financial designs, inc. · financial designs, inc. product portfolio revised 3/18/09 the financial...

Financial Designs, Inc.Product Portfolio

REVISED 3/18/09

Need a Quote?–Call our Team of Professionals at (800) 828-1422 or visit us online at www.financial-designs.com 2

Financial Designs, Inc. Product Portfolio REVISED 3/18/09

Table of ContentsFinancial Designs Introduction 3Agent Commission Schedule 4

Financial Designs’ Group ProductsCarrier Comparison Grid 9Am Best Ratings 9

Proposal Request FormsProposal Request Form For Groups 2-99 10Census Form For Groups 2-99 11

Plan Options for Sole ProprietorsSmall Business Association Of Michigan (SBAM) 12

Groups 2 To 9: Employer Paid Dental and Vision PlansDental – AlwaysDental 14Dental - Allied National 15Dental - Security Life Insurance 15Vision – AlwaysVision 16Vision – AIG / American General 17Vision – Security Life Insurance 17

Groups 2 To 9: Employer Paid Life / AD&D / STD / LTD PlansLife / Accidental Death & Dismemberment – Group Summary 18Short-term Disability – Group Summary 18Long-term Disability – Group Summary 18

Voluntary PlansCincinnati Life 19Security Life 19AIG / American General 19

Chamber and Association PlansDetroit Regional Chamber Of Commerce 20Small Business Association Of Michigan (SBAM) 21

True Groups 10+ Employer Paid Dental and Vision PlansSecurity Life Insurance 24AIG 24

True Groups 10+ Employer Paid Life / AD&D / STD / LTD Plans Life / Accidental Death & Dismemberment – Group Summary 25Short-term Disability – Group Summary 25Long-term Disability – Group Summary 25

Plan Options for IndividualsAlways Dental & Vision 26



The Financial Designs TeamCatherine L. CooperExecutive Vice President

(800) 828-0759, [email protected]

Kitty Beard Manager of Financial Designs

(800) 828-0759, x440 Fax: (248) 675-2219 [email protected]

Larry Gillis Senior Agent Consultant

(800) 828-0759, x490 Fax: (248) 675-4580 [email protected]

Our HistoryFounded in 1970, the mission of Financial Designs, Inc. (FDI) has been clear: To provide agents with quality, cost-ef-fective programs that will protect their clients from financial hardships as a result of death, sickness, or disability.

FDI provides group and individual insurance products that meet the changing needs of today’s market. The carriers we represent have been selected based on their financial strength, competitiveness, and quality.

Our team is focused on providing exceptional service. That is why we strive, with every case, to make FDI your FIRST resource for ancillary products and services.

Contact Information39500 High Pointe Blvd., Suite 400Novi, MI 48375

Phone: (800) 828-1422 or (248) 348-8200 • Fax: (248) 348-1697www.financial-designs.com

Please contact FDI’s billing department at (800) 828-1422 and/or email [email protected]. Enrollments/ terminations may be faxed to (248) 675-4506.



Agent Commission Schedules

Allied NationalHorizons Life and Disability

1st Year Renewal

Standard Plan – All Sizes 15% 10%

Custom Plan – 10-24 15% 10%

Custom Plan – 25+ 12% 8%

Horizons Dental

Both Dental plans 1 & 2 10%

Cincinnati LifeWorksite Plans:

LifeHorizons Payroll Deduction:

UL1 – (Unismoke) 62.5% 2.5% (2-5) 1% (6-10)

UL2 – (Non-Smoker/Smoker) 62.5% 2.5% (2-5) 1% (6-10)

Payroll Deduction Term Life 62.5% 2.5% (2-5) 1% (6-10)

Whole Life (ESP-Flex) 62.5% 3.75% (2-10)

Disability Income D1 (Unismoke) 40% 6% (2-10) 1% (11 on)

Disability Income D2 (Non-smoker/smoker) 40% 6% (2-10) 1% (11 on)

Fort Dearborn LifeLife 10%

Short-term Disability 10%

Long-term Disability 10%

Dental 10%

Security LifeDental 10%

Vision 10%

Small Business Assoc. of MI (SBAM)Michigan Dental Plan 6%

Fort Dearborn Life 15%



Agent Commission Schedules (continued)

AlwaysCare Benefits, Inc. offers quarterly bonus payments in addition to our standard commissions to reward our partners for placing and maintaining books of business with us. Our insured group dental and vision plans are eligible for bonus payments. Any group with 2 or more enrolled employees is eligible for inclusion in the bonus calculation.

Agent Bonus ProgramHow to Qualify: • Sell 8 new coverages with a total of 300 enrolled employees within twelve months prior to the measurement period of the last day of each quarter or •8 renewal coverages with a total of 500 employees enrolled with AlwaysCare on the last day of qualifying quarter and 4 new coverages with a total of 100 employees sold within the twelve months prior to the measurement period-the last day of each quarter

What is a “Coverage?” A coverage is any AlwaysDentalSM or AlwaysVisionSM plan purchased by a 2+ enrolled employee group. If a group purchases dental and vision, then the group counts as 2 coverages. For example, a group with 25 employees enrolled in dental and vision plans counts as 2 coverages and 50 enrolled employees.

See back for further details and information.

AlwaysRewards Agent Commission and Bonus Plan

Agent Commission Program

Group Sales:

AlwaysDental CommissionsFirst Year & Renewal

(per group)

10%Employer Funded & Voluntary

AlwaysVision CommissionsFirst Year & Renewal

(per group)

10% Employer Funded12% Voluntary

Individual Dental Sales:

Earn Commissions and Bonuses for your AlwaysCare Sales!

Contacting AlwaysCare:

1-888-729-5433, ext 2013Monday–Friday: 7:30 A.M. to 8:30 P.M.

