Give your employees something they can all smile about.

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2 Give your employees something they can all smile about. Capital Advantage Insurance Company is giving everybody something to smile about with BlueCross Dental, the region s only Blue-branded dental plan. n Enrollment and billing fully integrated with your medical plan one card, one bill when you purchase medical and dental plans from the Capital BlueCross family of companies n Flexible dental benefit plan options at competitive rates n Wide PPO dental network within Capital BlueCross coverage areas n Discounts on most noncovered dental services n Highly trained customer service representatives n Dental coverage from a name you know and trust Choose BlueCross Dental and give your employees the confidence and quality they can expect from the Capital BlueCross family of companies. For more information, contact your account executive, agent, or producer today or visit capbluecross.com.

3 When your employees are smiling, everybody s happy. Start enjoying the convenience of one bill, one ID card, and a variety of flexible plan options with BlueCross Dental, the region s only Blue-branded dental plan. Full Program IntegratI on BlueCross Dental enrollment and billing is fully integrated with your medical benefit program when you purchase medical and dental plans from the Capital BlueCross family of companies. This gives you and your employees the convenience of one ID card containing all benefit information. r obust PPo n etwork BlueCross Dental offers a robust PPO dental network within Capital BlueCross coverage areas. For dental services outside our coverage areas, BlueCross Dental is complemented by Dominion Dental Services USA networks.* ConvenI ent C lai ms P roc essi n g BlueCross Dental participating providers file claims on behalf of members and do not balance bill for covered services. D I s C ounts on n oncovered s ervice s BlueCross Dental participating providers offer discounts on noncovered services and services received after program maximums are met. s ervice F rom a ny licensed DentI s t BlueCross Dental allows members to receive dental service from any licensed dentist. Selecting a participating PPO dental network provider, however, results in the greatest savings for members. e x C e P t I onal Customer s ervice BlueCross Dental program members can count on the same exceptional service they ve come to expect from the Capital BlueCross family of companies. e x P eri enc e & v alue BlueCross Dental brings together more than 70 years of Capital BlueCross experience with a promise to provide your company with outstanding value and quality in your dental benefits. For more information on BlueCross Dental, contact your account executive, agent, or producer today or visit capbluecross.com. Poor oral hygiene may increase the risk of having a preterm delivery or a baby with a low birth weight.** * Dominion Dental Services USA, Inc. assists in the administration of dental benefits on behalf of Capital BlueCross. Dominion Dental is an independent company. **Source: American Dental Association, 2009

4 An Array of Flexible Plan Options BlueCross Dental offers your company a wide range of benefit plan options. From preventive care to orthodontic treatment, BlueCross Dental provides you with your choice of plan options that take into consideration office visit copayments, deductibles, and annual and lifetime limits. For additional information on the BlueCross Dental benefit plan options available for your company, and to discuss the plan that will best meet the needs of your employees, please contact your account executive, agent, or producer today. Researchers have found a link between periodontitis (the advanced form of gum disease that can cause tooth loss) and cardiovascular disease, stroke, and bacterial pneumonia.**

5 Standard Benefit Plans Value Plan 75 Value Plan 80 Basic Plan 100/80 Classic Plan 100/80/50 Plus Plan 100/80/50/50 Voluntary Basic 100/80 Voluntary Classic 100/80/50 Deductible N/A N/A Program Maximum $1000 $1000 $1500 $1500 $1500 $1500 $1500 DiagnOStiC & PReventive SeRviCeS (deductible waived) Routine Exams 100% after $15 copayment 80% 100% 100% 100% 100% 100% X-Rays 75% 80% 100% 100% 100% 100% 100% Fluoride Treatments 75% 80% 100% 100% 100% 100% 100% Prophylaxis 75% 80% 100% 100% 100% 100% 100% Sealants 75% 80% 100% 100% 100% 100% 100% Space Maintainers 75% 80% 100% 100% 100% 100% 100% Palliative Emergency Treatment 75% 80% 100% 100% 100% 100% 100% Consultations 75% 80% 100% 100% 100% 100% 100% BaSiC SeRviCeS Basic Restorative Not Covered 50% 80% 80% 80% 80% 80% Endodontics Not Covered Not Covered 80% 80% 80% 80% 80% Periodontics Not Covered Not Covered 80% 80% 80% 80% 80% Oral Surgery Not Covered Not Covered 80% 80% 80% 80% 80% MaJOR SeRviCeS Major Restorative Not Covered Not Covered Not Covered 50% 50% Not Covered 50% Prosthodontics/Implants Not Covered Not Covered Not Covered 50% 50% Not Covered 50% ORthODOntiCS (deductible waived) Orthodontic Treatment (covers dependent children to age 19) Not Covered Not Covered Not Covered Not Covered 50% Not Covered Not Covered Orthodontics Lifetime Maximum Not Covered Not Covered Not Covered Not Covered $1000 Not Covered Not Covered Includes one additional exam and cleaning for pregnant women. Restricted by group size and participation. Please contact your account executive, agent, or producer for details. Programs are subject to change. This is a general description of benefits, limitations, and exclusions for dental plan coverage. Actual terms and conditions of coverage shall be governed by the contract issued to your group. This is not intended to be a complete list or complete description of benefits. Exclusions and limitations may apply. Please contact your account executive, agent, or producer for additional benefit details. Deductibles, coinsurance, and copayments under this program are separate from deductibles, coinsurance, and copayments described in your company s other health benefits coverage. capbluecross.com

6 We ve got your smile covered. One of the area s most trusted names in health insurance for more than 70 years, the Capital BlueCross family of companies is proud to now offer the region s only Blue-branded dental plan, BlueCross Dental. n Convenience of one insurer, one relationship, one bill, one ID card when you purchase medical and dental plans from Capital BlueCross n Array of flexible benefit plan options n Robust network of providers n Discounts on noncovered dental services n The same customer service you ve come to expect from Capital BlueCross When your employees are smiling, everybody s happy. For more information on BlueCross Dental, contact your account executive, agent, or producer today or visit capbluecross.com. Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company and Keystone Health Plan Central. Independent licensees of the Blue Cross and Blue Shield Association, serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies. BCD-10 (July 2009)