MEDICAL INSURANCE – Biweekly Employee Contributions BCBS PPO SAVER BCBS PPO BCBS HMO –NE ONLY Employee $6.07 $64.65 $51.47 Employee + One $35.12 $136.11 $110.97 Family $63.44 $219.12 $179.86 KAISER PERMANENTE – CA ONLY Employee $19.23 Employee + One $150.15 Employee + Child(ren) $136.49 Family $204.73 DENTAL – ABC Company offers two competitive Dental Plan Options Dental Blue High Plan - $2,000 Calendar Year Maximum - 100% Covered Orthodontia Benefits for members up to age 19 with a $2,000 lifetime max - 100% Coverage for Preventative and Basic Benefit Care - 60% Coverage for Major Care - Additional Support for members with qualifying conditions Dental Blue Low Plan - $1,000 Calendar Year Maximum - 100% Covered Orthodontia Benefits for members up to age 19 with a $500 lifetime max - 100% Coverage for Preventative Care - 80% Coverage for Basic Care - 60% Coverage for Major Care - Additional Support for members with qualifying conditions DENTAL INSURANCE – Biweekly Employee Contributions DENTAL BLUE HIGH PLAN DENTAL BLUE LOW PLAN Employee $2.42 $1.03 Employee + One $6.18 $2.20 Family $12.25 $3.07 2022 BENEFIT SUMMARY