$ 77$ 7210 SURGICAL EXT. ERUPTED TOOTH WITH REMOVAL OF BONE 257$ 70$ 149$ 7220 REMOVAL OF IMPACTED TOOTH-SOFT TISSUE 291$ 78$ 175$ 7230 REMOVAL OF IMPACTED TOOTH PARTIALLY BONY 370$ 144$ 214$ 7240 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY 464$ 186$ 255$ 7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY W/ UNUSUAL SURG. COMPLICATION 547$ 213$ 302$ 7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) 291$ 107$ 165$ 7270 TOOTH REIMPL. AND/OR STAB. OF ACC.EVULSED OR DISPL. TOOTH 529$ 211$ 215$ 7280 SURGICAL ACCESS OF AN UNERUPTED TOOTH 478$ 208$ 319$ 7285 BIOPSY OF ORAL TISSUE-HARD (BONE-TOOTH) 389$ 170$ 218$ 7286 BIOPSY OF ORAL TISSUE-SOFT 292$ 127$ 128$ 7310 ALVEOPLASTY IN CONJ. WITH EXT.- PER QUAD 275$ 105$ 126$ 7320 ALVEOPLASTY NOT IN CONJ WITH EXT- PER QUAD 423$ 156$ 175$ 7510 INCISION AND DRAINAGE ABSCESS- INTRAORAL SOFT TISSUE 212$ 82$ 96$ 7910 SUTURE OF RECENT SMALL WOUNDS UP TO 5CM 302$ No Cost 81$ 7960 FRENULECTOMY (FRENECTOMY OR FRENOTOMY)- SEPARATE PROCEDURE 427$ 110$ 192$ 7970 EXCISION OF HYPERPLASTIC TISSUE- PER ARCH 523$ 186$ 207$

9110 EMERGENCY PALATIVE TREATMENT OF DENTAL PAIN- MINOR PROCEDURE 113$ 39$ 62$ 9230 ANALGESIA, ANXIOLYSIS, INHALATION OF NITROUS OXIDE - FIRST 30 MINUTES 74$ 21$ 31$ 9310 CONSULTATION (DIAG. SERV. PROV. BY DENTIST OR PHYSICIAN OTHER THAN PRACTIONER PROV. TREATMNT) 133$ No Cost 55$ 9910 APPLICATION OF DESENSITIZING MEDICAMENT 63$ 5$ 39$ 9941 FABRICATION OF ATHLETIC MOUTHGUARD 265$ 90$ 83$ 9951 OCCLUSAL ADJUSTMENT-LIMITED 185$ 67$ 87$ 9952 OCCLUSAL ADJUSTMENT-COMPLETE 661$ 245$ 603$ 9999 MISSED APPOINTMENT (WITHOUT 24 HOUR NOTICE) 54$ 30$ 35$

Prosthodontics (Removable) / Complete Dentures, etc. Cont.

NOTE: In addition to the fees listed above in section 5000 thru 6000, additional fees may be charged for upgraded teeth and enhanced cosmetics, personalization beyond norm or techniques involving precision dentures.

Prosthodontics (fixed)/Partial Dentures, etc.)

Oral Surgery (Extractions, etc.)

General Miscellaneous Services

These co-payments do not include an allowable $138 lab fee (per unit). Doctors, please make sure that all members understand what their fees will be and what the saving are from your Usual and Customary fees.



NORMAL FEE

WITH ALPHA

WITH CHOICE

13 MONTH TREATMENT PLAN ($125/MONTH) 2,852$ 2,200$ 2,200$ 16 MONTH TREATMENT PLAN ($125/MONTH) 3,320$ 2,575$ 2,575$ 19 MONTH TREATMENT PLAN ($125/MONTH) 3,787$ 2,950$ 2,950$ 22 MONTH TREATMENT PLAN ($125/MONTH) 4,218$ 3,325$ 3,325$ 25 MONTH TREATMENT PLAN ($125/MONTH) 4,724$ 3,700$ 3,700$ 28 MONTH TREATMENT PLAN ($125/MONTH) 5,192$ 4,075$ 4,075$ 31 MONTH TREATMENT PLAN ($125/MONTH) 5,659$ 4,450$ 4,450$ 34 MONTH TREATMENT PLAN ($125/MONTH) 6,127$ 4,825$ 4,825$ 36 MONTH TREATMENT PLAN ($125/MONTH 6,439$ 5,075$ 5,075$

Orthodontics (Braces) for children & adults Monthly Payment

Other Orthodontic Guidelines 1. A $350 charge will apply at the end of treatment (included in the above amounts) to cover all retention office visits (unlimited). 2. Services not listed above will be discounted 30% off of the participating Orthodontist's Usual and Customary fees (except #5 listed below).3. Services must only be provided by a contracted Orthodontic Specialist.4. The amounts listed above also include an initial one-time $225 charge for all records, mold, x-rays, etc. to determine the Orthodontic Treatment for the patient.5. Invisalign® procedures are to be discounted 15% off the participating Orthodontist's Usual and Customary fees._____________________________ ____________________________________________________________________________________________

All Plans General Limitations and Exclusions

1. All fees listed above DO NOT include all appropriate lab fees. Member must agree (in writing) to all upgraded materials before treatment is started. See each section for specific details (if applicable).2. All patients are responsible for paying all fees (as listed above) at the time services are rendered.3. These fees are for General Dentists only. A participating specialist list is available by calling our office at 303-744-3007 or 1-800-807-0706. 4. Any procedures not listed will be discounted 20% off the participating General Dentists normal fees.5. Medical costs associated with any dental procedures are not covered.6. Dentures or appliances will be replaced only after 3 years have elapsed since such dentures or appliances were provided under any plan program, unless the denture or appliance becomes unserviceable due to illness or other causes not controlled by other means. Replacement of dentures, appliances, or bridgework due to loss or theft are not covered. 7. Any dental treatment started prior to the Member's eligibility to receive services under this plan or started after a Member's termination are not covered.8. Failure to follow the prescribed treatment or accidents occurring during the course of treatment may result in additional charges by your plan provider.9. Failure to pay scheduled fees at the time service is rendered may prevent future dental services from being received until all fees have been paid in full.10. Services provided by non-participating dentists are not covered. 11. Services which, in the opinion of the attending dentist, are not necessary for the patient's dental health, or are contrary to established dental ethics are not covered.12. Cosmetic dental procedures are covered only if the attending dentist and patient agree on the specific procedure.13. Services which are compensable under Worker's Compensation or employer liability laws are not covered.14. General anesthesia and IV sedation are not covered.15. Myofunctional therapy procedure for training, treating or developing muscles in and around the jaw or mouth including TMJ are not covered except by participating plan specialists.16. Any dental procedure or service that cannot be performed in the dental office due to general and/or physical limitations of a member are not covered.17. Expenses incurred for dental procedures initiated prior to member's eligibility or after termination are not covered.18. Any services that the Participating General Dentist recommends be performed by a specialist are covered only by a plan participating specialist.19. The liability of Beta Health Association, Inc. is limited to the return of the membership fee's paid for one year by the member.20. Extractions for asymptomatic third molars (wisdom teeth) are not covered unless causing movement of the teeth. An example of symptomatic include severe decay, and ontogenic cysts, chronic pericoronitis, and infection. 21. The Beta Health Association, Inc. dental programs do not constitute dental insurance and are considered discount, fee-for- service dental plans.22. Fee's are subject to change on an as needed basis. Please contact Beta Health Association, Inc. for current fee's.


“We believe that

the single most

important consideration

of our provider

network is

quality dental

care”

Our Contracted Providers Are Proven Professionals!

We are known by the quality of our contracted dentists Beta Health Association has developed network relationships with some of the finest dentists in the cities and suburbs where our members live and work. Our reputation depends on dentists who are dedicated to providing quality services Beta Health Association believes that the single most important consideration of our provider network is quality dental care. The key to quality dental care is the building of dental networks that allow for the convenience of location, adequate appointment availability, band the availability of a wide selection of private practice dentists who are committed to establishing a positive patient/ dentist relationship. We use high standards to select our dentists All participating Family Dentists and Specialists are subject to a credentialing process to ensure their qualifications meet our high standards. The program provides that Beta Health Association should: • Perform background checks with the State

Board of Dental Examiners

• Validate proof of current dental license • Validate proof of current DEA and

Radiology Certification where applicable

• Validate proof of professional liability Insurance

• Review information regarding any past malpractice history, including past or present license sanctions

Proven Professionals Page 2 Practice standards set us apart Our experienced provider relations staff goes to great lengths to carefully measure all elements of a dental practice, including the following:

• The overall attitude and demeanor of the office staff • Accessibility, including: parking, waiting room, and appointment availability • The office follows established infection control procedures, and is compliant with OSHA standards • The dental equipment is state of the art • A patient recall system is in place to encourage preventive dental care • Adequate record keeping and patient health history to encourage quality care

Accessibility of Dental Services

• Access to emergency treatment, 7 days a week, 24 hours a day

• Routine appointments generally available within 5 to 6 weeks

• Family Dentists with office hours at least

3 days per week

• Multilingual and after-hour capabilities by some Family Dentists are available

More than you might expect Admittedly, few patients ever scrutinize a dental provider the way we do. And, our interest in customer service extends to the area of member satisfaction, with regular evaluations of selected dental offices and the care received there. We randomly survey our members to determine how our program is performing, not from our standpoint but from their standpoint. These results are currently as follows:

• 94.3% feel as though they receive good to excellent care

• 97.3% are satisfied with the scheduling

of their first appointment

• 96.8% would recommend our plan to their friends and family members

• 91% of our members stay with the first

dentist they select when they enroll

Beta Health Association Complete Provider Directory 9/29/2005

NAME OFFICE NAME PROVIDER ADDRESS PHONE CITY SPECIALTY CODES

Dr. Richard Williams Dr. Richard Williams ADP #56 315 Edison (719) 589-3686 Alamosa General Dentist *, **, C, E1-2, E3-4

