Life is Good: Dental Highlight Sheet

Life is Good Dental Highlight Sheet www.reliancematrix.com Plan 1: Dental Plan Summary Plan Benefit Type 1 100% Type 2 100% Type 3 80% Deductible $50/Calendar Year Type 2 & 3 Waived Type 1 $150/family Maximum (per person) $2,000 per calendar year Allowance 90th U&C Maximum Rewards Included Waiting Period None Annual Eye Exam None Annual Open Enrollment None Orthodontia Summary - Child Only Coverage Allowance U&C Plan Benefit 50% Lifetime Maximum (per person) $1,500 Waiting Period None Takeover Benefit Initial Insureds Only Sample Procedure Listing (Current Dental Terminology © American Dental Association.) Type 1 Type 2 Type 3  Routine Exam (2 per benefit period)  Bitewing X-rays (2 per benefit period)  Full Mouth/Panoramic X-rays (1 in 3 years)  Periapical X-rays  Cleaning (2 per benefit period)  Fluoride for Children 18 and under (1 per benefit period)  Sealants (age 13 and under)  Space Maintainers  Fillings for Cavities  Restorative Composites (anterior and posterior teeth)  Endodontics (nonsurgical)  Endodontics (surgical)  Periodontics (nonsurgical)  Periodontics (surgical)  Simple Extractions  Complex Extractions  Anesthesia  Onlays  Crowns (1 in 5 years per tooth)  Crown Repair  Denture Repair  Implants  Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 5 years) Reliance Standard Life Insurance Company Reliance Standard Life Insurance Company (Reliance Standard) was incorporated in 1907 as the Central Standard Life Insurance Company in Chicago, Illinois. In 1967 the administrative offices moved to Philadelphia, PA and the company was renamed Reliance Standard Life Insurance Company. Reliance Standard is domiciled in Illinois, and its headquarters remain in Philadelphia. Reliance Standard is a member of The Tokio Marine Group. Effective Date: 1/1/2026

Life is Good Dental Highlight Sheet www.reliancematrix.com Rx Savings Our valued plan members and their covered dependents can save on prescription medications at over 60,000 pharmacies across the nation including CVS, Walgreens, Rite Aid and Walmart. This Rx discount is offered at no additional cost, and it is not insurance. To receive this Rx discount, members just need to visit us at www.reliancematrix.com and sign into (or create) a secure member account where they can access and print an online-only Rx discount savings ID card. Eyewear Savings Plan members may receive up to 10% off eyewear frames and lenses purchased at any Walmart Vision Center nationwide. Members may also bring in their current vision prescription from any vision care provider and purchase eyewear at Walmart. This savings arrangement is not insurance: it is available to members at no additional cost to their plan premium. To receive the eyewear savings identification card, plan members can visit www.reliancematrix.com and sign-in (or create) a secure member account. Members must present the Eyewear Savings Card at time of purchase to receive the discount. Customer Service Our Customer Relations Department is open from 7 am to midnight (CST) Monday through Thursday and 7 am to 6:30 pm (CST) on Fridays. You can call toll-free at 800-497-7044. Your claim forms can be faxed in to (402) 467-7336. We will be happy to answer any questions you may have regarding a specific claim you have filed or to answer questions about benefits for dental procedures being considered. Maximum Rewards This dental plan includes a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum. A member earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year, while staying at or under the threshold amount for benefits received for that year. Employees and their covered dependents may accumulate rewards up to the stated maximum carryover amount, and then use those rewards for any covered dental procedures subject to applicable coinsurance and plan provisions. If a plan member doesn't submit a dental claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year. Benefit Threshold $750 Dental benefits received for the year cannot exceed this amount Annual Carryover Amount $400 Maximum Rewards amount is added to the following year's maximum Maximum Carryover $1,200 Maximum possible accumulation for Maximum Rewards Orthodontia - Initial Insureds Only Reliance Standard Life will provide coverage on current orthodontic treatment programs and pay up to Reliance Standard Life’s orthodontic maximum minus any benefits the plan member has received from the prior carrier. These takeover benefits only apply to initial employees and their dependents on the plan’s effective date and are not available to new enrollees who enroll after case implementation.

Life is Good Dental Highlight Sheet www.reliancematrix.com Dental Network Information To find providers near you, visit our website at www.reliancematrix.com. Click on "Find a Dentist" to access our online directory and follow the step-by-step instructions. California Residents: When prompted to select your network, choose the network found on your ID Card. Your provider network is Classic Network. Pretreatment While we don't require a pretreatment authorization form for any procedure, we recommend them for any dental work you consider expensive. As a smart consumer, it's best for you to know your share of the cost up front. Simply ask your dentist to submit the information for a pretreatment estimate to our customer relations department. We'll inform both you and your dentist of the exact amount your insurance will cover and the amount that you will be responsible for. That way, there won't be any surprises once the work has been completed. Late Entrant Provision We strongly encourage you to sign up for coverage when you are initially eligible. If you choose not to sign up during this initial enrollment period, you will become a late entrant. Late entrants will be eligible for only exams, cleanings, and fluoride applications for the first 12 months they are covered. This form is a benefit highlight, not a certificate of insurance. The coverage outlined here highlights the benefits available through Reliance Standard Life, and does not include exclusions and limitations. For details on exclusions and limitations, or a complete list of covered procedures, contact your benefits coordinator.