9 DENTAL Good oral care enhances overall physical health, appearance and mental well-being. Problems with the teeth and gums are common and easily treated health problems. Keep your teeth healthy and your smile bright with our dental benefit plan. Hover over the insurance terms below to learn what they mean. LOW PLAN HIGH PLAN In Network In Network Out of Network ANNUAL DEDUCTIBLE Individual: $50 Family: $150 Individual: $50 Family: $150 Individual: $50 Family: $150 ANNUAL PLAN MAXIMUM $1,750 $1,750 $1,750 PREVENTIVE SERVICES 100% 100% 100% BASIC SERVICES 80% 100% 100% MAJOR SERVICES 50% 60% 60% ORTHO SERVICES 50% 50% 50% ORTHO LIFETIME MAXIMUM $1,000 $1,500 $1,500 RATES PER BI-MONTHLY PAY PERIOD Employee: $2.56 Employee + Spouse: $5.50 Employee + Children: $7.74 Family: $10.73 The benefits and rates in this guide are for illustrative purposes only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. REVIEW PLAN SUMMARY