1. Coverage A: Preventative & Diagnostic Deductible: Zero in and out of network Coinsurance: 20% in network 30% out of network Coverage B: Maintenance & Simple Restorative; Oral surgery; Periodontic & Endodontic Services Deductible: Zero in network $50 out of network Coinsurance: 20% In network 30% out of network Coverage C: Complex and Restorative Dentistry Deductible: $25 in network $50 out of network Coinsurance: 50% In network 50% out of network 2013/14 Dental Benefits Option 2

2. 2013/14 Dental Benefits Option 4 Coverage A: Preventative & Diagnostic Deductible: Zero in network and out of network Coinsurance: 20% in network 30% out of network Coverage B: Maintenance & Simple Restorative ; Oral Surgery; Periodontic & Endodontic Services Deductible: Zero in network and out of network Coinsurance: 20% in network 30% out of network 2

3. 2013/14 Dental Benefits Option 4 Coverage C: Complex Restorative Deductible: Zero in and out of network Coinsurance: 20% in network 30% out of network Coverage D: Orthodontic Dentistry Deductible: Zero in network $25 out of network Coinsurance: 50% in and out of network Contract benefit maximum: $2,000 Per covered family member. 3

4. EmployeeEE & Child(ren)EE & SpouseFamily $489.06$904.78$1,027.04$1,379.05 Medical Rates 4

5. Dental Rates Option 2 EmployeeEE & Child(ren)EE & SpouseFamily $24.28$44.90$50.97$68.47 5

6. EmployeeEE & Child(ren)EE & SpouseFamily $45.71$84.57$96.00$128.93 Dental Rates Option 4 6