Argus Customer Care: Monday Friday: 8 a.m. 8 p.m. ET

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1 Argus Customer Care: Monday Friday: 8 a.m. 8 p.m. ET

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3 TABLE OF CONTENTS Welcome to Argus Dental... 1 Member ID Card... 2 Dentist Directory... 2 Contact Argus... 3 Emergency Dental Services... 3 Make a Dental Appointment... 4 Dental Benefit Coverage... 5 Member Rights & Responsibilities... 6 Complaints & Appeals... 7 Question and Answers (Q&A)... 7 Dental Word Search... 8 Toothbrush Reminder Activity... 9 Important Member Checklist... 10

4 Welcome to Argus Dental Plan & Florida Healthy Kids! Florida Healthy Kids was designed for children ages 5 through 18 to provide quality, affordable health insurance for uninsured children. Florida Healthy Kids mission and values are to assure access to quality health services for Florida s children with a focus on families, cultural awareness, innovation and compassion. Founded in 2007 by a Florida Dentist, Argus Dental is pleased to join Florida Healthy Kids as your preferred dental benefits carrier and committed to deliver superior dental coverage through our strong provider network. We are accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) as the first dental plan meeting nationally recognized standards for quality care. Your member handbook details important information about your child s dental plan benefits. Please read through to learn about how to schedule a dental appointment, questions and answers, contact information and much more. We welcome you and look forward to creating your child s Healthy Kids smile. Sincerely, Argus Dental Plan 4010 West State Street Tampa, FL Toll-free:

5 Member Identification Card Please keep your child s identification card (ID) with you at all times. The ID card can be found on your Welcome Letter on the lower right corner. Simply detach the card and keep it safely with your personal belongings. You are responsible for bringing it with you to your child s scheduled dental appointment. You will need to show your Argus Dental card each time your child sees the dentist. If you lose or misplace your child s ID card, please call Argus Customer Care toll-free at You will receive a replacement within business days via postal mail. Member Name: Sarah Doe Member ID: Effective Date: 7/1/2013 Plan Type: Healthy Kids Group ID: 1200 Argus Customer Care: Florida Healthy Kids: Dentist Directory To view dentist s in your area, log on to our website for Argus Dental s Find a Dentist search at You can search by the following fields: County City Name ZIP Code If you would like to request a hard copy of our dentist directory, you may contact Argus Customer Care at or healthykids@argusdental.com. Please make sure you have your member ID available to expedite your request. All dentist directories will be mailed within 10 business days.

6 Contact Argus Dental Argus Dental is available to service you and your child s needs and requests. If you have any questions relating to your child s dental benefits, Argus Customer Care will explain the services that are covered under the Healthy Kids Program. Our hours of operation and corporate location is listed below: Argus Customer Care Monday Friday: 8 a.m. -8 p.m. ET Toll-free: TDD: Fax: You may also visit our website at or you may contact our representatives via at healthykids@argusdental.com Corporate Location Argus Dental Plan 4010 West State Street Tampa, FL Emergency Dental Service If your child is in need of emergency dental services, please contact your preferred dentist immediately for assistance. If their office is closed or they are unable to assist, you may call Argus Customer Care tollfree at or dial 911 for immediate assistance. If you are located more than a fifty (50)-mile radius from your preferred dentist, you may visit a dentist in the current location. You will be reimbursed for any covered services and are not obligated to pay the dental office up front. Simply submit the following information to Argus Dental within 180 days (6-months) of service: Member Name and Contact Information Member Identification (ID) Number Receipt/Documentation of Service Dentist Name and Contact Information Please call Argus Customer Care for assistance or you may customer.care@argusdental.com with your submission information or fax to for immediate handling.