Dr. Kathy Tomlinson Comfort Dental of North Arvada ADP #36 8390 W. 80th Ave (303) 425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Shayna Barr Comfort Dental of North Arvada ADP #36 8390 W. 80th Ave (303) 425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. Juan Materon Comfort Dental of North Arvada ADP #36 8390 W. 80th Ave (303) 425-6419 Arvada General Dentist *, **, C, E1-2, E3-4

Dr. M. Scott Peppler New Impressions Dental ADP #39 9122 W. 88th Ave (303) 422-0836 Arvada General Dentist **, C, E1-2, E3-4

Dr. Anita Vedi New Impressions Dental ADP #39 9122 W. 88th Ave (303) 422-0836 Arvada General Dentist **, C, E1-2, E3-4

Dr. Mark Dean Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. (303) 421-7000 Arvada General Dentist *, C, E1-2, E3-4, N

Dr. Alan Bueltel Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. (303) 421-7000 Arvada General Dentist *, C, E1-2, E3-4, N

Dr. Neil Zimmet Comfort Dental - Arvada ADP #62 12380 W. 64th Ave. (303) 421-7000 Arvada General Dentist *, C, E1-2, E3-4, N

Dr. Roy Theriot Dr. Roy Theriot ADP #10 941 S. Havana, #200 (303) 341-5313 Aurora General Dentist C, E1-2, E3-4

Alpha Dental Plan Providers

Complete Participating Provider Directory(For All Beta Health Association Dental Products)

Statewide

Telephone number 1-800-807-0706

PLEASE NOTE: UNDER THE PROVIDER COLUMN THE ADP # IS FOR ALL ALPHA DENTAL PLANS. THE CDP # IS FOR CHOICE DENTAL PLAN. PLEASE BE VERY CAREFUL TO CHECK

THE PRODUCT YOU ARE ENROLLING IN BEFORE CHOOSING A PROVIDER.(Providers are listed in alphabetical order according to city)

Page 1 of 21



Dr. Kris Komanduri Hanu Dental Care ADP #163 11275 E. Mississippi Ave. #1 W2 (303) 340-0087 Aurora General Dentist *, C, E1-2

Dr. Steven Perry Dental Health Center ADP #168 250 S. Sable (303) 360-0991 Aurora General Dentist *, C, E1-2, E3-4

Dr. Frank Weir Dental Health Center ADP #168 250 S. Sable (303) 360-0991 Aurora General Dentist *, C, E1-2, E3-4

Dr. Saadia Basit Dental Health Center ADP #168 250 S. Sable (303) 360-0991 Aurora General Dentist *, C, E1-2, E3-4

Dr. Jeffrey Gilliam Comfort Dental of Aurora ADP #173 1050 S. Peoria (303) 367-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Matthew Rowan Comfort Dental of Aurora ADP #173 1050 S. Peoria (303) 367-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Gerald Edwards Comfort Dental of Aurora ADP #173 1050 S. Peoria (303) 367-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Scott Henderson Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. (303) 680-9990 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Jeffrey Hamilton Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. (303) 680-9990 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Michael Gioia Comfort Dental - Orchard Rd. ADP #177 15250 E. Orchard Rd. (303) 680-9990 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Sean Phelan Comfort Dental of Aurora ADP #34 2131 S. Chambers Road (303) 750-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Jim Parfitt Comfort Dental of Aurora ADP #34 2131 S. Chambers Road (303) 750-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Lorraine Loustalet Comfort Dental of Aurora ADP #34 2131 S. Chambers Road (303) 750-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Nicole Ward Comfort Dental of Aurora ADP #34 2131 S. Chambers Road (303) 750-2273 Aurora General Dentist *, C, E1-2, E3-4, N

Dr. Steven Rush Wohlgemuth & Rush, DDS ADP #41 1450 S. Havana, #200 (303) 755-8388 Aurora General Dentist C

Dr. Barry Wohlgemuth Wohlgemuth & Rush, DDS ADP #41 1450 S. Havana, #200 (303) 755-8388 Aurora General Dentist C

Dr. Robert Browning Robert Browning, DDS ADP #44 11275 E. Mississippi Ave. Ste. 2-5-6 (303) 343-3910 Aurora General Dentist *, C, E1-2, E3-4

Dr. Thomas E. Daniel Dr. Thomas E. Daniel ADP #46 1101 Havana (303) 366-3577 Aurora General Dentist E1-2

Dr. Bryan Elliott Blue Mesa Dental - S. Chambers Rd. ADP #70 1700 S. Chambers Road (303) 337-0789 Aurora General Dentist C, E1-2, E3-4

Page 2 of 21



Dr. Camillo DiLizia Comfort Dental Quincy & Buckley ADP #76 16981 E. Quincy D1-D3 (303) 617-8400 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. James Lui Comfort Dental Quincy & Buckley ADP #76 16981 E. Quincy D1-D3 (303) 617-8400 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. John W. Thousand, III Comfort Dental Quincy & Buckley ADP #76 16981 E. Quincy D1-D3 (303) 617-8400 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Sharon Poczatek Todays Choice Dental ADP #11 2800 Valmont Rd. (303) 444-3232 Boulder General Dentist *, **, C, E1-2

Dr. Christopher Mehlhoff Bright Now Dental - Boulder ADP #136 1840 Folsom St. (303) 417-9401 Boulder General Dentist *, E1-2, E3-4

Dr. Allen Skromme Dental Health Center ADP #169 2525 28th Street, #140 (303) 443-0070 Boulder General Dentist *, E1-2, E3-4

Dr. Steven Perry Dental Health Center ADP #169 2525 28th Street, #140 (303) 443-0070 Boulder General Dentist *, E1-2, E3-4

Dr. Steven J. Hood Dental Health Center ADP #169 2525 28th Street, #140 (303) 443-0070 Boulder General Dentist *, E1-2, E3-4

Dr. Mary Connolly Dental Health Center ADP #169 2525 28th Street, #140 (303) 443-0070 Boulder General Dentist *, E1-2, E3-4

Dr. Lyndon Mata Mata Dental ADP #58 6363 W. 120th Ave #230 (303) 635-0100 Broomfield General Dentist *, **, C, E1-2, E3-4

Dr. Frederick Thrash Bright Now Dental - Castle Rock ADP #49 1001 S. Perry St., #105-A (303) 688-0252 Castle Rock General Dentist C, E1-2, E3-4

Dr. Zahra Nadji Nadji Dental, Inc. ADP #115 6979 S. Holly Cir. #230 (303) 221-2250 Centennial General Dentist *, **, C, E1-2

Dr. Jeanette Berner Comfort Dental of Centennial ADP #6 8223 S. Quebec St., Unit A (303) 689-2273 Centennial General Dentist *, **, C, E1-2, E3-4

Dr. Jacqueline Blasko Comfort Dental of Centennial ADP #6 8223 S. Quebec St., Unit A (303) 689-2273 Centennial General Dentist *, **, C, E1-2, E3-4

Dr. Cynthia Phelan Comfort Dental of Centennial ADP #6 8223 S. Quebec St., Unit A (303) 689-2273 Centennial General Dentist *, **, C, E1-2, E3-4

Dr. Richard W. Arbuckle Reliable Dental ADP #66 4490 Bent Brothers Blvd. #D1 (719) 676-3361 Colorado City General Dentist C, E1-2

Dr. Richard H. Wiedey Dr. Richard H. Wiedey ADP #106 1819 North Circle #6 (719) 520-5884 Colorado Springs General Dentist **, E1-2, E3-4, N

Dr. John Rollow, IV Comfort Dental Citadel Crossing ADP #108 509 N. Academy Blvd. (719) 591-7599 Colorado

Springs General Dentist *, C, E1-2

Dr. Steve Carter Comfort Dental Citadel Crossing ADP #108 509 N. Academy Blvd. (719) 591-7599 Colorado


Page 3 of 21



Dr. Michael Stoor Comfort Dental Citadel Crossing ADP #108 509 N. Academy Blvd. (719) 591-7599 Colorado


Dr. Paul Hennegan Bright Now Dental - North Cascade ADP #155 801 N. Cascade Ave.,

#38 (719) 632-1211 Colorado Springs General Dentist E1-2, E3-4

Dr. Victor L. Blatter Bright Now Dental at Parkmoor Village ADP #159 3208 N. Academy Blvd.,

#140 (719) 596-7000 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Jon F. Mathes Bright Now Dental at Parkmoor Village ADP #159 3208 N. Academy Blvd.,

#140 (719) 596-7000 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Kathleen Brower Jade Dental Professionals South ADP #164 2130 S. Academy Blvd.,

#100 (719) 380-5733 Colorado Springs General Dentist C, E1-2

Dr. Joseph A. Woods Stafford Management Company ADP #25 559 E. Pikes Peak Ave., #208 (719) 636-3311 Colorado

Springs General Dentist **, E1-2, E3-4

Dr. Monte Campbell Stafford Management Company ADP #25 559 E. Pikes Peak Ave., #208 (719) 636-3311 Colorado

Springs General Dentist **, E1-2, E3-4

Dr. Leopoldo Rodríguez Leopoldo Rodríguez ADP #31 1304 N. Academy Blvd. (719) 596-3939 Colorado Springs General Dentist C, E1-2

Dr. Benjamin Butler Bright Now Dental - Citadel Drive ADP #50 701 Citadel Drive East (719) 574-7288 Colorado

Springs General Dentist E1-2, E3-4

Dr. Curtis Broeker Premier Dentistry ADP #73 5745 Erindale Dr. #100 (719) 264-9355 Colorado Springs General Dentist *, C, E1-2, E3-4

