EBPA Dental Plan Options

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