ABOUT ACA INDIVIDUAL PLANS MAKE A PAYMENT TRANSPARENCY IN COVERAGE DETAILS DENTAL EXCHANGE GLOSSARY GLOSSARY OF DENTAL TERMS About Affordable Care Act (ACA) As the landscape of health and dental insurance changes due to the impact of the Affordable Care Act, Healthplex provides the support and knowledge to help guide our members and groups to making the best decisions. As the new laws are defined and updated, we will continue to be at the forefront so that our plans are compliant with all federal and state regulations. Healthplex offers stand-alone and embedded plans compliant with the Affordable Care Act both “ON-Exchange” (NY members enroll at www.nystateofhealth.ny.gov, FL members enroll at www.healthcare.gov and NJ members enroll at getcovered.nj.gov) and “OFF-Exchange” (members enroll directly with Healthplex - call 800-468-0466.) Why Choose Healthplex? Founded in 1977 by two dentists Dr. Stephen Cuchel and Dr. Martin Kane with core values of integrity and honesty; Healthplex is one of the largest dental administrators in the state of New York with over 3 million members. Healthplex is committed to providing access to high quality affordable dental care and to improving the oral health of our community. Healthplex develops and administers dental plans for small and large businesses, individuals and families. We offer Affordable Care Act plans “ON-Exchange” and “OFF-Exchange” in the states of New York, New Jersey and Florida that meet all Dental Essential Health Benefit requirements. Healthplex Dental plans are easy to use and fit within any budget. Let us show you why we are the dental benefit experts! SHOP NOW Contact our Sales Department at 800-468-0466 or sales@healthplex.com CAREERS | CONTACT | SITE MAP | PRIVACY POLICY | COMPLIANCE | CONDITIONS OF USE TRANSPARENCY IN COVERAGE DETAILS | NON‑DISCRIMINATION NOTICE

Provider Forms Healthplex Provider Web Portal Guide ADA Attestation Credentialing Package - Dentist Personal Profile ADA Claim Form Healthplex Provider Manual Provider Inquiry Request for Clarification Form W-9/Office Information Form Orthodontic Templates Orthodontic Form Interceptive Dismissal Letter Braces Removal and Retainer Consent Form Orthodontic Treatment Progress Consent Form Release From Treatment - Provider Release From Treatment - Patient Request Dental Clearance Note CAREERS | CONTACT | SITE MAP | PRIVACY POLICY | COMPLIANCE | CONDITIONS OF USE TRANSPARENCY IN COVERAGE DETAILS | NON‑DISCRIMINATION NOTICE