Saturday: 9 A.M. to 3 P.M. (CST)www.AlwaysCareBenefits.com

First Year (per individual applicant)

15%

Renewal(per individual applicant)

7%

GREATER

BAT

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2006

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ear




Rewards 6/06

Agent Bonus Program Specifications:1. Bonuses are paid quarterly upon qualifying and will be issued 45 days after the last day of the quarter.2. Individual producers in national arrangements must qualify on their own.3. Each office of a firm with multiple offices must qualify on its own.4. A maximum of commissions associated with $250,000 in premium per coverage may be applied to bonus calculations.5. A maximum bonus payout to any one local firm under this program will be $100,000.6. This program does not apply to any form of general agent.7. The bonus program begins 7/1/05. Any subsequent programs are at the discretion of AlwaysCare, which also reserves the right to terminate

or change a program at any time. First Payment will be made in the calendar year, 4th quarter, for 3rd quarter results.8. The writing agent will receive the credit and bonus for groups in which agents share/split commissions.9. If you qualify for either the coverage or number of employees threshold, but not both, then your bonus calculation is based on the tier where both thresholds are met.10. Agent of record transfers and carve-outs of existing groups do not count as new coverages.11. Measurement periods include the twelve months prior to the end of a calendar year quarter.12. Individual Dental sales do not qualify toward the Bonus Program.

Bonus CalculationsBonuses are paid quarterly as soon as you qualify, and are based on commissions paid through the last day of a calendar quarter, e.g., March 31. Premium qualifies if coverage is still in-force as of the last day of the qualifying quarter. Extensions to an existing coverage do not count as a new coverage.

At the end of every calendar year quarter, a measurement of the bonus calculation will be made and new sales qualifications will go back twelve months for every measurement period. Groups that are in-force for a minimum of twelve months are treated as Renewal Business in the calculation.The following chart illustrates the bonus percentage, which grows as your renewal and new business blocks increase. If you have no in-force business with AlwaysCare, then you become eligible for the bonus once you have sold 8 coverages with a total of 300 employee lives.

Your bonus will be your quarterly paid commissions multiplied by your bonus percentage.

New Business

Coverages Sold within 12 month

measurement periodEmployee

Lives

A B C D E

0 Coverages & 0 Lives

8 Coverages& 500 Lives

16 Coverages& 1,000 Lives



AA 4 100 0% 8% 12% 16% 20%

BB 8 300 8% 12% 16% 20% 24%

CC 12 600 12% 16% 20% 24% 28%

DD 16 900 16% 20% 24% 28% 32%

Examples of Bonus Percentage Calculation:• If you have no existing business with AlwaysCare, but sell 12 new coverages with 600 lives within the twelve month bonus measurement period, your bonus percentage is 12% (Column A, Row CC).• If you have 16 renewal coverages with 1,000 lives with AlwaysCare at the start of the twelve month bonus measurement period, and sell 12 new coverages with 600 lives within the measurement period, your bonus percentage is 20% (Column C, Row CC).• If you have 16 renewal coverages with 1,000 lives with AlwaysCare at the start of the twelve month bonus measurement period, and sell 12 new coverages with 400 lives within the measurement period, you bonus percentage is 16% (Column C, Row BB).




2006 producer compensation programs

Great employee benefits products...Excellent service and support...Top-notch commission programs...AIG Employee Benefit Solutions delivers to you — and your clients.

06675006-1149 R03/06

WE KNOW BENEFITS.SM

Schedule AAnnual Amount of Premium Commissions on Premium

First $20,000 15.0 %Next 20,000 10.0Next 20,000 7.5Next 40,000 5.0Next 100,000 2.5Next 300,000 2.0Next 500,000 1.5Thereafter 1.0

Schedule BAnnual Amount of Premium Commissions on Premium

First $10,000 10.0%Next 10,000 4.0Next 20,000 3.0Next 20,000 2.0Next 140,000 1.5Next 300,000 1.0Thereafter .6

STD, LTD and NJTDB1

Annual Amount of Premium Commissions on PremiumFirst $15,000 15.0%Next 10,000 10.0Next 35,000 5.0Next 50,000 1.0Next 400,000 .5Thereafter .375

NYDBLAnnual Amount of Premium Commissions on Premium

First $5,000 17.5%Next 5,000 13.0Next 40,000 5.0Next 200,000 2.0Next 250,000 2.0Next 1,500,000 1.0Next 2,000,000 1.0Thereafter .5

STD advise to pay administrative services onlyAnnual Amount of Premium Commissions on Administration Fees

First $15,000 1.5%Next 10,000 1.0Next 35,000 .5Next 50,000 .1Next 400,000 .05Thereafter .0375

Group Short-Term Disability (STD), Long-Term Disability(LTD), New Jersey Temporary Disability Benefits (NJTDB)and New York Disability Benefits Law (NYDBL)

Group Dental and Vision

Annual Amount of Premium Commissions on PremiumFirst $10,000 10.0 %Next 10,000 7.5Next 10,000 5.0Next 20,000 2.5Next 200,000 1.5Next 250,000 1.5Thereafter 1.0

Group Term Life and AD&D

Employer-funded product commissions schedules

Annual Amount of Premium Commissions on PremiumAll Premium 2.75%

Work & Family Benefits, Inc.2 Values Package®




Producer first year target commissions program

Employee-paid product commissions schedules

Annual Amount of Premium Commissions on PremiumFirst $25,000 20.0%Next 25,000 17.5Next 25,000 15.0Next 25,000 12.1Next 100,000 10.0Next 100,000 7.5Next 100,000 5.0Thereafter 2.5

Annual Amount of Premium Commissions on PremiumAll Premium 10%

AIG Group Discount3 DentalSM

Annual Amount of Premium Commissions on PremiumFirst Year Thereafter

First $60,000 20.0% 8.5%Next 40,000 15.0 6.0Next 100,000 10.5 1.5Next 100,000 7.5 1.5Next 100,000 5.0 1.0Thereafter 2.5 1.0

Group Dental4 and Vision

Earn up to an extra 2.5 percent commission

Standard commission schedules will be in effect from January 1, 2006, toDecember 31, 2006. The First Year Target Commissions program is good onlyon non-New York cases underwritten by AIG Life Insurance Company,effective January 11, 2006 to December 31, 2006. Producers must remain ingood standing with AIG Employee Benefit Solutions underwriting companies.

www.aigebs.com

Products not available in all states. Insurance services provided by members of American International Group, Inc., 70 Pine Street, New York, New York.©2006 American International Group, Inc. All rights reserved.