Dr. Paul Rodríguez Dr. Paul Rodríguez ADP #77 703 N. Tejon Street, #D (719) 633-5501 Colorado Springs General Dentist **, C, E1-2, E3-4

Dr. Douglas Peak All Smiles Family Dentistry ADP #81 3505 Austin Bluffs Parkway #306 (719) 599-0665 Colorado

Springs General Dentist **, C, E1-2

Dr. Steven Castillo Castillo Dental Associates ADP #88 1910 Vindicator Drive, #103 (719) 268-9030 Colorado

Springs General Dentist C, E1-2, E3-4

Dr. Colleen Jenson Jade Dental Associates ADP #89 703 N. Tejon St., #A (719) 633-0770 Colorado Springs General Dentist C, E1-2, E3-4

Dr. Daniel Ward Comfort Dental North Academy ADP #9 1635 York Road (719) 522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4, N

Dr. Steven Krendl Comfort Dental North Academy ADP #9 1635 York Road (719) 522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4, N

Dr. Rick Christensen Comfort Dental North Academy ADP #9 1635 York Road (719) 522-0800 Colorado Springs General Dentist *, C, E1-2, E3-4, N

Dr. Donald Connor Alpha Dental Care I ADP #1 6411 East Colfax Avenue (303) 388-2558 Denver General Dentist **, E1-2, E3-4

Dr. Gary Saddler Comfort Dental North Denver ADP #113 4901 W. 38th Ave. (303) 455-2273 Denver General Dentist C, E1-2, E3-4

Page 4 of 21



Dr. Robert Unrath Comfort Dental North Denver ADP #113 4901 W. 38th Ave. (303) 455-2273 Denver General Dentist C, E1-2, E3-4

Dr. Tom Marschner Comfort Dental North Denver ADP #113 4901 W. 38th Ave. (303) 455-2273 Denver General Dentist C, E1-2, E3-4

Dr. Alan Coombs Alpha Dental II, P.C. ADP #12 1660 S. Albion, #715 (303) 758-4287 Denver General Dentist E1-2, N

Dr. Norris Sadler Dr. Norris Sadler ADP #13 3025 W. 38th Avenue (303) 458-7051 Denver General Dentist *, E1-2, E3-4, N

Dr. Thomas Sniegowski Dr. Thomas Sniegowski ADP #151 7475 Dakin, Ste. #309 (303) 429-2727 Denver General Dentist *, E1-2, E3-4

Dr. Makala Bannister Dental Health Center ADP #170 1600 Stout St., #600 (303) 592-1133 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Steven Perry Dental Health Center ADP #170 1600 Stout St., #600 (303) 592-1133 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Amir Hashemi Dental Health Center ADP #171 2005 Franklin St., #590 (303) 832-8611 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Karen Suchyta Dental Health Center ADP #171 2005 Franklin St., #590 (303) 832-8611 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Steven Perry Dental Health Center ADP #171 2005 Franklin St., #590 (303) 832-8611 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Todd Light Comfort Dental of Cherry Creek ADP #183 201 University Blvd., #101 (303) 321-2233 Denver General Dentist *, C, E1-2, E3-4

Dr. David Dinsmore Comfort Dental of Cherry Creek ADP #183 201 University Blvd., #101 (303) 321-2233 Denver General Dentist *, C, E1-2, E3-4

Dr. Mark Jolested Comfort Dental of Cherry Creek ADP #183 201 University Blvd., #101 (303) 321-2233 Denver General Dentist *, C, E1-2, E3-4

Dr. Donald Mardis Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. (303) 377-3876 Denver General Dentist *, **, C, E1-2

Dr. Gary Rotolo Comfort Dental - East Colfax ADP #26 5200 E. Colfax Ave. (303) 377-3876 Denver General Dentist *, **, C, E1-2

Dr. Thomas Pyne Dr. Thomas Pyne ADP #29 12075 E. 45th Ave., #333 (303) 371-9131 Denver General Dentist *, C, E1-2, E3-4

Dr. Steven Zervas Bright Now Dental - Denver Downtown ADP #30 1955 Arapahoe St., Ste.

A (303) 296-0888 Denver General Dentist C, E1-2, E3-4

Dr. Donald Langley Dental Health Center ADP #37 5031 S. Ulster St., #100 (303) 779-8587 Denver General Dentist C

Dr. Christina Lee Dental Health Center ADP #37 5031 S. Ulster St., #100 (303) 779-8587 Denver General Dentist C

Page 5 of 21



Dr. Michael Buchler Bright Now Dental - Cherry Creek ADP #47 3865 Cherry Creek Dr.

North, #200 (303) 321-1181 Denver General Dentist C, N

Dr. David R. Huskey Dr. David R. Huskey, DDS ADP #51 2465 S. Downing, #104 A (303) 722-0204 Denver General Dentist C, E1-2, N

Dr. Timothy Wachuta Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. (303) 756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Ekatrina Butkevich Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. (303) 756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Laura S. Brenner Dr. Timothy Wachuta ADP #53 2709 S. Colorado Blvd. (303) 756-2770 Denver General Dentist C, E1-2, E3-4

Dr. Thomas L. Losacco Family Dental Center III ADP #7 824 E. 18th Avenue (303) 839-1396 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Jenny Terada Family Dental Center III ADP #7 824 E. 18th Avenue (303) 839-1396 Denver General Dentist *, C, E1-2, E3-4, N

Dr. Greg Schlagel AAA Dental Center ADP #84 3805 Newton Street (303) 455-0233 Denver General Dentist **, E1-2, E3-4, N

Dr. Kelly White Auraria Dental Centre ADP #96 1050 W. Colfax, Suite G (303) 573-5533 Denver General Dentist *, **, C, E1-2, E3-4

Dr. Larry Nessel Comfort Dental of Englewood ADP #45 2780 S. Broadway (303) 783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. W. Michael Love Comfort Dental of Englewood ADP #45 2780 S. Broadway (303) 783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. Jeffrey Spiegel Comfort Dental of Englewood ADP #45 2780 S. Broadway (303) 783-0100 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. Paul S. Weyman Paul S. Weyman, DDS ADP #60 3601 S. Clarkson (303) 726-8048 Englewood General Dentist *, C, E1-2, E3-4, N

Dr. William Case Dr. William Case ADP #71 7180 E. Orchard Rd., #302 (720) 488-6600 Englewood General Dentist *, **, C, E1-2, E3-4

Dr. Jennifer Mansky Blue Mesa Dental - S. Quebec ADP #72 8100 S. Quebec, #A-14 (720) 489-9800 Englewood General Dentist *, **, C, E1-2, E3-4

Dr. Douglas Haschke Comfort Dental - Ft. Collins ADP #32 934 S. Lemay (970) 498-8300 Fort Collins General Dentist *, C, E1-2, E3-4, N

Dr. King Campbell Comfort Dental - Ft. Collins ADP #32 934 S. Lemay (970) 498-8300 Fort Collins General Dentist *, C, E1-2, E3-4, N

Dr. Matthew Draper Comfort Dental - Ft. Collins ADP #32 934 S. Lemay (970) 498-8300 Fort Collins General Dentist *, C, E1-2, E3-4, N

Dr. Alois Tripam Comfort Dental - Ft. Collins ADP #32 934 S. Lemay (970) 498-8300 Fort Collins General Dentist *, C, E1-2, E3-4, N

Page 6 of 21



Dr. Scott Novak Bright Now Dental - Fort Collins ADP #38 1217 E. Elizabeth St., #5 (970) 498-8706 Fort Collins General Dentist C, E1-2

Dr. Thomas L. Losacco Dr. Thomas L. Losacco ADP #8 801 6th Street (303) 569-3141 Georgetown General Dentist *, C, E1-2, E3-4, N

Dr. Joel Kaye Alpine Family Dental ADP #178 1614 Grand Ave. (970) 947-1717 Glenwood Springs General Dentist *, C

Dr. William McGlashan Comfort Dental of Glenwood Springs ADP #91 1512 Grand Ave. (970) 947-1273 Glenwood

Springs General Dentist *, C, E1-2, E3-4

Dr. Michael Shea Comfort Dental of Glenwood Springs ADP #91 1512 Grand Ave. (970) 947-1273 Glenwood

Springs General Dentist *, C, E1-2, E3-4

Dr. Ekatrina Butkevich Dr. Timothy Wachuta ADP #128 2305 Jackson Street (303) 278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Laura S. Brenner Dr. Timothy Wachuta ADP #128 2305 Jackson Street (303) 278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Timothy Wachuta Dr. Timothy Wachuta ADP #128 2305 Jackson Street (303) 278-2800 Golden General Dentist C, E1-2, E3-4

Dr. Thomas Mulheran Golden View Dental ADP #21 727 Simms Street, #E (303) 232-3636 Golden General Dentist *, C

Dr. Michael Miller Golden View Dental ADP #21 727 Simms Street, #E (303) 232-3636 Golden General Dentist *, C

Dr. Paulette Dilizia Comfort Dental of Golden ADP #90 17531 S. Golden Road (303) 278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Matthew Carlston Comfort Dental of Golden ADP #90 17531 S. Golden Road (303) 278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Eric Morrison Comfort Dental of Golden ADP #90 17531 S. Golden Road (303) 278-6953 Golden General Dentist *, **, C, E1-2, E3-4

Dr. Brett Clifton Grand Dental ADP #86 1035 Grand Ave. (970) 243-8580 Grand Junction General Dentist C, E1-2, E3-4

Dr. Clark A. King, Jr. Grand Valley Family Dental ADP #97 132 Walnut St., Ste. #6 970-242-5151 Grand Junction General Dentist C, E1-2, E3-4

