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$>hCK8ðt_]h^=Pihy5L|.'0(~mj0,Lk~l.c%_@0[ZZwi|r}ls6Ŧk`VfqA~tr0{=!awE"s Zmo~Ǐ$L'˴̷aK5@O!npe(L(5yvX}{'b?HlUg^aY\cQuRz`WZ9 & . `fpuӤne|exXîbK@d[OMfv"laujc=gEqPqCn>{Xp'>ï 5m 8  ՠ  endstream endobj 141 0 obj<> endobj 142 0 obj[/Separation/PANTONE#20157#20U/DeviceCMYK 143 0 R] endobj 143 0 obj<>stream n endstream endobj 144 0 obj<>stream /GS0 gs 1 g 0 792 0 0 re f /GS1 gs q BT /F0 1 Tf 14 0 0 14 36 237.9976 Tm 0 0 0 1 k (5.)Tj ET Q /GS2 gs /GS1 gs q BT /F2 1 Tf 11 0 0 11 54 237.9976 Tm 0 0 0 1 k 0.025 Tw [(DENTIST INFORMA)70(TION, )]TJ ET Q /GS2 gs /GS1 gs q BT /F1 1 Tf 11 0 0 11 186.2707 237.9976 Tm 0 0 0 1 k 0.025 Tw (including the Delta Dental program in which he or she participates for that claim.)Tj ET Q /GS2 gs /GS1 gs q BT /F0 1 Tf 14 0 0 14 36 216.9976 Tm 0 0 0 1 k (6.)Tj ET Q /GS2 gs /GS1 gs q BT /F3 1 Tf 14 0 0 14 54 216.9976 Tm /CS0 cs 1 scn (NEW!)Tj ET Q /GS2 gs /GS1 gs q BT /F2 1 Tf 11 0 0 11 87.8653 216.9976 Tm 0 0 0 1 k 0.025 Tw [(MAXIMUM INFORMA)70(TION EXPANDED, )]TJ ET Q /GS2 gs /GS1 gs q BT /F1 1 Tf 11 0 0 11 292.5234 216.9976 Tm 0 0 0 1 k 0.025 Tw (to include all maximums applicable to the plan the patient is)Tj -21.68395 -1.27273 TD [(covered under instead of showing plan maximum only)80(.)]TJ ET Q /GS2 gs /GS1 gs q BT /F0 1 Tf 14 0 0 14 36 181.9976 Tm 0 0 0 1 k (7.)Tj ET Q /GS2 gs /GS1 gs q BT /F2 1 Tf 11 0 0 11 54 181.9976 Tm 0 0 0 1 k 0.025 Tw [(DET)70(AILED EXPLANA)70(TIONS AND DESCRIPTIONS OF INFORMA)70(TION IN THE COLUMNS, )]TJ ET Q /GS2 gs /GS1 gs q BT /F1 1 Tf 11 0 0 11 500.619 181.9976 Tm 0 0 0 1 k (including)Tj -40.60172 -1.27273 TD 0.025 Tw (descriptions of each procedure number and explanations, if appropriate, of processing policies \(up to 3 per line)Tj T* (item allowed\).)Tj ET Q /GS2 gs /GS1 gs q BT /F3 1 Tf 14 0 0 14 72 132.9976 Tm /CS0 cs 1 scn (NEW!)Tj ET Q /GS2 gs /GS1 gs q BT /F2 1 Tf 11 0 0 11 105.8653 132.9976 Tm 0 0 0 1 k 0.025 Tw [(S)23(eparate \324S)31(ubmitted Procedure N)23(o.\325 and \324P)31(aid Procedure N)23(o.\325 added, )]TJ ET Q /GS2 gs /GS1 gs q BT /F1 1 Tf 11 0 0 11 426.8974 132.9976 Tm 0 0 0 1 k 0.025 Tw (to better illustrate when an)Tj -32.2634 -1.27272 TD [(alternative benef)20(it has been applied.)]TJ -1.63636 -2.54546 TD [(F)40(or questions about specif)20(ic claims, contact the number for Claims Inquiries on your Explanation of Benef)20(its)]TJ 0 -1.27272 TD [(statement, or e-mail Customer S)23(ervice at )]TJ ET Q /GS2 gs /GS1 gs q BT /F2 1 Tf 11 0 0 11 246.4851 76.9976 Tm 0 0 0 1 k (service@deltadentalnj.com)Tj ET Q /GS2 gs /GS1 gs q BT /F1 1 Tf 11 0 0 11 372.0022 76.9976 Tm 0 0 0 1 k (.)Tj ET 0 0 0 0.05 k 0 285 612 507 re f /GS2 gs q 0 285 612 507 re W n q 24 49.222 564.48 719.2416 re W n BT /F5 1 Tf 8.7026 0 0 8.7026 37.4066 747.295 Tm 0.749 0.678 0.671 0.902 k 0.004 Tc (I)Tj 0.282 -0.00001 TD (MPORTANT )Tj ET /GS3 gs 0.8702 w 0.749 0.678 0.671 0.902 K 39.03 747.3 m 39.03 753.54 l 38.19 753.54 l 38.19 747.3 l h 46.47 747.3 m 46.47 753.54 l 45.2614 753.54 l 43.5023 748.2747 l 43.485 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Notice of Privac)Tj 8.11401 0 Td (y)Tj 0.77803 0 Td (Practices)Tj -8.89204 -1.39389 TD 0.023 Tc 0.234 Tw [(You may access )-1(Delta Dental's )-2(Notice )-1(of )1(Priva)]TJ 23.29444 0 Td 0.235 Tw (cy Pract)Tj 4.03138 0 Td 0.236 Tw [(ices on )3(our)]TJ -27.32582 -1.15137 TD 0.01 Tc 0.095 Tw [(website )1(at )-1(www.deltadentalnj.com. )7(You may also obtain )1(a )-1(har)]TJ 28.57703 0 Td (d)Tj 0.94896 0 Td (copy of)Tj -29.52599 -1.12107 TD 0 Tc 0 Tw (this notice )Tj 4.78001 0 Td [(b)20(y contacting our c)1(ompliance manager at (866) 861-)]TJ 23.15701 0 Td (4716.)Tj -27.93702 -1.78766 TD (8. 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