1. EBPA Dental Plan Options WDH offers 2 dental plan options; the Core Plan and the Caps/Crowns Plan through EBPA. There is no network of providers, you may see any dentist you choose. Both plans cover the following dental services at 100%*: (*Paid up to the “Reasonable and Customary” charges for services) Cleaning and exam twice per calendar year X-rays, bitewings twice per calendar year X-rays, full mouth/panorex once per calendar year X-rays of individual teeth as necessary Flouride treatment once in a 12-month period for children through age 18 Space maintainers Sealants for children through age14 on certain teeth

2. Deductibles and Plan Year Maximums Core Plan No deductible Plan Year Maximum = $1,000 per person beginning in January Caps/Crowns Plan $25 per person deductible ($75 per family) per Plan Year Plan Year Maximum = $2,000 per person beginning in January

3. EBPA Dental Plan Options The following services are covered by the Core Plan at 50% and by the Caps/Crowns Plan at 80%*: (*Paid up to the reasonable and customary charges for services) Fillings Surgical and routine tooth extractions Root canal therapy Treatment of gum disease Periodontal prophlaxis (cleaning), once per 6-month period Removeable denture repair to its original condition Emergency treatment

4. EBPA Dental Plan Options The following services are covered under the Caps/Crowns Plan at 50%* (they are not covered by the Core Plan) (*Paid up to the reasonable and customary charges for services) Bridges Partial and complete dentures Rebase and reline Crowns Onlay Dental implants

5. More Questions? EBPA Customer Service hours: Monday through Friday, 8:00 AM – 7:00 PM 1 (800) 578-3272 www.ebpabenefits.com