Dr. Steven Perry Dental Health Center ADP #48 1600 23rd Ave., #200 (970) 353-4329 Greeley General Dentist *, C, E1-2, E3-4, N

Dr. Randy Hatch Dental Health Center ADP #48 1600 23rd Ave., #200 (970) 353-4329 Greeley General Dentist *, C, E1-2, E3-4, N

Dr. Charles Johnson Dental Health Center ADP #48 1600 23rd Ave., #200 (970) 353-4329 Greeley General Dentist *, C, E1-2, E3-4, N

Dr. Stephen Brown Dr. Stephen Brown ADP #65 3400 W. 16th Street, Bldg. 3, Ste. S (970) 356-8118 Greeley General Dentist *, C, E1-2, E3-4

Page 7 of 21



Dr. Patrick Rinaldis Comfort Dental - Greeley ADP #67 3766 West 10th Street (970) 304-1273 Greeley General Dentist C, E1-2, E3-4

Dr. Patrick Harrison Sunrise Dental Center ADP #83 10006 A. Street (970) 352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Dinorah Moya Sunrise Dental Center ADP #83 10006 A. Street (970) 352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Alex Knecht Sunrise Dental Center ADP #83 10006 A. Street (970) 352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Kent Day Sunrise Dental Center ADP #83 10006 A. Street (970) 352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Shivaun McArtor Sunrise Dental Center ADP #83 10006 A. Street (970) 352-0048 Greeley General Dentist *, **, C, E1-2, E3-4

Dr. Matthew Huffaker Northeastern Family Dental ADP #103 115 S. Colorado (970) 774-7999 Haxtun General Dentist **, C, E1-2, E3-4

Dr. Khiem Hoang Comfort Dental of Highlands Ranch ADP #40 129 W. County Line

Road (303) 738-9499 Highlands Ranch General Dentist *, C, E1-2, E3-4, N

Dr. Michael Vetowich Comfort Dental of Highlands Ranch ADP #40 129 W. County Line


Dr. Michael Love Comfort Dental of Highlands Ranch ADP #40 129 W. County Line


Dr. Christopher Hasselback Comfort Dental of Highlands Ranch ADP #40 129 W. County Line


Dr. Mark Jolested Comfort Dental of Highlands Ranch ADP #40 129 W. County Line


Dr. Sarira Martin Bright Now Dental - Highlands Ranch ADP #93 3626 Highlands Rnch.

Pkwy #107 (303) 488-9922 Highlands Ranch General Dentist E1-2, E3-4, N

Dr. Dwight M. Bratton Bright Now Dental - Highlands Ranch ADP #93 3626 Highlands Rnch.

Pkwy #107 (303) 488-9922 Highlands Ranch General Dentist E1-2, E3-4, N

Dr. Matthew Huffaker Northeastern Family Dental ADP #104 111 W. Emerson (970) 774-7999 Holyoke General Dentist **, C, E1-2, E3-4

Dr. Efren Martinez Dr. Efren Martinez ADP #130 1200 S. Wadsworth (303) 733-7533 Lakewood General Dentist **, E1-2, E3-4

Dr. Richard Glucksman Alpha Dental XX ADP #3 7373 W. Jefferson, #203 (303) 988-1530 Lakewood General Dentist C, E1-2, E3-4

Dr. Ibrahen Ackall High Plains Community Health Center ADP #54 200 Kendall Drive (719) 336-8445 Lamar General Dentist **, C, E1-2

Dr. Zachery Bacus High Plains Community Health Center ADP #54 200 Kendall Drive (719) 336-8445 Lamar General Dentist **, C, E1-2

Page 8 of 21



Dr. Bill Bender Dr. Bill Bender ADP #23 202 2nd Street (970) 284-7930 Lasalle General Dentist *, **, C, E1-2

Dr. Jason Ray Blue Mesa Dental - Arapahoe ADP #116 2275 E. Arapahoe RD. #136 (303)-703-4544 Littleton General Dentist C, E1-2, E3-4

Dr. Richard Handelman Blue Mesa Dental - Arapahoe ADP #116 2275 E. Arapahoe RD. #136 (303)-703-4544 Littleton General Dentist C, E1-2, E3-4

Dr. Brad Weekes Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. (303) 904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Bill Oldershaw Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. (303) 904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Thomas Klumb Comfort Dental - Littleton ADP #182 8420 W. Coal Mine Ave. (303) 904-2273 Littleton General Dentist *, C, E1-2, E3-4

Dr. Ellias Najjar Belleview Dental Associates ADP #69 10184 W. Belleview (303) 932-1077 Littleton General Dentist *

Dr. Steven Echols Belleview Dental Associates ADP #69 10184 W. Belleview (303) 932-1077 Littleton General Dentist *

Dr. Margareta Pavel Dutch Creek Dental ADP #78 8370 W. Coal Mine Ave, #103 (303) 978-1522 Littleton General Dentist *, C, E1-2, E3-4

Dr. Jason Ray Blue Mesa Dental - Lone Tree ADP #176 10047 Park Meadows Drive #B 303-768-8848 Lone Tree General Dentist C, E1-2, E3-4

Dr. Richard Handelman Blue Mesa Dental - Lone Tree ADP #176 10047 Park Meadows Drive #B 303-768-8848 Lone Tree General Dentist C, E1-2, E3-4

Dr. Robert Hamblin Dental Health Center ADP #172 1250 S. Hover Rd., #F (303) 678-1125 Longmont General Dentist *, C, E1-2, E3-4, N

Dr. Ronald Magnuson Dental Health Center ADP #172 1250 S. Hover Rd., #F (303) 678-1125 Longmont General Dentist *, C, E1-2, E3-4, N

Dr. Steven Perry Dental Health Center ADP #172 1250 S. Hover Rd., #F (303) 678-1125 Longmont General Dentist *, C, E1-2, E3-4, N

Dr. Stephen Brown Affordable Dental Clinic ADP #22 2051 Terry Street (303) 678-7232 Longmont General Dentist *, E1-2

Dr. John Weber Comfort Dental of Louisville ADP #17 339 McCaslin Blvd., #B (303) 673-0500 Louisville General Dentist *, **, C, E1-2, E3-4, N

Dr. Kelvin Webster Comfort Dental of Louisville ADP #17 339 McCaslin Blvd., #B (303) 673-0500 Louisville General Dentist *, **, C, E1-2, E3-4, N

Dr. Ciaran Finbar Murphy Bright Now Dental - Loveland ADP #146 1440 W. 29th Street, #400 (970) 622-0922 Loveland General Dentist **, E1-2

Dr. Murphy Bright Now Dental - Loveland ADP #146 1440 W. 29th Street, #400 (970) 622-0922 Loveland General Dentist **, E1-2

Page 9 of 21



Dr. King Campbell Comfort Dental Thompson Valley ADP #185 1405 10th St. S.W. (970) 962-9995 Loveland General Dentist *, C, E1-2, E3-4

Dr. Douglas Haschke Comfort Dental Thompson Valley ADP #185 1405 10th St. S.W. (970) 962-9995 Loveland General Dentist *, C, E1-2, E3-4

Dr. J. Kallio Comfort Dental Thompson Valley ADP #185 1405 10th St. S.W. (970) 962-9995 Loveland General Dentist *, C, E1-2, E3-4

Dr. Alois Tripam Comfort Dental Thompson Valley ADP #185 1405 10th St. S.W. (970) 962-9995 Loveland General Dentist *, C, E1-2, E3-4

Dr. K. Sorensen Comfort Dental Thompson Valley ADP #185 1405 10th St. S.W. (970) 962-9995 Loveland General Dentist *, C, E1-2, E3-4

Dr. Patrick Harrison Loveland Community Health Center ADP #87 450 N. Cleveland Ave. (970) 461-8942 Loveland General Dentist *, **, C, E1-2, E3-4

Dr. Shivaun McArtor Loveland Community Health Center ADP #87 450 N. Cleveland Ave. (970) 461-8942 Loveland General Dentist *, **, C, E1-2, E3-4

Dr. Howard Kellogg Dr. Howard Kellogg ADP #174 124 E. 120th Ave. (303) 457-9328 Northglenn General Dentist *, C, E1-2, N

Dr. Stuart Moss Stuart Moss & Associates ADP #4 421 W. 104th Ave., #201 (303) 427-6462 Northglenn General Dentist C, E1-2, N

Dr. Scott Welch Stuart Moss & Associates ADP #4 421 W. 104th Ave., #201 (303) 427-6462 Northglenn General Dentist C, E1-2, N

Dr. Michael G. Hale Dr. Michael G. Hale ADP #27 9750 E. Parker Square Dr. #105 (303) 841-3322 Parker General Dentist *, C, N

Dr. Tony G. Oreskovich Oreskovich Dental ADP #5 1111 Pueblo Blvd. Way, #140 (719) 542-8182 Pueblo General Dentist C, E1-2, E3-4

Dr. Tony I. Oreskovich Oreskovich Dental ADP #5 1111 Pueblo Blvd. Way, #140 (719) 542-8182 Pueblo General Dentist C, E1-2, E3-4

Dr. Richard C. Moreschini Dr. Richard C. Moreschini ADP #52 1000 W. 6th Street (719) 542-7420 Pueblo General Dentist C, E1-2, N

Dr. Gino Ortegon Dr. Gino Ortegon ADP #85 401 W.12th Street (719) 583-0555 Pueblo General Dentist **, C, E1-2, N

Dr. Gary Graves Dr. Gary Graves ADP #99 2099 W. Highway 50, #120 (719) 542-3595 Pueblo General Dentist *, **, C, E1-2

Dr. Stephen Dembitsky Stephen Z. Dembitsky, DDS ADP #24 160 E. 26th St., Suite 1 (970) 625-2345 Rifle General Dentist C, E1-2

