Horizon NJ Health offers comprehensive dental services to NJ FamilyCare A, B, C, D and ABP members as well as to Managed Long Term Services & Supports and Horizon NJ TotalCare (HMO SNP) members. These services include preventive, diagnostic, restorative, endodontic, periodontal, prosthodontic, oral surgical and adjunctive dental services. Some procedures require prior authorization. When necessary, orthodontic services are age-restricted (covered for members under 21 years of age or as allowed by Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) and only approved with adequate documentation of medical necessity). Referring a member to a dentist by one year of age is mandatory and should continue annually thereafter through age 20.
EPSDT requires the plan to cover all medically necessary dental services for children through age 20. NJ FamilyCare C and D members are responsible for a $5 copay for dental services, except for diagnostic and preventive dentistry services. These two groups of services do not require a copay.
For more information, refer to the Provider Administrative Manual.