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CURRENT 1 MARKET OPTION 9 MARKET OPTION 10 <br />Delta Dental of Minnesota Guardian Guardian <br />Dental Flex Plan Plan 1 Plan 2 <br />INN INN INN INN <br />[Delta Dental [Delta Dental OON Dental Guard OON Dental Guard OON <br />Premier] Premier] Preferred Preferred <br />b9 <br />p <br />E <br />CO4) <br />2> V' <br />p>- <br />o <br />O <br />Lo <br />69- <br />0 0 <br />co <br />L <br />E <br />a) <br />L <br />L <br />O <br />Q <br />N <br />N N O <br />0 0 0 0> 0 0 0 0c 2 <br />>- Oo Oo�UC a) .— O <br />O Z <br />z <br />90th Percentile 90th Percentile <br />Plan 1 Plan 2 <br />$31.11 <br />$76.45 <br />$124.95 <br />$124.95 <br />Estimated Annual Premium $49,315 $39,412 $44,701 <br />Dollar Difference from Current 9 902 2 720 <br />• <br />0 0 <br />Percent Chan a from Current :-20.08 /o -5.74 /o <br />PLAN PROVISIONS <br />Rate Guarantee 1 Year rate guarantee ending 12/31/2022 1 year rate guarantee 2 year rate guarantee <br />Eligibility FTE 30HRS/WK FTE 30HRS/WK FTE 30HRS/WK <br />m..j/$ 3 <br />$1,500 plus Maximum <br />Rollove. <br />Yes <br />O O <br />O O <br />0 <br />E <br />CO <br />Lcc) <br />0 <br />0_ <br />N <br />-0 <br />L) <br />a) 0 0 0 0 >O C <br />z <br />N O <br />O O 0 <br />� <br />o 69- <br />~ <br />3/ <br />$1,500 plus Maximum <br />Rollover <br />Yes <br />0 c <br />co <br />c.c. <br />E <br />O <br />Lco <br />cE <br />L <br />O <br />0 <br />N <br />-a <br />2 N <br />O <br />o 0 0 0 >\ O o 0 2 <br />O0 O c cm z <br />o69- <br />Z ~ <br />$27.43 <br />$67.40 <br />$110.17 <br />$110.17 <br />$. /$15C <br />$1,500 plus Maximum <br />Rollover <br />Yes <br />0 o <br />O O <br />00 <br />- — <br />O <br />o <br />E <br />CO <br />L <br />N <br />L <br />N <br />0_ <br />N <br />-�. <br />L O <br />cn 0 0 0 0 > 0 0 0 <br />o O 0 0 0 O O O° Lo O <br />>-oo S LaiSULo c6 - <br />O Z <br />Z ~ <br />O <br />{� <br />O <br />in <br />O <br />O Q <br />Z <br />ta <br />0 <br />co co <br />L <br />Ct <br />>, <br />0 <br />a)Oo <br />- --, <br />N <br />N <br />O O OO <br />OZO <br />>- Lco C.) <br />Z <br />0) cn <br />i--, <br />ca E <br />Dentist Fee <br />Dental Flex Plan <br />� M M <br />4 4 <br />co CONM _M <br />6F3 d9 H} H} <br />O <br />co <br />L� <br />b� <br />o <br />O O <br />L() <br />r Z <br />o o <br />co coO <br />L <br />g, <br />N <br />cn <br />N <br />N O� cn <br />L r <br />o 0 0 0 > o O 0 0 c <br />N 0 O) Ln O <br />>- Ls)O cc)O Lc)O Lc) 0 Lc) CO Z 0 <br />O 12 Ei} N <br />Z <br />O <br />69- <br />\ <br />in <br />Lo 0 <br />Z <br />K} <br />a 0 <br />co O <br />r <br />L <br />(a <br />>, <br />Q <br />O <br />N <br />-o <br />2 <br />Col o 0 0 0 > o <br />00o LOn LOn LOn 3,s <br />— <br />6) L <br />aa O L O <br />Z. E <br />O ER N <br />Carrier Name <br />Plan Name <br />PLAN DESIGN* <br />Network <br />Calendar Year (CY) Deductible (Individual / <br />Family) <br />Annual Maximum <br />Annual Maximum Provision <br />Coinsurance <br />Preventive Services <br />Periodontal Maintenance <br />Cleaning Frequency <br />Deductible Waived? <br />Basic <br />Periodontics <br />Endodontics <br />Major <br />Implants <br />Orthodontics <br />Maximum Age <br />Deductible <br />Lifetime Max <br />Ortho Waiting Period <br />OON Reimbursement Level <br />COST ANALYSIS <br />PEPM Rates - Enrollment per AMP Plan 1 <br />c) O M O� ti <br />Employee (EE) Only <br />EE + Spouse/EE + 1 <br />EE + Child(ren) <br />EE + Family <br />Total Enrollment <br />0 <br />Q) <br />▪ 0 <br />4) <br />0 <br />Q) <br />0) <br />(o <br />0 <br />U � <br />o c0 <br />co <br />o E N <br />- coo <br />•-s- • o a <br />• E <br />0 0 Q <br />CO • ° c <br />W z <br />Guardian - No waiting periods <br />