7 Make a Dentist Appointment It is simple to make a dentist appointment for your child! Simply call Argus Customer Care toll-free at to find out what preferred dentist in our network you are assigned to. You may also visit to search for a preferred network dentist. Once you have the dentist s information, call the office to schedule an appointment. Please make sure you have your child s member identification (ID) card on hand and let the office know that you are a Healthy Kids member with Argus Dental. On appointment day, remember to bring your Argus ID card. Cancellation If you need to cancel an appointment, please notify the dentist within hours prior to the scheduled appointment. You may reschedule during that time or wait until you have a confirmed date and time in mind. Specialist Your child s general dentist will provide most of the dental treatment that you need, such as general examinations, X-rays and basic cleanings. Even though general dentists are trained on all segments of dentistry, they may sometimes feel the need to refer you to a specialist to provide you with additional expertise and treatment. If you are referred to a specialist, the general dentist will provide Argus with a referral document detailing the specialist s information and treatment request. Argus will then locate a specialist and will contact you to arrange an appointment to see the specialist. If you need assistance or have questions, please contact Argus Customer Care toll-free at

8 DENTAL BENEFITS The following dental benefits are included in your child s plan: Preventative Services Office Visits Cleanings/Prophylaxis Topical fluoride application, limit one every 6 months Sealants, limits one application per tooth every 3-years Space maintainers Oral Exam Initial Oral Exam Periodic Oral Exam, limit one every 6 months X-rays Intraoral periapical Bitewings, limit one every 6 months Complete set of X-rays, limit one every 3-years Panoramic X-rays, limit one every 3-years Restorative Services (Fillings & Crowns) Amalgam restoration (silver fillings) Composite/Resin restorations (white fillings) Prefabricated stainless steel crowns* Crowns* Oral Surgery (Extractions) Routine Extractions Biopsies* Surgical treatment of diseases* Injuries, deformities and defects* Endodontic Services (Root Canals) * Root canal therapy on primary and permanent teeth* Apicoectomy, surgery involving the root surface* Periodontal Services* Gingival curettage, including local anesthesia* Gingival flap procedure* Scaling and root planning* Removable Prosthodontics (Dentures)* Upper, lower or complete set of dentures, limited to 1 per the lifetime of the child* Orthodontic Services (Braces)* Services are limited to those circumstances where the child's condition creates a disability and impairment to their physical development. Not covered for cosmetic purposes. Analgesia & Sedation* The administration of a drug to temporarily stop the feeling of pain in a child* Limited to children who have severe physical or mental disability or are difficult to manage. Service is limited to 3 times every 12 months Intravenous administration of drugs* Non-intravenous administration of drugs, limit 3 times per year Injectable Medications The injection of medication to treat illness or disease Palliative Treatment Covered services necessary to relieve pain and discomfort on an emergency basis Hospitalization* Hospitalization for dental treatment is covered only if a child's health is so jeopardized that procedures cannot be safely performed in the dental office; and/or, the child is so uncontrollable due to emotional instability or developmental delay* * Prior Authorization Required

9 Member Rights & Responsibilities As an Argus Member, you are your child have rights and responsibilities. It is important that you understand your rights and responsibilities. Please review your rights listed below: You and Your Child s Rights Be treated with respect by Argus personnel and participating network dentists Privacy and confidentiality on procedures you receive Voice concerns about the service and care you receive File complaints and appeals about Argus or your network dentist about the care you received Receive timely responses to your concerns Discuss and make decisions with your network dentist about appropriate treatment options Be provided with access to participating network dentist Participate in decisions about your care with your doctor and other health care professionals Receive information about Argus dental benefits and coverage Have the option to change your preferred network dentist if you need to You and Your Child s Responsibilities Know and confirm your benefits before receiving treatment Contact your network dentist when you have a dental need or concern Show your Argus member ID card before receiving dental services Pay any necessary copayments at the time you receive treatment Use emergency room services ONLY for injury or illness that requires immediate treatment Keep scheduled dental appointments Provide information needed for your care Follow agreed-upon instructions and guidelines of dentist Participate in developing mutually agreed-upon treatment goals Notify Argus and Healthy Kids Program of changes in your address or family status Contact Argus Customer Care about your eligibility, benefits and claims Contact Argus Customer Care to make sure your dentist participates in the Healthy Kids Program

