1. BOR DENTAL Blue Cross and Blue Shield One Time Enrollment Participating Dentists Network  http://www.usg.edu/admin/humex/benefits/dentalhttp://www.usg.edu/admin/humex/benefits/dental  National Network  (use of non-network providers will be subject to balance billing)  -------------------------- 24 month prior enrollment for replacement of prosthetics Crown replacement when necessary after 5 years from installation Surgical extraction of impacted wisdom teeth is not covered 6 month prior enrollment for access to orthodontic See detail exclusions pg. 14 of the BOR Indemnity Dental Book

2. BOR PREVENTIVE DENTAL CARE NO DEDUCTIBLE - PLAN PAYS 100% n FLUORIDE TREATMENT n ORAL EXAMINATIONS n PROPHYLAXIS (Cleaning) n X-RAYS

3. BOR DENTAL CARE AFTER $50 DEDUCTIBLE - PLAN PAYS 80% n ANESTHESIA n EXTRACTIONS n FILLINGS n ROOT CANAL TREATMENT nBRIDGES n CROWNS n DENTURES n INLAYS/ONLAYS

4. ORTHODONTIC APPLIANCES & TREATMENT BOR ORTHODONTIC CARE AFTER $50 DEDUCTIBLE - PLAN PAYS 80%

5. BOR DENTAL Blue Cross and Blue Shield Lifetime Maximum  ($1,000 for orthodontics) Claim Form Greater Out-of-Pocket Expense Calendar Year Maximum ($1,000)

6. BOR DENTAL COST PER MONTH   -Single $27.24  -Employee/Child $51.74 -Employee/Spouse $54.46  -Family $87.14