Covered Service In Network Benefit Benefit Guidelines Preventative & Diagnostic Services Periodic Oral Exam (Office Visit) 100%* Twice per year*** Prophylaxis (Teeth Cleaning) 100%* Twice per year*** Bitewing X-Rays 100%* One set every year*** Full Mouth X-Rays Discount (Average 42%)** Basic Services Resin-Based Composite (Fillings) 100%* One filling per year (two surfaces)*** Additional Fillings Discount (Average 32%)** Major Services Root Canals Discount (Average 34%)** Surgical Extractions Discount (Average 31%)** Crowns Discount (Average 27%)** Upper Denture Discount (Average 48%)** Orthodontia Discount (Average 20%)**

OTHER PLAN PROVISIONS Annual Deductible None Benefit Waiting Periods None Annual Benefit Maximum $500 per listed family member

The Essential Dental Solutions program may not be available in all states.

The Dental Plan is provided through a group policy issued to the National Congress of Employees Association located in Washington, D.C. This affordable Dental Plan is administered by Group Dental Service, a company that has been providing quality dental plans and services for over 42 years.

*Members can receive benefits from any provider! However, benefits are calculated using a Maximum Allowable Charge. Maximum Allowable Charges are limitations on billed charges and are based on fees paid to Network Providers in the geographic area where the expenses are incurred. For Out of Network Providers, members are responsible for amounts charged by the provider that exceed benefits, and may be required to remit payment at the time of service.

**Active Members will enjoy discounts, on average 20% to 50% off standard fees, on other covered dental procedures when you see a participating Network Provider. Members who see an Out of Network Provider will not be entitled to a discount. Discounts will vary by provider and location.

***The Benefit Guidelines are for each listed family member and the benefits cannot be transferred or combined between members.

Notices:

To be eligible to receive these insurance benefits all members must be an active dues paying member of National Congress of Employees Association (NCE). This insurance plan is underwritten by National Guardian Life Insurance Company, NAIC # 66583, domiciled in Wisconsin with their principal place of business located at 2 East Gilman St., Madison, WI 53703, and is licensed in Washington D.C. National Guardian Life is not affiliated with The Guardian Life Insurance Company of America, aka The Guardian or Guardian Life. These benefits are provided under the Group Dental Policy (Policy Form NDNGRP 04/06) issued to the NCE and are subject to the exclusions, limitations, terms and conditions of coverage as set forth in the Certificate of Insurance. The insurance premiums for these benefits are paid by NCE out of membership fees collected. The membership fees charged for this program are not insurance premiums. The dental product may vary by State and may not be available in all States.