1Calculated independently2Work & Family Benefits, Inc. services are provided exclusively by Work & FamilyBenefits, Inc. These services are not insurance and are not provided by one of theAIG member companies.

3AIG Group Discount Dental provides discounts only and is NOT insurance.4Includes Indemnity and PPO plans.

When you sell a target case you will be eligible for a flat 2.5 percentfirst-year commission, on a per-coverage basis, on manually ratedcases. This is in addition to your regular commission for the business.

Target cases are in certain SIC codes that have been historicallyunderserved by our competition. This is an almost untapped marketwaiting for you.

Go to our private Agents/Brokers site within www.aigebs.com for acomplete listing of the approved SIC codes.

Qualifications for a target case:• must be sold under a designated SIC code industry• a manually rated case

First Year Target Commissions make it well worth your while toseek out these underserved groups.

For more information contact your AIG Employee Benefit Solutions Sales Representative today.

Please note: Each state mandates that the producer hold an insurance license with linesof authority for life and health in the same state in which the policyholder is domiciled.If you are not licensed in the state of sale, the case will not qualify unless a valid licenseis received within the qualifying period.

06675006-1149 R03/06

Group Term Life, AD&D, STD and LTD

Eligibility

Back for 2006, our First Year Target Commissions program can help open often-overlooked markets – and offer you special first-year commissions.



LifeDependent

LifeAD&D

Short Term Disability

Long Term Disability

Dental Vision Other

AIG /American General ✓ ✓ ✓ ✓ ✓ ✓ ✓

Supplemental Life, Voluntary Life, STD, LTD, Vision, Dental

Allied National ✓ ✓ ✓ ✓ ✓

AlwaysCare ✓ ✓Voluntary Dental & Vision

Cincinnati LifeWorksite marketing, Universal, Whole Life, Term

Fort Dearborn Life (SBAM, DRC) ✓ ✓ ✓ ✓ ✓ ✓

Voluntary Life, Short-Term Disability, Long-Term Disability, Dental, Critical Illness

Michigan Dental Plan (SBAM) ✓

Security Life ✓ ✓Voluntary Vision & Dental

AM Best RatingAIG / American General A++

AlwaysCare (underwritten by National Guardian Life) A

Cincinnati Life A+

Fort Dearborn Life A+

Security Life B

Group Products



Proposal Request Form ❒AIG ❒Allied National ❒AlwaysCare

❒Fort Dearborn Life ❒MI Dental ❒Security Life

AG

ENT Agent: Phone: Fax:

Email: Current AOR? ❒Yes ❒No Date Presenting to Client:

Date Proposal Needed: Send Proposal Via: ❒Mail ❒Fax ❒Email

GR

OU

P

Group Name: # Eligible Employees: # Participating:

Choose ONE Type: ❒Non-Contributory ❒Contributory ❒Voluntary Targeted Effective Date:

Address: City: State/ZIP:

SIC: Nature of Business:

LIFE

In-Force Plan Design: Requested Plan Design (if different):

Current Rates: Renewal Rates: Competitor Rates:

Dependent Life: ❒Yes ❒No Amount of Coverage: Spouse $ Child(ren) $

STD

In-Force Plan Design: / / ❒50% ❒60% ❒66 2/3% ❒70% Other: Max: $


Requested Plan Design: / / ❒50% ❒60% ❒66 2/3% ❒70% Other: Max: $

LTD

In-Force Plan Design: ❒50% ❒60% ❒66 2/3% ❒70% Other: Max: $

Elimination Period: ❒90 Day ❒180 Day Duration: RBD SSNRA 5YR 2YR


Requested Plan Design (if available): / / ❒50% ❒60% ❒66 2/3% ❒70% Other: Max: $

Elimination Period: ❒90 Day ❒180 Day Duration: RBD SSNRA 5YR 2YR

DEN

TAL


In-Network: Deductible: Coinsurance% / / Max: $

Out-of-Network: Deductible: Coinsurance% / / Max: $

In-Force Rates: EE E+Spouse E+Child Fam

Renewal Rates: EE E+Spouse E+Child Fam

Competitor Rates: EE E+Spouse E+Child Fam

Endodontics: Type: ❒Basic ❒Major Oral Surgery Type: ❒Basic ❒Major

Periodontics: Type: ❒Basic ❒Major Orthodontics: % Lifetime Max: $

VIS

ION


In-Network Copay or Reimbursement %: Out-of-Network Copay or Reimbursement %:

In-Force Rates: EE E+Spouse E+Child Fam

Renewal Rates: EE E+Spouse E+Child Fam

Competitor Rates: EE E+Spouse E+Child Fam



Employee Name Birth Date M / F Salary Salary Paid Class Occupation Family Status

❒Weekly❒Bi-Monthly❒Monthly❒Yearly

❒Single❒EE + Spouse❒EE + Child❒Family























Group / Individual Census



Small Business Association of Michigan

SBAM Plan

Fort Dearborn Life

Life / Accidental Death & Dismemberment

Trust Group (1-9 eligible) True Group (10+ eligible)

Guaranteed Issue Limit $15,000-$35,000 $50,000-$100,000

Dependent CoverageSpouse– $2,000 / $5,000 MaximumChildren– $1,000 / $2,000 Maximum

Spouse– $2,000 / $5,000 MaximumChildren– $1,000 / $2,000 Maximum

Rating 5 Year Age Band Composite Rating

Short-Term Disability


Weekly Maximum $750 $750

Duration 13 / 26 / 52 Weeks 13 / 26 / 52 Weeks

Percent of Annual Salary 66.7% 66.7%

Long-Term Disability


Own Occupation 24 Months 24 Months

Monthly Maximum $4,000 $5,000 or $6,000 $4,000 $5,000 or $6,000

Percent of Salary 60% 60%

Elimination Period 90 or 180 days 90 or 180 days

Supplemental Term Life

Trust Group True Group (10+ eligible)