Dr. Gary Weber Dr. Gary Weber ADP #15 1402 S. 3rd Avenue (970) 522-6280 Sterling General Dentist *, C, E1-2, E3-4

Page 10 of 21



Dr. Greg Schlagel AAA Family Dental Center ADP #154 710 Eppinger Blvd. (303) 289-3358 Thornton General Dentist *, **, C, E1-2, E3-4, N

Dr. Jack Moss Dental Health Center ADP #129 7970 Sheridan Blvd., 3rdFl. (303) 427-0730 Westminster General Dentist *, C, E1-2, E3-4, N

Dr. Allen Skromme Dental Health Center ADP #129 7970 Sheridan Blvd., 3rdFl. (303) 427-0730 Westminster General Dentist *, C, E1-2, E3-4, N

Dr. Steven Perry Dental Health Center ADP #129 7970 Sheridan Blvd., 3rdFl. (303) 427-0730 Westminster General Dentist *, C, E1-2, E3-4, N

Dr. Thomas Herrera Sante Fe Dental ADP #114 6175 W. 38th Ave. (303) 940-9755 Wheatridge General Dentist *, **, C, E1-2, E3-4

Dr. Thomes Jorgensen Sante Fe Dental ADP #114 6175 W. 38th Ave. (303) 940-9755 Wheatridge General Dentist *, **, C, E1-2, E3-4

Page 11 of 21



Name Office Provider Address Phone City Specialty Codes

Dr. Frank Welch Welch Dental, LLC CDP #440 206 Crestone Ave. (719) 589-6229 Alamosa General Dentist *, E1-2

Dr. Christopher Welch Welch Dental, LLC CDP #440 206 Crestone Ave. (719) 589-6229 Alamosa General Dentist *, E1-2

Dr. John A. Carpenter Dr. John Carpenter CDP #354 5310 Ward Road #101 (303) 421-6165 Arvada General Dentist **, C, E1-2, E3-4

Dr. Sharon Fahmy Sharon Fahmy, D.D.S. CDP #42713741 E. Rice Place #100 (303) 617-5212 Aurora General Dentist C

Dr. Nelson S. Joo Nelson S. Joo, DMD CDP #35214364 E. Evans Ave.,#281 (303) 671-0305 Aurora General Dentist *, C, E1-2

Dr. Michael Chang Michael W. Chang, D.D.S., P.C. CDP #4221344 S. Chambers Rd., #102 (303) 338-2004 Aurora General Dentist *, C, E1-2

Dr. Farhad Farbod Farhad Farbod, D.M.D., P.C. CDP #42814991 E. Hampden Ave. #270 (303) 699-9880 Aurora General Dentist *, C, E1-2

Dr. Falona Glenn Falona Glenn, DDS, PC CDP #450 1732 S. Chambers Rd. (303) 751-6916 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Gerald Glenn Falona Glenn, DDS, PC CDP #450 1732 S. Chambers Rd. (303) 751-6916 Aurora General Dentist *, **, C, E1-2, E3-4

Dr. Ronald Montano Kids Choice Dental CDP #462 15159 E. Colfax Ave. B 303-374-5437 Aurora General Dentist *, C, E1-2, N

Dr. Davood Manshadi Kids Choice Dental CDP #462 15159 E. Colfax Ave. B 303-374-5437 Aurora General Dentist *, C, E1-2, N

Dr. Mario Montanez Kids Choice Dental CDP #462 15159 E. Colfax Ave. B 303-374-5437 Aurora General Dentist *, C, E1-2, N

Dr. Kendall BurnsBroadlands Family Dentistry, LLC CDP #447 3800 W. 144th Ave. #400 303-460-8700 Broomfield General Dentist **, C, E1-2, E3-4

Dr. Kerry TurnquistBroadlands Family Dentistry, LLC CDP #447 3800 W. 144th Ave. #400 303-460-8700 Broomfield General Dentist **, C, E1-2, E3-4

Dr. Hani Marogil Hani Marogil DMD, PC CDP #471 340 E. 1st Ave., #202 (303) 466-4646 Broomfield General Dentist C, E1-2

Dr. Neal Wilsted Neal K. Wilsted, D.D.S. CDP #4267920 S. University Blvd. #200 (720) 489-0797 Centennial General Dentist *, C, E1-2

Dr. David Wearly David W. Wearly, D.D.S., LLC CDP #467 6650 S. Vine St. #120 (303) 805-9256 Centennial General Dentist *, C, E1-2

Choice Dental Plan Providers

Page 12 of 21



Dr. Timothy Boeyink Timothy R. Boeyink, D.D.S. CDP #4697900 S. University Blvd. #210 (720) 489-7333 Centennial General Dentist

Dr. Gregory Moore Gregory B. Moore, D.D.S. CDP #4245859 E. Pikes Peak Ave.,#319 (719) 633-4028

Colorado Springs General Dentist C, E1-2

Dr. Arnold CullumColo Springs Restorative Dentistry CDP #331

685 Citadel Drive East, #300 (719) 591-2004

Colorado Springs General Dentist *, C

Dr. Gregory D. Mock Aspen Dental Associates CDP #3322504 E. Pikes Peak Ave.,#202 (719) 473-9222

Colorado Springs General Dentist *, **, E1-2

Dr. Michael Gilbert Aspen Dental Associates CDP #3322504 E. Pikes Peak Ave.,#202 (719) 473-9222

Colorado Springs General Dentist *, **, E1-2

Dr. Arnold Cullum Lowell District Dental, P.C. CDP #412 251 E. Fountain #100 (719) 473-4300Colorado Springs General Dentist *, E1-2, E3-4

Dr. Ann Hill Ann S. Hill, D.D.S. CDP #430 6685 Delmonico Dr. #A (719) 535-8049Colorado Springs General Dentist C

Dr. Gregory M. ReichGregory M. Reich, D.D.S., M.S., P.C. CDP #437

595 Chapel Hills Drive #300 (719) 339-2562

Colorado Springs General Dentist *, C, E1-2

Dr. Raymond Baros Family Dental Care CDP #439 513 Kiva Drive (719) 392-5300Colorado Springs General Dentist *, C, E1-2

Dr. Stephen G. Sosdian Uptown Dental Associates CDP #448 523 N. Nevada Ave. 719-635-5815Colorado Springs General Dentist C, E1-2

Dr. Quynh Dung Vo Sosdian Uptown Dental Associates CDP #448 523 N. Nevada Ave. 719-635-5815Colorado Springs General Dentist C, E1-2

Dr. Michael Gorsky Broadmoor Valley Dental Care CDP #4532965 Broadmoor Valley Rd. (719) 632-7636

Colorado Springs General Dentist C, E1-2

Dr. James Cady Centennial Dental Care, PC CDP #4565731 Silverstone Terrace #200 (719) 632-7778

Colorado Springs General Dentist *, C, E1-2

Dr. Kye Lee Kye W. Lee, D.D.S., P.C. CDP #421 7159 E. Hampden Ave. (303) 337-8385 Denver General Dentist *, C, E1-2

Dr. Shih Chien Shih M. Chien, D.D.S. CDP #423 500 E. 84th Ave. #E-3 (303) 288-0888 Denver General Dentist C, E1-2

Dr. Richard H. Koch Greentree Dental CDP #353 10101 E. Hampden, #100 (303) 671-0101 Denver General Dentist C, E1-2

Dr. Arnold Cullum Blake Street Dental, P.C. CDP #411 1732 Blake Street (303) 814-2200 Denver General Dentist *, E1-2, E3-4

Dr. Preet Clair Quebec Square Family Dentistry CDP #451 7505 E. 35th Ave. #304 (303) 322-2081 Denver General Dentist *, C, E1-2

Dr. James Maniatis James Maniatis, DDS CDP #457 2601 E. 3rd Ave. (303) 399-1650 Denver General Dentist *, C, E1-2

Page 13 of 21



Dr. Peter Maniatis James Maniatis, DDS CDP #457 2601 E. 3rd Ave. (303) 399-1650 Denver General Dentist *, C, E1-2

Dr. Brigitte Steeghs Brigitte Steeghs, DDS CDP #4595800 E. Evans Ave., Suite 202 (303) 638-8728 Denver General Dentist *, C, E1-2

Dr. Elena Isabela Bodoni Elena Isabela Bodoni, D.D.S. CDP #4086900 E. Belleview Ave., #203 303-781-2107 Englewood General Dentist C, E1-2

Dr. Thomas Allen All Family Dentistry CDP #302 373 W. Drake Road (970) 223-0424 Fort Collins General Dentist *, C, E1-2, E3-4

Dr. James Fischer Fischer Dental CDP #3031331 E. Prospect Rd., #B2 (970) 482-6333 Fort Collins General Dentist *, C, E1-2, E3-4

Dr. Cory Foster Cory Foster, D.D.S. CDP #425 373 W. Drake Road (970) 223-5258 Fort Collins General Dentist *, C, E1-2

Dr. Thomas Harvey Thomas Harvey, DDS CDP #449 718 S. College Ave. (970) 224-4093 Fort Collins General Dentist C

Dr. Joseph M. Simpson Alpine Dental Health CDP #463 718 S. College (970) 484-5297 Fort Collins General Dentist C

Dr. Leon Green Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #G (970) 407-8080 Fort Collins General Dentist *, C, E1-2, E3-4

Dr. Rich Wuerker Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #G (970) 407-8080 Fort Collins General Dentist *, C, E1-2, E3-4

Dr. Zachery Green Boardwalk Dental CDP #468 140 E. Boardwalk Dr. #G (970) 407-8080 Fort Collins General Dentist *, C, E1-2, E3-4

Dr. Doyle Fulton Dr. Doyle Fulton CDP #355 607 4th Street (303) 279-5420 Golden General Dentist **, C