10 Complaints and Appeals If you and your child are not satisfied with your services with a preferred dentist in your network, Argus Dental will work with you on establishing a formal complaint. Please contact Argus Customer Care tollfree at to speak with our grievance coordinator or you may send a written notice to our corporate address below. For expedited service, you may fax the notice to or healthykids@argusdental.com. Argus Dental Plan, Inc. ATTN: Grievance 4010 West State Street Tampa, FL Once a grievance is filed there will be a decision on the complaint. If the decision is not satisfactory, you may request to appeal a decision if you feel that it is unacceptable. Appeals can be made before dental services are performed as well as after. For appeal requests and expedited assistance contact Argus Customer Care toll-free at Questions & Answers 1) Can I make an appointment with any dentist? No, you must make an appointment to see a preferred dentist in the Argus network. Please call Argus Customer Care toll-free at to find a dentist near you. 2) At what age should I take my child in to see a dentist? A first dental visit should happen once the child turns one (1) year of age or when all the baby teeth are exposed. The first visit is all about fun for kids and parent education. Healthy Kids begins covering dental visits at age 5 and regular check-ups should occur every six (6) months moving forward. 3) What do I need to do to cancel or reschedule a dentist appointment? Please notify the dentist with hours of the scheduled appointment to avoid cancellation fees if applicable. 4) If I receive a bill from the dentist, what should I do? Contact Argus Customer Care toll-free at and a representative will work with you on a resolution. 5) If I have changes to the family size, names and home address, who do I contact? Please contact Florida Healthy Kids toll-free at and a representative will work with you on the changes.

11 Dental Word Search M D E N T I S T U K D D T H Q V C A V I T Y E E Y D S V W I H P B N E G N R G U M S L D T T I S M I L E R A E A H E A L T H Y S Q C L C N L C H I P G U A R S E N F L O S S E Y CAVITY DENTAL GUMS PLAQUE CHIP DENTIST HEALTHY SMILE DECAY FLOSS HYGIENE TEETH Check out Argus Dental s Pediatric Dental Playroom online for fun activities and trivia. Visit

12 Toothbrush Reminder Activity Create an outline of a toothbrush with the days of the week on the bristles (see below). Instructions: Cut out the toothbrush and then cut in between each bristle (day of the week) then have your child remove a bristle for the day of the week they remember to brush their teeth. You may also put a star or smiley face on the bristle for the day of the week. Check out Argus Dental s Pediatric Dental Playroom online for fun activities and trivia. Visit

13 Parent Dental Checklist Infancy (Birth to 12 months) Clean your infant s gums and teeth with a washcloth or soft infant brush at least twice a day Using the bottle as a pacifier can lead to tooth decay. Milk and juices contain sugar that can lead to tooth decay From six months to age 3, your child may have sore gums when teeth erupt. Many children like a clean, chilled teething ring, cool spoon, or cold wet washcloth Thumb sucking and a pacifier are natural and newborns derive satisfaction from them. During the first year of life, these do not require intervention During the first year of life, children should drink water and whole milk Toddler (1-2 years) Take your child to the dentist soon after the first tooth erupts, no later than 1 year of age. Clean your child s gums and teeth with a soft toothbrush and water in the morning and before bedtime. Unless it is advised by the pediatric dentist, do not use fluoridated toothpaste until age 2 Trade a bottle for a cup by age one At age 2, you should continue to brush for your child and begin to use a small (pea-sized) amount of fluoride toothpaste. You should not allow your child to swallow the toothpaste Injuries to the primary (baby) teeth can affect the development of the permanent (adult) teeth. If an injury occurs, contact your dentist right away Limit the total number of times per day and amounts that your child eats and drinks. Limit sugary foods like soda, fruit juice and sweetened cereals Use positive reinforcement School Age (6-12 years) Thumb sucking or a pacifier that continues past 5 or 6 years of age can lead to an excessive overbite. Consult your dentist, who will assess the need for an orthodontic evaluation Children can begin brushing independently at age 8 under parental supervision Children should begin flossing independently around age 10 Sealants (a protective coating that covers the chewing surfaces of the teeth) may be placed on newly erupted permanent back teeth to protect them from dental decay If your child plays a contact sport, a mouth guard should be worn to protect against dental injury If a child s permanent tooth is dislodged during an injury, place it in a container of milk and bring your child to the dentist as soon as possible. Permanent teeth can sometimes be re-implanted successfully Adolescence (12 to 18 years) Discourage your child from using tobacco products. Tobacco use, including smoking and chewing, causes cancer, heart disease and other serious illnesses as well as discoloration of the teeth and bad breath Teenagers care a lot about their appearance. A pediatric dentist can make a chipped tooth look whole, change discolored teeth to a natural white, contour an oddly shaped tooth and even fill in the gaps between widely spaced teeth

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16 Argus Customer Care Monday-Friday, 8 a.m. to 8 p.m. ET healthykids@argusdental.com TDD: West State Street, Tampa, Florida 33609

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