Guaranteed Issue1-4 None5-9 $20,000

10-49 $30,00050-99 $80,000

Participation Minimum of 25% Participation

ScheduleFlat ($10,000 increments)Minimum-$10,000 / Maximum-$500,000

Plan Options for Sole Proprietors




SBAM Plan

Michigan Dental PlanSole Proprietor Groups

Coverage and Amounts Plan A Plan BCopayment

(Amount Covered)

CombinedPlan Year

Deductible

Combined Plan Year Maximum

Copayment(Amount Covered)

Combined Plan Year

Deductible


Class IPreventive and Diagnostic

50% 0 $1,000 100% 0 $1,000

Class IIRestorative Services, Oral Surgery, Endodontic and Periodontics

50% $50 $1,000 75% $50 $1,000

Class IIIInstallment And Repair Of Crowns, Bridges and Dentures

50% $50 $1,000 50% $50 $1,000

Special Provisions: 1. Installation and repair of crowns is a Class III benefit. 2. There is a “missing tooth” limitation whereby there is no reimbursement for dental services related to a

tooth missing at the inception of coverage until the individual has been covered for at least twenty-four (24) months.

3. Class II & III benefits are delayed six (6) months.

Basic Monthly Rates (By Area)

Plan A Plan B

Employee Only

Employee Plus 1

Dependent

Employee Plus Family

Employee Only

Employee Plus 1

Dependent


AREA ILivingston, Macomb, Oakland, Washtenaw, Wayne Counties

$26.65 $48.58 $74.23 $47.59 $86.75 $132.61

AREA IIBay, Eaton, Genesee, Grand Traverse, Ingham, Lapeer, Midland, Saginaw, St. Clair, Tuscola Counties

$25.74 $46.84 $71.61 $45.94 $83.68 $127.94

AREA IIIClinton, Iosco, Isabella, Jackson, Kalamazoo, Kent, Mecosta, Monroe, Shiawassee Counties

$26.85 $42.97 $65.75 $42.15 $76.77 $117.38

AREA IVAll other counties

$21.92 $39.94 $61.13 $39.17 $71.41 $109.78

Plan Options for Sole Proprietors (continued)



Groups 2 to 9Employer Paid Dental Plans



Groups 2 to 9Employer Paid Dental Plans

AlwaysCare Benefits, Inc. (a Starmount Life Insurance company) andFinancial Designs, Inc. have teamed for a great opportunity to offer your clients dental insurance for little or no cost to them.

Dental Insurance–FOR LITTLE OR NO COST TO THE EMPLOYER!

Contacting AlwaysCare:Call Toll Free

888.729.5433,ext 2013Monday–Friday:

7:30 A.M. to 8:30 P.M. Saturday:

9 A.M. to 3 P.M. (CST)AlwaysCareBenefits.com

AlwaysDentalSM

AlwaysCareSM

This form is not a contract of insurance. Please note: this is a brief description of the AlwaysDental plan. It should be used only as a guide. It does not contain complete plan details. Terms and conditions, including a complete list of benefits, limitations and exclusions, are defined in the member certificate issued following enrollment in the plan. If questions arise concerning coverage, the subscriber certificate and riders will govern.

AlwaysDental is underwritten by National Guardian Life (NGL) and administered by AlwaysCare Benefits, Inc. (a Starmount Life Insurance company).

National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a.k.a. The Guardian, Guardian Life.

Contact Larry Gillis ([email protected]) or Kellie Hauman ([email protected]) for a group proposal!

800.828.0759

Participation Guidelines:• If 2-4, 100% of eligible employees must enroll.• If 5 or more, the greater of 5 eligible employees or 20% must enroll AlwaysDentalSM

&

• Dental insurance is the number onerequested benefit behind health insurance.

• AlwaysDental allows the employee to choose any dentist.

• A fully insured plan with no in or out-of-network coinsurance differences.

• Employer determines their premium contribution amount, with the option of $0 contribution.

• Another great addition to a Section 125 Premium Only Plan or a Flexible Spending Account (FSA).

Outline of Benefits Dental PlanDeductible Group as a whole has a choice between:

$100 Lifetime. Applies to Class A, B, C. or$50 benefit year. Maximum 3 per family. Applies to Class B, C.

Benefit Year Maximum $1000 for Class A, B, C.

Class APreventive Services100%

Waiting Period: None• Routine exams (1 per 6 months)• Prophylaxis (1 per 6 months)• Bitewing X-rays (max 4 films; 1 per 12 months• Flouride to age 16 (1 per 12 months)• Sealants to age 16 (permanent molars, once)• Space maintainers to age 16 (1 per 24 months)

Class BBasic Services80%

Waiting Period: None• Full mouth X-ray (1 per 24 months)• Emergency pain• Fillings• Anesthesia• Simple extractions• Oral surgery• Crown, denture, bridge repair

Class CMajor Services50%

Waiting Period: 12 months*• Simple periodontics• Endodontics (root canals)• Surgical periodontics• Inlays and Onlays• Crowns, bridges, and dentures

Class DOrthodontics**50%(optional benefit)

Waiting Period: 12 months*• Annual maximum: $500• Separate Lifetime maximum: $1,000• Dependent children to age 19 only

* Takeover credit available. **Orthodontics available for groups of 10 or more.



Allied National — Horizon Dental Design PlanHorizon Dental Design Plan Highlights

Maximum Benefit (per person per year) Indemnity$1,000

PPO$1,000

Preventive & Diagnostic Services Plan Pays (reasonable charges)

Plan Deductible/Copay

Waiting Period

100%

NONE

NONE

100% in network80% out of network$10 Copay per Visit(waived in-network)NONE

Basic Services Plan Pays (reasonable charges)

Waiting Period

80% after a $75 per person combined basic/major calendar year deductible

6 Months

Pays 80% in network, 60% out of network after a $75 per person combined basic/major calendar year deductible(deductible waived in-network)6 Months

Major Services Plan Pays (reasonable charges)

Waiting Period

Pays 50% after a $75 pp combined basic/major calendar year deductible – max 3 per family

12 Months

Pays 50% in and out of network after a $75 pp combined basic/major calendar year deductible – max 3 per family(deductible waived in-network)12 Months