Dr. John Burchfield J.R. Burchfield, D.D.S. CDP #443 2007 Jackson Street (303) 279-3992 Golden General Dentist C, E1-2

Dr. Nicholas Jimison Nicholas A. Jamison, II D.D.S. CDP #4334669 W. 20th Street Road (970 506-1122 Greeley General Dentist *, C

Dr. Timothy Schroeder Timothy Schroeder, D.D.S. CDP #420 6565 W. Jewell #3 (303) 939-6345 Lakewood General Dentist *, C, E1-2

Dr. Owen Crockett Owen C. Crockett, DDS CDP #458 1345 Wadsworth (303) 238-1209 Lakewood General Dentist

Dr. James T. Kern James T. Kern, D.D.S. CDP #465 10815 W. Jewell Ave. #L (303) 988-6860 Lakewood General Dentist C

Dr. James Preston James M. Preston, D.D.S. CDP #4385950 Platte Canyon Road (303) 797-2286 Littleton General Dentist *, C, E1-2

Dr. Brian RichardsonBlanchard & Richardson Family Dentistry CDP #442 8089 S. Lincoln St. #102 (303) 794-9271 Littleton General Dentist *, **, C, E1-2

Page 14 of 21



Dr. Jason BlanchardBlanchard & Richardson Family Dentistry CDP #442 8089 S. Lincoln St. #102 (303) 794-9271 Littleton General Dentist *, **, C, E1-2

Dr. Cindy Kempton Cindy Kempton, D.D.S. CDP #444 7261 S. Broadway, #102 (303) 738-3888 Littleton General Dentist *, **, C, E1-2

Dr. Tram Tran Tram Tran, DDS, LLC CDP #454 9860 W. Belleview Ave. (303) 933-9969 Littleton General Dentist *, C, E1-2

Dr. Kevin Dawson Advanced Dental Solutions CDP #455 7261 S. Broadway #103 (303) 798-1300 Littleton General Dentist *, C, E1-2, E3-4

Dr. Craig Greene Craig S. Greene, DDS, P.C. CDP #4618441 W. Bowles Ave., Suite 220 303-979-2544 Littleton General Dentist *, C, E1-2, E3-4

Dr. Craig Greene Craig S. Greene, DDS, P.C. CDP #4618441 W. Bowles Ave., Suite 220 303-979-2544 Littleton General Dentist *, C, E1-2, E3-4

Dr. M. William Meyer M. William Meyer, D.D.S. CDP #470 6691 W. Ken Caryl Ave. (303) 979-4994 Littleton General Dentist *, **, C, E1-2

Dr. Donald Hobbs M. William Meyer, D.D.S. CDP #470 6691 W. Ken Caryl Ave. (303) 979-4994 Littleton General Dentist *, **, C, E1-2

Dr. Ramzi Matar M. William Meyer, D.D.S. CDP #470 6691 W. Ken Caryl Ave. (303) 979-4994 Littleton General Dentist *, **, C, E1-2

Dr. David Gryzick M. William Meyer, D.D.S. CDP #470 6691 W. Ken Caryl Ave. (303) 979-4994 Littleton General Dentist *, **, C, E1-2

Dr. M. Shawn Lawler Four Seasons Dental CDP #4649896 Rosemont Ave. #203 (303) 705-5700 Lone Tree General Dentist C, E1-2

Dr. David Robinson David B. Robinson, D.D.S., P.C. CDP # 435 1560 Bonforte Blvd. (719) 544-5340 Pueblo General Dentist *, C, E1-2

Dr. Elmer Villalon Dr. Elmer Villalon CDP #323 1225 N. Main St., #207 (719) 542-7844 Pueblo General Dentist *, **, C, E1-2, E3-4

Dr. Tony Roberts Dr. Tony Roberts CDP #329 1225 N. Grand Avenue (719) 542-6014 Pueblo General Dentist *, C, E1-2, E3-4

Dr. Duilio Stricca Duilio A. Stricca, D.D.S. CDP #432 753 W. Abriendo Ave. (719) 543-5604 Pueblo General Dentist C, E1-2

Dr. Vikash Kanchanlal Gentle Touch Family Dentistry CDP #4341315 S. Pueblo Blvd. #100 (719) 564-3900 Pueblo General Dentist C, E1-2

Dr. Thomas W. Ready Gentle Dental CDP #445 643 S. Pueblo blvd. 71-561-8170 Pueblo General Dentist *

Dr. Naethan Haerr Advantage Dental Group CDP #452 1800 W. Fortino Blvd. (719) 545-1400 Pueblo General Dentist *, C, E1-2, E3-4

Dr. Eric Berry Advantage Dental Group CDP #452 1800 W. Fortino Blvd. (719) 545-1400 Pueblo General Dentist *, C, E1-2, E3-4

Page 15 of 21



Dr. Tim Townsend Tim F. Townsend, D.D.S. CDP #418 501 Anglers Drive #102 970-879-2290Steamboat Springs General Dentist C, E1-2

Dr. Matthew Janda Matthew C. Janda, D.D.S. CDP #431 801 Iris Drive (970) 522-4050 Sterling General Dentist *, **, C, E1-2, E3-4

Dr. Christopher Welch Welch Dental CDP #441 209 E. Main Street (719) 8546-087 Trinidad General Dentist *, E1-2

Dr. Frank Welch Welch Dental CDP #441 209 E. Main Street (719) 8546-087 Trinidad General Dentist *, E1-2

Dr. Phil Warlick Phil Warlick, D.D.S., Inc. CDP #436 620 S. Albert Ave. (719) 738-6448 Walsenberg General Dentist *, C, E1-2

Dr. Ray Lack Ray E. Lack, D.D.S., P.C. CDP #4295130 W. 80th Ave. Bldg. A #200 (303) 429-1426 Westminster General Dentist C, E1-2

Dr. Alan Bueltel Kenneth J. Polke, D.D.S., P.C. CDP #446 12030 Melody Drive 303-920-4900 Westminster General Dentist *, C, E1-2, E3-4

Dr. Kenneth Polke Kenneth J. Polke, D.D.S., P.C. CDP #446 12030 Melody Drive 303-920-4900 Westminster General Dentist *, C, E1-2, E3-4

Dr. Claude Pareja Westminster Dental Associates CDP #466 4070 W. 72nd Ave. (303) 429-7072 Westminster General Dentist *, **, C, E1-2, E3-4

Dr. Daniel Yahnian Westminster Dental Associates CDP #466 4070 W. 72nd Ave. (303) 429-7072 Westminster General Dentist *, **, C, E1-2, E3-4

Dr. Alan Bernbaum Alan N. Bernbaum, D.D.S. CDP #415 6654 W. 38th Ave. (303) 424-1517 Wheatridge General Dentist *, C, E1-2

Dr. Bryan Dahler Bryan M. Dahler, D.D.S., P.C. CDP #310 3785 Kipling Street (303) 421-8857 Wheatridge General Dentist **, C, E1-2, E3-4

Dr. Judson Valstad Judson D. Valstad, DMD, Inc. CDP 460 519 Main Street (970) 686-7121 Windsor General Dentist *, C, E1-2

Page 16 of 21



Name Office Provider Address Phone City Specialty Codes

Dr. Howard Stringert Dr. Howard Stringert Not Needed 511 Main Street (719) 589-6496 Alamosa Orthodontist (Child & Adult)

Dr. Damon C. WIlkerson Colo Orthodontics Not Needed 6390 Gardenia St., #200 (303) 421-2616 Arvada Orthodontist (Child & Adult)

Dr. James H. Mason Colo Orthodontics Not Needed 6390 Gardenia St., #200 (303) 421-2616 Arvada Orthodontist (Child & Adult)

Dr. James H. Mason Colo Orthodontics Not Needed 2993 S. Peoria St., #260 (303) 751-5700 Aurora Orthodontist (Child & Adult)

Dr. Damon C. WIlkerson Colo Orthodontics Not Needed 2993 S. Peoria St., #260 (303) 751-5700 Aurora Orthodontist (Child & Adult)

Dr. Hilary Neilberg-Baskin Comfort Smile Center Not Needed 15403 E. Hampden Ave. (303) 680-3295 Aurora Orthodontist (Child & Adult)

Dr. Jack E. Duran Dr. Jack E. Duran Not Needed11275 E. Mississippi Ave. Unit #1 N-2 (303) 789-9251 Aurora Orthodontist (Child & Adult)

Dr. Theresa Shaver Front Range Ortho Not Needed 14001 E. Iliff, #201 (303) 755-5505 Aurora Orthodontist (Child & Adult)

Dr. Damon C. WIlkersonUniversity of Colorado Department of Orthodontics Not Needed 1635 N. Ursula St. (720) 848-2538 Aurora Orthodontist (Child & Adult)

Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 460 County Road 43 (303) 988-0844 Bailey Orthodontist (Child & Adult)

Dr. Wojciech Bobak Dr. Wojciech Bobak Not Needed 460 County Road 43 (303) 988-0844 Bailey Orthodontist (Child & Adult)

Dr. John Walker Dr. John Walker Not Needed 350 Broadway #120 (303) 494-3535 Boulder Orthodontist (Child & Adult)

Dr. David Schroeder Apple Orthodontics Not Needed1694 E. Cheyenne Mtn. Blvd. (719) 538-4671

Colorado Springs Orthodontist (Child & Adult)

Dr. Louis Talmoumis Apple Orthodontics Not Needed1694 E. Cheyenne Mtn. Blvd. (719) 538-4671


Dr. Scott Sutter Front Range Ortho Not Needed3100 N. Academy Blvd., #200 (719) 550-0222


Dr. Voytek Bobak Dr. Voytek Bobak Not Needed26697 Pleasant Park Rd., #B-120 (303) 988-0844 Conifer Orthodontist (Child & Adult)

