1. Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Delta Dental of New Mexico  Oral Health is Our Passion Quality Benefits, Quality Dentists … administering the dental program for State of New Mexico General Services Department Risk Management Division Dental Plan Benefits August, 2010 Administered by Delta Dental of New Mexico

2. Delta Dental PPO SM Delta Dental Premier ® Select a Delta Dental PPO dentist to help reduce patient out-of-pocket costs. Select a Delta Dental Premier dentist if your dentist or specialist only participates in this network. Find a Dentist UNM Hospitals Dental Plan Provider Network Overview – Point-of-Service Plan One Plan, two network choices! Plan Participants can select any dentist in either the Delta Dental Premier or Delta Dental PPO network at the time dental services are received. 817 points of access in New Mexico Over 138,900 dentist locations nationally Almost 220,000 dentist locations nationally Over 1,180 points of access in New Mexico Log on to deltadentalNM.com to search for a dentist.  Pre-selection of a dentist is not required and every member of your family may visit a different dentist.  There is no need to contact Delta Dental to change your dentist; you may change as often as you like.  Whenever possible, use in-network dentists. Lower out-of-pocket costs, and important member protections apply when services are received in-network!

3. UNM Hospitals Dental Plan Dental Plan Benefits Overview Separate Lifetime Maximums apply to Orthodontic Services Calendar Year Deductibles $50 per enrolled person $150 aggregate per family Does not apply to Diagnostic & Preventive Services Does not apply to Orthodontic Services Calendar Year Maximums $1,200 per enrolled person per benefit period

4. Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees. Delta Dental PPO SM Delta Dental Premier ® Diagnostic and Preventive Services – No Deductible Covered Oral Exams & Cleanings (2 per Calendar Year), X-rays, Fluoride Application, Emergency Treatment, Sealants, Space Maintainers, and Diagnostic Casts Delta Dental Pays 100% You Pay 0% Delta Dental Pays 100% You Pay 0% Basic Services Fillings, Stainless steel crowns, Extractions, Oral Surgery, Root canals, Periodontics (surgical or non-surgical), and General Anesthesia Delta Dental Pays 80% You Pay 20% Delta Dental Pays 80% You Pay 20% Major Services Onlays, Crowns, Bridges, Partials or Complete dentures, Specified Implant Procedures Delta Dental Pays 50% You Pay 50% Delta Dental Pays 50% You Pay 50% UNM Hospitals Dental Plan Dental Plan Benefits Overview

5. Out-of-network dentists may balance bill patients for amounts over Maximum Approved Fees. UNM Hospitals Dental Plan Orthodontic Benefit Overview ORTHODONTIC SERVICES (child and adult) No deductible Delta Dental Pays 50% up to $1,000 lifetime maximum Enrollees Pay 50% plus balance of cost up to the applicable Delta Dental Maximum Approved Fee

6. UNM Hospitals Dental Plan Predetermination of Benefits ASK YOUR DENTIST FOR A PREDETERMINATION OF BENEFITS when more costly procedures are anticipated. Patient Disclosure – You’re entitled to it!  An advance estimate of benefits before dental care services are received  Not required but strongly recommended  No charge for this service.

7. UNM Hospitals Dental Plan Special Eligibility Provisions Please remember…  If you enroll one dependent (spouse/domestic partner/child), you must enroll all dependents except children under the age of 3 with proof of other coverage.  Children are covered through age 18  Full-time students are covered through age 24 (verification of full-time student status must be provided to UNMH Human Resources)

8. UNM Hospitals Dental Plan Information Available 24/7! Enrollees have online access to personalized benefit information, oral health information, privacy policies and more. No software to purchase or download required. Featured Plan Information Available at deltadentalnm.com in the Subscriber Section Subscriber Materials are accessed with the UNMH group number (4101). Enrollees may view, print, or save coverage documents:  Summary of Benefits  Dental Benefit Plan Provisions  Provider Directory Consumer Toolkit Enrollees may also select Consumer Toolkit and sign in to: Verify eligibility of subscriber and dependents  Confirm status of deductibles and plan maximums  Review how a specific claim was processed  Print a personalized subscriber ID card www.deltadentalNM.com

9. UNM Hospitals Dental Plan Customer Service Dental plan claims and administration services provided in New Mexico Experienced Benefit Representatives Available Monday – Friday 8:00am-4:30pm Albuquerque 505-855-7111 Toll free 1-877-395-9420 Over 95% of calls answered in fewer than 45 seconds

10. UNM Hospital Dental Rates Per Pay Period(24/Year) COVERAGE TYPE EE COST Full Time EE COST Part Time Employee $ 0.00$ 6.10 Employee + 1 $ 17.50$ 23.60 Employee + 2 or more $ 33.50$ 39.60