Deductible for Basic & Major Services Per Person

Max # Deductibles per Family per Year

$50 Combined Per Year

3

$50 combined per year(waived in network)$100 combined life time deductible3

Orthodontia (children only)Optional for Both Plans Plan Pays (reasonable charges) Deductible Waiting Period Lifetime Maximum

50%$50 per person – one time12 Months$1,000

Additional Plan Options – Groups of 10+ Employees (for both plans)This option moves endodontics from Major to Basic Services and sets Basic Services waiting period to 0 months and Major Services waiting Period to 6 months.Takeover, Orthodontia benefits are all plan options and are available only if shown as included on proposal page.Please see the Allied Dental Design brochure for complete details on takeover and all other benefits. Network: AIG National Dental Network

Security Life InsurancePlan Deductible* Annual Maximum Orthodontia

100 / 80 / 50 $50 $1,000 / $1,500 Optional

80 / 80 / 50 $50 $1,000 / $1,500 Optional

100 / 50 / 50 $100 $1,000 / $1,500 Optional

*Deductible waived for Preventive ServicesWaiting Periods: Preventative = 0 Basic = 3 months Major = 12 months Ortho = 12 monthsNetwork: Indemnity

Groups 2 to 9 – Employer Paid Dental Plans (continued)





Vision Insurance–FOR LITTLE OR NO COST TO THE EMPLOYER!

This form is not a contract of insurance. Please note: this is a brief description of the AlwaysVision plan. It should be used only as a guide. It does not contain complete plan details. Terms and conditions, including a complete list of benefits, limitations and exclusions, are defined in the member certificate issued following enrollment in the plan. If questions arise concerning coverage, the subscriber certificate and riders will govern.

AlwaysVision is underwritten by National Guardian Life (NGL) and administered by AlwaysCare Benefits, Inc. (a Starmount Life Insurance company).National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a.k.a. The Guardian, Guardian Life.

AlwaysCareSM

AlwaysVisionSM

Contacting AlwaysCare:Call Toll Free

888.729.5433, ext 2013Monday–Friday:

7:30 A.M. to 8:30 P.M. Saturday:

9 A.M. to 3 P.M. (CST)AlwaysCareBenefits.com

AlwaysVisionSM

&

• Vision insurance is one of the fastest growing employee benefit offerings.

• AlwaysVision offers consumers state of the art facilities and an impressive selection of eyewear.

• Employer determines their premium contribution amount, with the option of $0 contribution.

• Another great addition to a Section 125 Premium Only Plan or a Flexible Spending Account (FSA).

AlwaysCare Benefits, Inc. (a Starmount Life Insurance company) andFinancial Designs, Inc. have teamed for a great opportunity to offer your clients vision insurance at little or no cost to them.

* If 2-4 eligible, 100% of eligible employees must enroll in both AlwaysDental and AlwaysVision. If 5-100 eligible, the greater of 5 or 20% of total eligible must enroll in AlwaysVision.** If 10-100 eligible, the greater of 10 or 80% of eligible employees must enroll in AlwaysVision.

Service In-Network Out-of-NetworkAllowances

Exam (once per 12 months) $10 co-pay Up to $35

Materials: $10 co-pay

Std. Plastic Lenses (once per 12 months):

Single VisionBifocalTrifocalLenticularProgressive

CoveredCoveredCovered$80 allowance$70 allowance

Up to $25Up to $40Up to $50Up to $50Up to $40

Frames (once per 24 months):Member may select any frame available

$120 retail allowance($94 at Wal-Mart and Sam’s Club)

Up to $50 retail allowance

Contact Lenses (once per 12 months):Fit, follow-up and materials • Elective• Medically Necessary

Up to $120 retail allowanceUp to $210 retail allowance

Up to $100 retail allowanceUp to $210 retail allowance

Rates:• Employee• Employee + Spouse• Employee + Child(ren)• Family

Base* Incentive**$ 8.09 $ 4.63

$ 16.18 $ 9.26 $ 14.00 $ 8.01 $ 22.09 $ 12.64

The above rates are valid through March 31, 2006.

Contact Larry Gillis ([email protected]) or Kellie Hauman ([email protected]) for more information!

800.828.0759

Groups 2 to 9Employer Paid Vision Plans

Groups 2 to 9Employer Paid Vision Plans



AIG / American General Premier-Plus Plan

Plan Provision Plan Details

In-Network Out-of-Network

Exam $10 co-pay $40 reimbursement

Exam Frequency Annual Same as In-Network Plan

Frames Frequency • Annual• Every 2 years (option)

Same as In-Network Plan

Frames (any frame available at provider location)

$0 copay, $120 allowance20% off balance over $120

$45 reimbursement

Standard Plastic Lenses Single vision, bifocal, trifocal, and lenticular $20 copay

Single Vision - $45 reimbursementBifocal - $60 reimbursementTrifocal - $80 reimbursementLenticular - $80 reimbursement

Other Lens Options $12 copay-$45 copay N/A

Contact Lenses $0 copay$105 allowance-$210 allowance

Elective-$80 reimbursementMedically Necessary-$210 reimbursement

Laser Vision Correction 15% off retail or 5% off promotional price from US Laser Network

N/A

Other Services, Materials,or Add-on features

20% discount, plus 45% savings through the Premier-Plus Secondary Purchase Plan

N/A

Network: EyeMed

Security Life InsuranceService* Benefit Plan 1 Plan 2

Eye Exam $40 Once per benefit year Once per benefit year

Single Pair Lens $60 Once per benefit year Every other benefit year

Bifocal Pair Lens $90 Once per benefit year Every other benefit year

Trifocal Pair Lens $130 Once per benefit year Every other benefit year

Progressive Pair Lens $150 Once per benefit year Every other benefit year

Contacts (pair) $90 Once per benefit year Every other benefit year

Frames $45 Once per benefit year Every other benefit year

*Contact lens benefit is in lieu of other material benefits. Benefit for one contact lens I half of benefit year allowance.Network: Indemnity Plan

Groups 2 to 9 – Employer Paid Vision Plans (continued)



Groups 2 To 9

Employer Paid Life / AD&D / STD / LTD Plans

Life/Accidental Death & Dismemberment

AIG Allied National

Guaranteed Issue Limit 2-4: n/a5-9: $100,000(w/prior carrier proof)

