Monthly Rates Effective: July 1, 2006

DENTAL PLAN RATES

D-1

D-2

D-3

D-4

Premier:

No Ortho

Child Only Ortho

Adult/Child Ortho

Child Ortho/70% Pros

Composite

$83

$86

$87

$92

Employee Only

$42

$42

$44

$49

Employee + One

$78

$81

$82

$87

Employee + Family

$113

$116

$118

$124

A $1,500

B $2,000

A $1,500

B $2,000

Child Ortho

Adult/Ch Ortho

Premier Add-on Costs:

D1, D2, D3

D1, D2, D3

D4

D4

to $1,000

to $1,000

Composite

$10.00

$15.50

$11.00

$17.00

$2

$3

Employee Only

$5.00

$8.00

$6.00

$9.00

$2

$3

Employee + One

$9.50

$14.50

$10.50

$16.00

$2

$3

Employee + Family

$13.50

$21.00

$15.00

$23.00

$2

$3

D-1 DPO

D-2 DPO

D-3 DPO

Delta Preferred Option (DPO):

No Ortho

Child Only Ortho

Adult/Child Ortho

Composite

$63

$65

$66

Employee Only

$32

$32

$33

Employee + One

$59

$61

$62

Employee + Family

$85

$87

$89

A $1,500

B $2,000

Child Ortho

Adult/Ch Ortho

DPO Add-on Costs:

Annual Max

Annual Max

to $1,000

to $1,000

Composite

$8

$12

$2

$3

Employee Only

$4

$6

$2

$3

Employee + One

$7

$11

$2

$3

Employee + Family

$10

$16

$2

$3