Dr. Wojciech Bobak Dr. Wojciech Bobak Not Needed26697 Pleasant Park Rd., #B-120 (303) 988-0844 Conifer Orthodontist (Child & Adult)

Orthodontic Providers

Page 17 of 21



Dr. Paul Rocke Downtown Orthodontics Not Needed 1050 W. Colfax, Suite G (303) 573-5533 Denver Orthodontist (Child & Adult)

Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7200 E. Hampden, #203 (303) 692-9610 Denver Orthodontist (Child & Adult)

Dr. Peter G. Sendroy Dr. Peter G. Sendroy Not Needed7150 E. Hampden Ave., #202 (303) 757-3307 Denver Orthodontist (Child & Adult)

Dr. David Richter Dr. David Richter - Englewood Not Needed 5031 S. Ulster St., #100 (303) 779-8587 Englewood Orthodontist (Child & Adult)

Dr. Jack E. Duran Orthodontics Exlusively Not Needed 3601 S. Clarkson (303) 789-9257 Englewood Orthodontist (Child & Adult)

Dr. Mary Kay Becher Dr. Mary Kay Becher Not Needed32156 Castle Court, Ste. 211 (303) 620-5878 Evergreen Orthodontist (Child & Adult)

Dr. William W. Iversen Dr. William W. Iversen Not Needed 1103 S. Shields (970) 484-3214 Fort Collins Orthodontist (Child & Adult)

Dr. T. Allan Hymas Mesa Orthodontics Not Needed1190 Bookcliff, Ave., Ste. 202 (970) 245-8810 Grand Junction Orthodontist (Child & Adult)

Dr. David Richter Dr. David Richter Not Needed 1600 23rd Ave., #200 (970) 353-4329 Greeley Orthodontist (Child & Adult)

Dr. Gary Barth Dr. Gary Barth Not Needed 1003 29th Avenue Ct. (970) 353-4249 Greeley Orthodontist (Child & Adult)

Dr. John C. GentileFront Range Orthodontic Specialists Not Needed 2855 35th Ave, #D (970) 330-5363 Greeley Orthodontist (Child & Adult)

Dr. David Richter West Greeley Orthodontics Not Needed 7251 W. 20th Street (970) 392-1733 Greeley Orthodontist (Child & Adult)

Dr. Bryan Nelson Dr. Bryan Nelson Not Needed9567 S.University Blvd., #C-1A (720) 344-2662

Highlands Ranch Orthodontist (Child & Adult)

Dr. Paul Rocke Front Range Ortho Not Needed 7901 S. Park Plaza, #204 (303) 730-7002Highlands Ranch Orthodontist (Child & Adult)

Dr. Howard Stringert Dr. Howard Stringert Not Needed 313 W. 3rd Street, #104 (719) 384-5583 La Junta Orthodontist (Child & Adult)

Dr. Damon C. WIlkerson Colo Orthodontics Not Needed12018 W. Jewell Ave., #B (303) 980-6411 Lakewood Orthodontist (Child & Adult)

Dr. James H. Mason Colo Orthodontics Not Needed12018 W. Jewell Ave., #B (303) 980-6411 Lakewood Orthodontist (Child & Adult)

Dr. Voytek Bobak Dr. Voytek Bobak Not Needed1840 S. Wadsworth Blvd. (303) 988-0844 Lakewood Orthodontist (Child & Adult)

Dr. Wojciech Bobak Dr. Wojciech Bobak Not Needed1840 S. Wadsworth Blvd. (303) 988-0844 Lakewood Orthodontist (Child & Adult)

Page 18 of 21



Dr. Andrey Nazarov Front Range Ortho Not Needed 7125 W. Jefferson, #380 (303) 989-5607 Lakewood Orthodontist (Child & Adult)

Dr. Cathy R. Carnes Front Range Ortho Not Needed 7125 W. Jefferson, #380 (303) 989-5607 Lakewood Orthodontist (Child & Adult)

Dr. Hilary Neilberg-Baskin Comfort Smile Center Not Needed 5055 S. Kipling Parkway (303) 933-8464 Littleton Orthodontist (Child & Adult)

Dr. Michael D. Bellon Dr. Michael D. Bellon Not Needed 7325 S. Pierce St., #204 (303) 933-6830 Littleton Orthodontist (Child & Adult)

Dr. Robert B. Gardner Dr. Robert B. Gardner Not Needed 9878 W. Belleview Ave. (303) 978-1316 Littleton Orthodontist (Child & Adult)

Dr. Voytek Bobak Dr. Voytek Bobak Not Needed 5728 S. Gallup St. (303) 794-4043 Littleton Orthodontist (Child & Adult)

Dr. Wojciech Bobak Dr. Wojciech Bobak Not Needed 5728 S. Gallup St. (303) 794-4043 Littleton Orthodontist (Child & Adult)

Dr. Paul Rocke Front Range Orthodontics Not Needed200 West County Line Rd., #340 (303) 730-7002 Littleton Orthodontist (Child & Adult)

Dr. David Albert Personalized Orthodontic Not Needed 7889 S. Lincoln, #102 (303) 798-0928 Littleton Orthodontist (Child & Adult)

Dr. Eunic P. Lee SouthPark Orthodontics Not Needed8199 South Park Lane #150 303-738-8828 Littleton Orthodontist (Child & Adult) *

Dr. Amir R. Fereydouni SouthPark Orthodontics Not Needed8199 South Park Lane #150 303-738-8828 Littleton Orthodontist (Child & Adult) *

Dr. David Richter Lone Tree Orthodontics Not Needed7430 E. Park Meadows Dr., #20 (303) 754-0040 Lone Tree Orthodontist (Child & Adult)

Dr. Jonathan Weinbach Front Range Ortho Not Needed1075 S. Boulder Rd., #235 (303) 604-0300 Louisville Orthodontist (Child & Adult)

Dr. Roger B. Elton Dr. Roger B. Elton Not Needed 10522 S. Parker Road (303) 364-6433 Parker Orthodontist (Child & Adult)

Dr. Andrey Nazarov Front Range Ortho Not Needed11211 S. Dransfeldt Rd. #122 (720) 842-4544 Parker Orthodontist (Child & Adult)

Dr. Howard Stringert Dr. Howard Stringert Not Needed 3955 Sandelwood Lane (719) 564-3333 Pueblo Orthodontist (Child & Adult)

Dr. James H. Mason Colo Orthodontics Not Needed 3984 E. 120th Avenue (303) 428-8800 Thornton Orthodontist (Child & Adult)

Dr. Damon C. WIlkerson Colo Orthodontics Not Needed 3984 E. 120th Avenue (303) 428-8800 Thornton Orthodontist (Child & Adult)

Dr. Greg Stoll Dr. Greg Stoll Not Needed 3861 E. 120th Ave. (303) 450-2211 Thornton Orthodontist (Child & Adult)

Page 19 of 21



Dr. Michael D. Bellon Family Dental Care VII Not Needed 2200 E. 104th Ave (303) 208-7385 Thornton Orthodontist (Child & Adult)

Dr. James H. Mason Colo Orthodontics Not Needed 2701 W. 84th Avenue (303) 428-8800 Westminster Orthodontist (Child & Adult)

Dr. Damon C. WIlkerson Colo Orthodontics Not Needed 2701 W. 84th Avenue (303) 428-8800 Westminster Orthodontist (Child & Adult)

Dr. Hilary Neilberg-Baskin Comfort Smile Center Not Needed 8113 W. 94th Avenue (303) 432-9773 Westminster Orthodontist (Child & Adult)

Dr. Jonathan Weinbach Front Range Ortho Not Needed 8120 Sheridan, #C-120 (303) 430-4200 Westminster Orthodontist (Child & Adult)

Page 20 of 21



Bottom page

General Provisions:

All specialty care (except for Orthodontics) has been contracted at a 20% discount. You must select a General Dentist for primary care. You may see any of the Specialists as the need arises. Call the plan office for a list ofparticipating specialists.

Orthodontic co-pays are listed in your schedule of benefits.

Each family member must see the same dentist.

You may change your selected dentist at any time by calling the Dental Plan administrative office.

Code Definitions:

* - These offices have nitrous oxide. C - Accepts most children age 4 and up for routine care. Other offices may accept older children, please check with your dental office. E1-2 -These offices have indicated they will provide 1 and 2 canal Endodontic Services (root canal) in certain situations. E3-4 -These offices have indicated they will provide 3 and 4 canal Endodontic Services (root canal) in certain situations. N –These offices will accept new patients the 1st of the month only, not mid-month. ** Estos consultorios tienen personal de habla hispana.

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OPTION #3

SECURIAN DENTAL INSURANCE / PPO PLAN

SELECT ANY DENTIST

CORPORATE GROWTH AT A GLANCE*

1987 2004Total managed revenue $57 million $931 million Operating expense ratio 16% (19% in 1986) 7%Members 600,000 3.9 million Equity $5.6 million $128 million

ABOUT US

2004 CLIENT BASEEmployer groups 14,900Members 3.9 million

2004 FINANCIALS*Total managed dental premium $931 millionOperating expenses $66 millionRevenues over expenses $13 millionEquity $128 million

2004 CUSTOMER SERVICE**Number of claims processed 6.2 millionFinancial accuracy rate 99.7%Avg. to process claim 98.7% within 10 business days

2004Fact Sheet

DeCare Dental, LLC is a leading dental benefit management company that houses our key market drivers, includingour management, insurance, analytic and technology companies. It oversees almost $1 billion in managed revenuesand serves more than 3.9 million individuals in 14,900 employer groups including Fortune 500 corporations, smallbusinesses, non-profits and government entities.