2-4: $10,000$35,000 – takeover5-9: $50,000 – non-takeover$75,000 – takeover

Minimum Life Benefit $10,000 $10,000

Maximum Life Benefit $100,000 $100,000

Dependent Life Coverage Spouse - $10,000 Spouse - $10,000

Child - $2,000 Child - $2,000

Rating Composite Five (5) Year Age Band

Special Terms Can be purchased as a standalone benefit

Short–Term Disability

AIG Allied National

Weekly Maximum $1,000 $1,000

Duration 13/26 or 52 weeks 13/26 weeks

Percent of Annual Salary 60% 60%

Flat Amount Available May not exceed 60% of weekly pay May not be less than 25% or more than 60% of earnings w/out approval

Special Terms Can be purchased as a standalone benefit

Long–Term Disability

AIG Allied National

Own Occupation 24 months 24 months

Monthly Maximum $6,000 $6,000

Percent of Annual Salary 60% 60%


Special Terms Can be purchased as a standalone benefit Can be purchased as a standalone benefit



Cincinnati Life

Worksite Marketing Plans – Five (5) Employees Must Participate

Plans Available• Universal• Whole Life• Term

Benefits for the Employer• Provides quality, voluntary life insurance for your employees• Expands your fringe benefits at virtually no additional cost to you• Promotes goodwill with your employees• Encourages employees to take more responsibility for their financial security• Helps redirect a philosophy that the employer must pay for all benefits

Benefits for the Employee• Modern, competitive products• Low-cost life insurance protection• Coverage is available for employees’ spouse, children and grandchildren• Convenience of paying premiums through payroll deduction• Employee owns policy• Guaranteed paid-up life insurance option available at any time• Cash values accumulate on a tax-deferred basis• Portable coverage – employee keeps the coverage at the same cost, even it the employee is no longer with the company• If the amount of insurance is less than $100,000, no blood profile or urine analysis is needed• No medical examinations required

Security LifeVoluntary Dental – Groups of 3 or more are eligible. Only 1 employee needs to enroll.

PLAN Deductible* Annual Maximum Orthodontia

100/80/50 $50 $1,000 / $1,500 Optional

80/80/50 $50 $1,000 / $1,500 Optional

100/50/50 $100 $1000 / $1,500 Optional

*Deductible waived for Preventive Services

Waiting Periods: Preventive = 3 months, Basic = 6 months, Major= 12 months, Ortho= 12 monthsNetwork: Indemnity

AIG / American GeneralIndemnity & PPO Plan

Plan Deductible Annual Maximum Orthodontia

Passive PPO100/50/50100/80/50

$100 life time deductible$50 per year

$1,500$1,000

Optional

Network: AIG National Dental Network Note: Two plans available Voluntary PPO Voluntary indemnity

Voluntary Plans



Chamber and Association Plans

Detroit Regional Chamber of Commerce(Underwritten by Fort Dearborn Life Insurance Company)


1-4 Eligible 5-9 Eligible

Guaranteed Issue Limit $25,000 $35,000

Dependent Coverage

Plan DSpouse @ $5,000Children (15 days – 6 months) $250Children (6 Months – Age 21 & Age 23 (full time student)) $2,500

Plan ESpouse @ 2,000Children (15 days – 6 months) $100Children (6 Months – Age 21 & Age 23 (full time student)) $1,000

Rating 5 Year Age Band

Short-Term Disability*

1-9 Eligible

Guaranteed Issue Limit $500

Weekly Maximum $500 (May not exceed 66 2/3% of employee’s weekly salary)

Maximum Benefit Duration 13/26 Weeks

Percentage of Annual Salary 50%, 60%, or 66 2/3%

*Short Term Disability Coverage Available Only When Life and AD&D Is Selected.

Long-Term Disability*

Maximum Benefit $6,000

Percentage of Basic Monthly Earnings 60%

Elimination Periods 90, 180 days

Maximum Benefit Duration Period 5 year and to age 65 with reducing benefit duration

*Must be sold in combination with Life and AD&D benefits.

Call an FDI Consultant at (800) 828-1422 for details & information about Voluntary products offered through the Detroit Regional Chamber.

Groups of 10 or more will be composite rated.



Chamber and Association Plans (continued)


SBAM Plan

Michigan Dental PlanGroups of 2–4 Lives

Coverage and Amounts Plan A Plan BCopayment

(Amount Covered)

CombinedPlan Year

Deductible


Copayment(Amount Covered)

Combined Plan Year

Deductible


Class IPreventive And Diagnostic

50% 0 $1,000 100% 0 $1,000

Class IIRestorative Services, Oral Surgery, Endodontic And Periodontics

50% $50 $1,000 75% $50 $1,000

Class IIIInstallment And Repair Of Crowns, Bridges And Dentures

50% $50 $1,000 50% $50 $1,000

Special Provisions: 1. Installation and repair of crowns is a Class III benefit. 2. There is a “missing tooth” limitation whereby there is no reimbursement for dental services related to a

tooth missing at the inception of coverage until the individual has been covered for at least twenty-four (24) months.

3. Class II & III benefits are delayed six (6) months.

Basic Monthly Rates (By Area)

Plan A Plan B

Employee Only

Employee Plus 1

Dependent


Employee Only

Employee Plus 1

Dependent


AREA ILivingston, Macomb, Oakland, Washtenaw, Wayne Counties

$23.03 $41.99 $64.15 $41.13 $74.98 $114.16

AREA IIBay, Eaton, Genesee, Grand Traverse, Ingham, Lapeer, Midland, Saginaw, St. Clair, Tuscola Counties

$22.26 $40.47 $61.90 $39.70 $72.32 $110.48

AREA IIIClinton, Iosco, Isabella, Jackson, Kalamazoo, Kent, Mecosta, Monroe, Shiawassee Counties

$23.20 $37.14 $56.82 $36.43 $66.36 $101.45

AREA IVAll other counties

$18.95 $34.52 $52.84 $33.86 $61.71 $94.34



Chamber and Association Plans (continued)


