Dental Benefits Summary SmartPremium 100 80 50 2

Dental Benefit Summary Dash Delivery Inc. Plan: SmartPremium Policy effective date: 10/01/2024 Group #: OR00704 Policy length: 12 months In-network Out-of-network Plan Coverage (PPO fee) (90th percentile UCR) Preventive & Diagnostic Diagnostic and preventive: exams, cleanings, fluoride, space 100% 100% maintainers, x-rays, and sealants Basic Emergency palliative treatment: to temporarily relieve pain Minor restorative: fillings 80% 80% Prosthetic maintenance: relines and repairs to bridges and dentures Major Endodontics: root canals Implants: endosteal in lieu of a 2 or 3 unit bridge Major restorative: crowns, inlays, and onlays Oral surgery: extractions and dental surgery 50% 50% Periodontics: to treat gum disease Prosthetics: bridges Prosthodontics: dentures Plan maxes Annual maximum applies to diagnostic & preventive, basic services, and major services. Lifetime maximum applies to orthodontic services. If at least one Covered Service is paid in a calendar (or plan) year and the total benefit paid does not exceed $1,000.00 in that calendar (or plan) year, $500.00 will be added to the next year rollover maximum. This amount will accumulate to the next period, but will not exceed $2,000.00. Annual max based on calendar year. Annual max $2,000 /yr Benefit period: calendar year Ortho Lifetime Max $0 /lifetime FIND A DENTIST QUESTIONS? CHECK CLAIMS & ELIGIBILITY dentists.beambenefits.com [email protected] providers.beambenefits.com BM-SOB-0035-202306 Valid as of 10/01/24 1 of 3