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. SMARTPREMIUM IN-NETWORK OUT-OF-NETWORK ANNUAL DEDUCTIBLE Individual: $50 Family: $150 PREVENTIVE SERVICES Plan pays 100% Plan pays 100% BASIC SERVICES Plan pays 80% You pay 20% Plan pays 80% You pay 20% MAJOR SERVICES Plan pays 50% You pay 50% Plan pays 50% You pay 50% ANNUAL PLAN MAXIMUM $2,000 $1,500 ORTHO LIFETIME MAXIMUM $0 EMPLOYEE MONTHLY CONTRIBUTIONS Employee: $36.71 Employee + Spouse: $73.41 Employee + Children: $82.20 Family: $118.92 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. SmartPremium Review Plan Summary