SBAM Plan

Fort Dearborn Life



Guaranteed Issue Limit $15,000-$35,000 $50,000-$100,000

Dependent CoverageSpouse– $2,000 / $5,000 MaximumChildren– $1,000 / $2,000 Maximum

Spouse– $2,000 / $5,000 MaximumChildren– $1,000 / $2,000 Maximum

Rating 5 Year Age Band Composite Rating

Short-Term Disability


Weekly Maximum $750 $750

Duration 13 / 26 / 52 Weeks 13 / 26 / 52 Weeks

Percent of Annual Salary 66.7% 66.7%

Long-Term Disability


Own Occupation 24 Months 24 Months

Monthly Maximum $4,000 $5,000 or $6,000 $4,000 $5,000 or $6,000

Percent of Salary 60% 60%


Supplemental Term Life

Trust Group True Group (10+ eligible)

Guaranteed Issue1-4 None5-9 $20,000

10-49 $30,00050-99 $80,000

Participation Minimum of 25% Participation

ScheduleFlat ($10,000 increments)Minimum-$10,000 / Maximum-$500,000



True Groups

10+

Employer Paid Dental and Vision Plans



True Groups 10+ Employer Paid Dental and Vision Plans (continued)

Security Life InsuranceEmployer Paid Dental75% employee participation and 50% dependent participation is required.For Groups of 3 with a Minimum of 3 enrolled.

Plan Deductible* Annual Maximum Orthodontia

100 / 80 / 50 $50 $1,000 / $1,500 Optional

80 / 80 / 50 $50 $1,000 / $1,500 Optional

100 / 50 / 50 $100 $1,000 / $1,500 Optional

*Deductible waived for Preventive Services

Waiting Periods: Preventative = 0 Basic = 3 months Major = 12 months Ortho = 12 months

Network: Indemnity Plan

AIGPPO & Indemnity Plan

Plan

Dental • Quote down to 2 lives• Orthodontics at 10 employees who have insured dependent children• Partial contribution option (100% employee participation required, 75% dependent), will

discount rates• Indemnity and PPO (AIG National Dental Network) plans• $100 lifetime deductible option• Quick claim turnaround time• Take over benefits available

Waiting Periods:PPO Plan Preventive = 0 Basic = 3 months Major = 12 monthsIndemnity Plan Preventive = 0 Basic = 3 months Major = 12 months



True Groups 10+

Employer Paid Life / AD&D / STD / LTD Plans

Life/Accidental Death & Dismemberment

AIG

Guaranteed Issue Limit Groups 10-24 lives: up to $100,000;Groups 10-50 plus: up to $150,000

Minimum Life Benefit $10,000

Maximum Life Benefit Limit subject to underwriting approval

Dependent Life Coverage Spouse - $10,000

Child - $5,000

Rating Composite rating

Short–Term Disability

AIG

Weekly Maximum $1,000+

Duration 13/26 or 52 weeks

Percent of Annual Salary 60% or 66 2/3%

Special Terms

Long–Term Disability

AIG

Own Occupation 24 months

Monthly Maximum $10,000 – 50+ group size

Percent of Annual Salary 40%; 50%; 60%; 66 2/3%; 70%

Pre-Existing Exclusion 12/6/243/6/12 – for groups 25+



Plan Options for Individuals

At Last! Affordable Quality Dental and Vision Coverage for You and Your Family!

AlwaysDental is now available to you as an individual insurance benefit. This program offers coverage for routine twice-annual exams and common dental procedures. We are including an annual vision exam performed by a licensed ophthalmologist or optometrist ($35 allowance—with no deductible—one visit per year).

Freedom of ChoiceChoose any dental provider you want for insured benefits. The plan pays a flat dollar amount per dental procedure based on the fee schedule for your specific region. You can also go to one of the over 54,000 dental providers (www.AlwaysDental.com) and generally pay even less. AlwaysDental pays the lesser of the provider’s actual charge and the amount listed in the Schedule of Covered Dental Procedures. The vision network provides vision discounts at over 10,000 locations nationwide (www.outlookvision.com).

Easy to GetIf you are age 19 to 64, simply enroll online at www.AlwaysCareBenefits.com or complete a simple application (available to download at www.AlwaysCareBenefits.com or by calling 888-729-5433, extension 2006), and mail it back to us. Your acceptance is guaranteed!

Flexible and AffordableWe offer many different coverage options: Individual; Individual & Spouse; One-Parent Family; or Two-Parent Family. Plus, you choose the billing option that’s most convenient for you. Premiums are based on your attained age (except in Florida) at each policy anniversary date. Please see accompanying rate information for details.

Hassle-FreeThere’s no guesswork. All you do is present your card and, in most cases, your dentist will submit your claim (Or you may send it to us.) For preventive care and basic dental services, coverage begins the very first day. No waiting!

AlwaysDentalSM

AlwaysCareSM

For IndividualsDid you know?Customer Service is the key to our business—we strive to be the company that is easy to do business with.

Tooth decay remains the most common chronic disease among children ages 5-17 with 59% affected.a

AlwaysDental gives you the affordable, first class benefits you seek.

Employed adults lose more than 164 million hours of work each year due to dental disease or dental visits.b

120 mental and physical diseases can be detected through the mouth.c

Our Customer Service Staff is available when you need us with extended and Saturday hours.

59% of Americans do not receive regular oral health care.d

a Issue Briefs on Challenge for the 21st Century: Chronic and Disabling Conditionb American Hygienist Association 02/03c Jed J. Jacobson, D.D.S., M.S., M.P.H. 2/06d Satcher D. Oral health in America: A report by the surgeon general. U.S Department of Health and Human Services. Rockville MD. NIH pub. 2000



Plan Options for Individuals

Offering All the Services You Need AlwaysDental products include the dental care you need, the services and procedures you want, where you want it done. You can also choose your own dentist, or go to one of over 54,000 dental providers in our nationwide network and generally pay even less!

Deductible Just $50 per year for each covered family member.

Maximum Benefit $1000 per year for each covered family member.

Plan Reimbursement 100% of the scheduled amount for the service required.

Plus an Extra Vision Benefit!You’ll receive an annual $35 eye exam allowance (except in WA). You may also be eligible for special pricing from over 10,000 vision providers on other vision services.