Through its affiliates and partners, it is active in all major markets across the United States and has expanded itsoperations into Europe. As a company focused on global leadership in oral health care management, DeCareDental sets the standard for innovation, quality, service and results. DeCare Dental is a wholly-owned subsidiaryof DeCare International.

CAPABILITIES

Networks: A subsidiary of DeCare Dental develops and manages dentist networks for business partners locally,nationally and around the world.

Analytics: DeCare Analytics, a subsidiary of DeCare Dental,develops proprietary, data-driven processes to implementsolutions that yield exceptional economic value to partnersand customers.

IT: DeCare Dental’s Irish software and Web-solutions affiliate,DeCare Systems Ireland, offers a number of services to ourbusiness partners, ranging from basic Web design capabilitiesto complex e-business solutions.

Customer Service: DeCare Dental offers fast, accurate serviceto meet the needs of our customers. We process more than24,000 claims a day, help members locate participating dentists, answer questions on benefits and more. As anadded convenience, we also offer a variety of online servicesfrom claims look-up to broker rate calculators and onlineenrollment capabilities.

GLOBAL BUSINESS OPERATIONS

Minnesota: Through its holding company, DeCare Dentalprovides dental benefit management services to Minnesota’slargest dental benefits provider. It also administers the MedicaHealth Plans of Minnesota’s dental benefit product line.

Securian Dental: Securian Life Insurance Company and aDeCare Dental affiliate are offering Securian Dental in 44states, which delivers a variety of plans to small groups oftwo employees up to large groups.

Blue Cross and Blue Shield Plans: Through a joint-venturepartnership with Blue Cross and Blue Shield of Minnesota(one of the largest health care providers in the UpperMidwest), DeCare Dental manages dental benefit programs atBlue Cross and Blue Shield of Minnesota, Empire BlueCrossBlueShield (the largest health insurance provider in NewYork), and Wellmark Blue Cross and Blue Shield of Iowa.

Vhi DeCare Dental: A DeCare Dental affiliate and Vhi Healthcare partnered to introduce Vhi DeCare Dental,Ireland’s first-ever comprehensive range of dental insurance products.

Patriot: A DeCare Dental affiliate has a partnership with Patriot Mutual Insurance Company to administer its dental business.

Europ Assistance: DeCare Dental affiliates, together withEurop Assistance, offer members access to emergency dental care in more than 137 countries.

For more information about DeCare Dental, visitwww.decare.com or contact Dimitri Senaratna at 651-994-5275 or [email protected].

*Consolidated financials for DeCare International, parent company of DeCare Dental, LLC.

**Might vary for plans with specific performance guarantees

Securian Dental Proposed Plan Design

And

Monthly Premiums

Participating Securian Dental Preferred Provider (PPO) Network (if quoted)

For a specific search for a Securian Dental participating PPO

provider in a particular city or state go to: http://www.dentemax.com/RadiusSearch/SearchProvGen.aspx

http://www.dentemax.com/RadiusSearch/SearchProvGen.aspx

Beta Health Association, Inc. and Securian Dental Participation and Underwriting Guidelines

Colorado Voluntary Dual and Triple Choice Groups

The following Participation Guidelines apply to all new voluntary groups: The above products are available to any employer on a voluntary basis as long as there is a minimum of two (2) eligible employees. A minimum of two employees must enroll in the Securian Dental option to start coverage.

For Groups with 2 to 4 eligible employees:

• One time open enrollment. • 100% of all eligible employees and dependents must enroll in one of the dental plan options.

For Groups with 5 to 99 eligible employees:

• One time enrollment for groups of 5 to 9 eligible employees. • Annual Open Enrollment for groups of 10 or more enrolled employees. • A minimum of 5 employees must enroll between all plans. Also, there is no minimum percentage participation

requirement. The following Underwriting Guidelines apply to all new groups:

• If coverage is waived at initial enrollment, a qualifying event must occur to gain coverage. • Employees who drop coverage may not re-enroll at any time unless a qualifying event occurs. • Groups must be based in the approved state and (for standard approval and rates) no more than 20% of the group can

be located outside the state. • Groups with more than 20% or more of eligible employees residing outside the approved state are subject to

underwriting review. • Coverage is not available for groups in which 50% or more of the employees are related by blood, marriage or

adoption. For groups of 5 or more where 50% or more are related by blood, marriage, or adoption, proof of employment is required.

• Coordination of benefits applies on the Securian Dental Plan. • Employee-only plans are available for groups of any size.

Colorado Employer Paid Dual and Triple Choice Groups

The following Participation Guidelines apply to all new employer paid groups: The above Products are available to any employer on an employer paid basis as long as there is a minimum of two (2) eligible employees. A minimum of two employees must enroll in the Securian Dental option to start coverage. The following other guidelines apply as well: For Groups with 2 to 4 eligible employees:

• One time open enrollment. • 100% of all eligible employees and dependents must enroll in one of the dental plan options.

Participation and Underwriting Guidelines For Groups with 5 to 99 eligible employees:

• One time enrollment for groups of 5 to 9 eligible employees. • Annual open enrollment for groups of 10 or more enrolled employees. • A minimum of 5 employees or at least 60% of all eligible employees must be enrolled between all dental plan

options (whichever is greater). Medical Lock availability:

• To qualify as a medical lock, enrollment must be tied to medical coverage, meaning employees may not enroll in one of the dental options unless they are enrolled in the medical plan as well.

• Employees selecting single medical coverage must select single dental coverage, while those opting for family medical coverage must select family dental coverage. (A copy of the medical plan billing must be included with the Securian Dental master application and employee enrollment forms.)

The following Underwriting Guidelines apply to all new groups:

• If coverage is waived at initial enrollment, a qualifying event must occur to gain coverage unless there is an open enrollment period. (After the initial open enrollment, open enrollment is only available to groups of 10 or more enrolled employees).

• Employees who drop coverage may not re-enroll at any time unless a qualifying event occurs.

• Groups must be based in the approved state and (for standard approval and rates) no more than 20% of the group can be located outside the state.

• Groups with 20% or more of eligible employees residing outside the approved state are subject to underwriting review.

• Coverage is not available for groups in which 50% or more of the employees are related by blood, marriage or adoption. For groups of 5 or more where 50% or more are related by blood, marriage, or adoption, proof of employment is required.

• Coordination of benefits applies on the Securian Dental Plan. General Comments - All Voluntary or Employer Paid Securian Dental Plans Orthodontic – (Optional add-on for Plans B, C, and D)

• Orthodontic coverage is available as an add-on for groups of 10 or more enrolled employees on the Securian Dental Plan. Employer must choose a Securian Dental Plan either with or without Orthodontics for all employees.

• Coverage is only for dependent children ages 8 through 18. • An eighteen-month waiting period applies on the Securian Dental Plan for all new groups. If the group has prior

comparable dental coverage, enrolled dependent children on the Securian Dental Plan will receive credit toward the waiting period for the time under the prior plan. The entire waiting period applies to dependent children of employees on the Securian Dental Plan who join after the initial enrollment.

• Coverage on the Securian Dental Plan includes limited, interceptive, and comprehensive Orthodontic treatment. Other items of note

• The above guidelines apply only for pooled groups of 2-99 employees. Call Beta Health Association, Inc. at 1-800-807-0706 for custom quote requests and for groups over 99 employees.

• This information is for Beta Health Association, Inc. and Securian Dental broker use, and is provided as a convenience only. Participation and underwriting determinations on the Securian Dental Plan are subject to Securian underwriting review, and complete coverage details are specified in the Securian Dental Benefit Plan Summary.

• Securian Dental is underwritten by Securian Life Insurance Company and administered by DeCare Dental Health International, LLC. Marketing is provided by Beta Health Association, Inc.

• The Beta Health Association, Inc. network dental plans are discount fee-for-service dental plans are in no way considered insurance.

Questions-please contact us at: 303-744-3007 or 1-800-807-0706

ATTENTION EMPLOYEES!

DENTAL PLAN OPEN ENROLLMENT

We are proud to make available to all of our employees a “Triple Choice” dental plan. This dental plan offering will allow you to select between three different dental plans. The features of these plans are as follows:

Option #1 Option #2 Option #3

See Network Dentist Only See Network Dentist Only Select Any Dentist No Deductibles to Satisfy No Deductibles to Satisfy Deductible to satisfy Lower Co-Pays Higher Co-Pays UCR – 80th or 90th Percentile No Claim Forms to Complete No Claim Forms to Complete Claim Forms to Complete Unlimited Services Unlimited Services Calendar year Maximum Applies Orthodontics (child & adult) Orthodontics (child & adult) Orthodontia (optional) No Waiting Periods No Waiting Periods Waiting Periods May Apply No Pre-authorizations No Pre-authorizations Authorization Suggested Cosmetic Dentistry Included Cosmetic Dentistry Included No Cosmetic Dentistry Rate Guaranteed 1 Yr. Rate Guaranteed 1 Yr. Rate Guaranteed 1 Yr. Low Monthly Cost Low Monthly Cost More Monthly Cost

PLEASE NOTE! EMPLOYEES MUST EITHER ENROLL IN THE PLAN

OR COMPLETE THE WAIVER FORM

REMEMBER! EMPLOYEES NOT ENROLLING WILL NOT BE ABLE TO ENROLL AGAIN

UNTIL THE NEXT ENROLLMENT PERIOD (ONE YEAR FROM NOW)

Coverage effective date:________________. Enrollments are due in no later than: ______________. Enrollments Meetings are scheduled for:

__________________________ and ___________________________

Questions: Call your supervisor!

ATTENTION EMPLOYEES TRIPLE CHOICE

Securian Dental PPO /

Indemnity Plan

Choice Dental (CDP)

Network Plan

Alpha Dental (ADP)

Network Plan

triple choice - beta health association colorado triple choice proposal.pdf · our triple choice...

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