Page 13 - The Raymond Group Supplemental Benefit Guide

ENHANCED DENTAL PLAN

The Standard | PPO Plan (Buy-up Option includes up to $300 per participant towards vision expenses)
This benefit is an enhanced plan that is voluntary and paid 100% by the employee.
No two people have the same health care needs. That is why we have partnered with The Standard to provide you a unique dental
and vision benefits plan that is flexible enough to fit your lifestyle. Included in this plan are special features:

PolicyLink Dental + Vision Plan Design
If you enroll into The Standard’s dental plan it includes a unique program called PolicyLink. Dental and Vision benefits share one
plan maximum, with up to $300 allocated to Vision. This enables you to take a flexible approach to managing your dental and
vision care, with the option to apply unused Vision benefits toward Dental care.

Dental VIsion Combined no more than

Maximum $2,000 $300 $2,000

If are enrolled in the Trust’s UHC vision plan and purchase contact lenses or prescription sunglasses, you may get reimbursed up to
$300 for your vision out of pocket expenses. You’ll submit a claim for reimbursement after paying at the point of care. Call The
Standard to find out more how it works 1-800-547-9515.

Max Builder
This dental plan includes a valuable feature that allows qualifying plan participants to carryover part of their unused annual
maximum. A participant earns dental rewards by submitting at least one claim for dental expenses incurred during the benefit year,
while staying at or under the threshold amount for benefits received for that year. If a plan participant doesn't submit a dental
claim during a benefit year, all accumulated rewards are lost. But he or she can begin earning rewards again the very next year.

Max Keeper
Benefits for Type 1/Preventive procedures are not deducted from the plan participant's annual maximum benefit.

The Standard
Plan Name PPO
In Network Non-Network

Network Name (Ameritas Classic PPO)
Dental Benefits

Calendar Year Maximum Benefit $2,000
Annual Deductible
- Individual $50
- Family $150
Preventive Services No Charge No Charge*
Basic Services Deductible, 20% Deductible, 20%*

Major Services Deductible, 50% Deductible, 50%*
Orthodontia
- Child 50% / $1,500 Lifetime Benefit Maximum
- Adult 50% / $1,500 Lifetime Benefit Maximum
*Dentists who are out-of-network have not agreed to pricing, and may bill you for the difference between what The Standard pays
them and what the dentist usually charges.

Employee Benefits 13