Ind Den Flat 3/06

Please Note: See Schedule of Covered Services for a sampling of covered procedures. A full listing will be provided with your policy. Services and benefits paid vary according to region. This form is not a contract of insurance. Please note: this is a brief description of the AlwaysDental plan. It should be used only as a guide. It does not contain complete plan details. Terms and conditions, including a complete list of benefits, limitations and exclusions, are defined in the member certificate issued following enrollment in the plan. If questions arise concerning coverage, the subscriber certificate and riders will govern.

AlwaysDentalSM & Vision Discounts

For Individuals

Services Available Frequency of Services

PreventiveNo Waiting Period

• Oral Evaluations • 2 times per 12 months

• Bitewing X-rays • 1 time per 12 months

• Full Mouth X-rays • 1 time per 60 months

• Simple Cleaning • 2 times per 12 months

• Fluoride Treatment • 1 time per 12 months up to age 16

BasicNo Waiting Period

• Sealants • 1 time per molar per 36 months

• Space Maintainers • 1 per lifetime per arch

• Fillings • 1 time per tooth surface per 24 months

• Simple Extractions

• Palliative Emergency Treatment • 1 time per 12 months

Major12 MonthWaiting Period

• Anesthesia*

• Oral Surgery

• Endodontics

• Periodontics

• Single Tooth Restorations (Crowns, Inlays, Onlays)

• 1 time per 7 years

Prosthodontic (Dentures)24 MonthWaiting Period

• Fixed Prosthodontics • 1 time per 7 years

• Removable Prosthodontics • 1 time per 7 years

• Prosthodontic Repairs and Adjustments

OrthodonticsNo Waiting Period

In-Network Discounts only

*In conjunction with oral surgery subject to review.

Contacting AlwaysCare:

1-888-729-5433Monday–Friday: 7:30 A.M. to 8:30 P.M.

Saturday: 9 A.M. to 3 P.M. (CST)www.AlwaysCareBenefits.com

©2006, Starmount Life Insurance Company. All rights reserved.

Form Series NDNIND2005 NGL

AlwaysDental is underwritten by National Guardian Life Insurance Company and administered by AlwaysCare Benefits, Inc. (a Starmount Life Insurance company). National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a.k.a. The Guardian, Guardian Life.



Plan Options for Individuals (continued)

Rates for AlwaysDental & Vision vary according to the region in which you live. To find your region: Locate your state and the fiRst thRee Digits of your Zip Code in the Area table below. To find your rate: Consult the rate chart for that region to determine the rate for your age and the type of coverage you want. Product not yet approved in all states.

Individual Dental Product Rates

RAtes iND 3/06

Rates and Coverage Regions


For Individuals

State/Zip Code RegionAlabama

All Areas 1

Alaska

All Areas 5

Arizona

850-857All Others

32

Arkansas

All Areas 1

California

902-922, 926-931933-935, 940-951954-961All Others

5554

Colorado

800-804All Others

43

Connecticut

062-065All Others

45

Delaware

All Areas 3

District of Columbia

All Areas 5

Florida

321-325All Others330-333

678

Georgia

304-310, 312-319All Others

23

Hawaii

All Areas 4

State/Zip Code RegionIdaho

All Areas 2

Illinois

600-608609-613, 627All Others

432

Indiana

462-466All Others

21

Iowa

500-503All Others

21

Kansas

660-666All Others

21

Kentucky

All Areas 1

Louisiana

700-702, 704, 709All Others

21

Maine

040-042All Others

32

Maryland

206-209All Others

43

Michigan

480-485All Others

32

Minnesota

550-555, 568-569All Others

21

Mississippi

All Areas 1

State/Zip Code RegionMontana

All Areas 2

Missouri

634-639, 644-648650-658All Others

112

Nebraska

All Areas 1

Nevada

All Areas 4

New Hampshire

All Areas 3

New Jersey

070-079, 085-089All Others

54

New Mexico

All Areas 2

North Carolina

All Areas 2

North Dakota

All Areas 1

Ohio

433, 437-439, 446448-449, 453, 455457-458All Others

1112

Oklahoma

730-732, 740-742All Others

21

Oregon

970-973All Areas

43

State/Zip Code RegionPennsylvania

189-194All Others

32

Rhode Island

All Areas 3

South Carolina & South Dakota

All Areas 1

Tennessee

370-372, 379, 381All Others

21

Texas

752-753, 770-772750-751, 760-762773-775, 787All Others

4332

Utah

All Areas 2

Virginia

220-223239-246All Others

412

Vermont

All Areas 3

Washington

980-986All Others

54

Wisconsin

532-534, 536-537All Others

32

West Virginia & Wyoming

All Areas 1

Area Table

Monthly Rates per person

Individual's Age*

Region Flat Rate for Child(ren) 19-39 40-59 60-64Region 1 $24.36 $19.40 $23.39 $25.88

Region 2 $27.66 $21.70 $26.16 $28.94

Region 3 $31.70 $24.52 $29.54 $32.68

Region 4 $36.11 $27.60 $33.23 $36.76

Region 5 $40.89 $30.93 $37.23 $41.17

Florida Flat Rate for Child(ren) Flat Rate for All AdultsRegion 6 (florida Only) $31.70 $29.54

Region 7 (florida Only) $36.11 $33.23

Region 8 (florida Only) $40.89 $37.23

to determine the total rate for the subscriber plus spouse and/or child(ren), simply find the rate for each person and add each person's rate together. OR Log on to our website at www.AlwaysCareBenefits.com and click "individual Dental." Our easy online enrollment will figure your rates for you!

Example: Joe smith, age 42, in Mississippi (Region 1) would have a rate of $23.39. if he were to enroll his spouse, Mary age 38, also in Region 1, her rate would be $19.40. Joe and Mary have two children they wish to enroll, so they would pay one flat rate for them, $24.36.

Joe's rate ($23.39)+ Mary's rate ($19.40)+ Child(ren) rate ($24.36) = $67.15Rates increase as each individual attains a new age bracket (except in fL).

NgLUnderwritten by National guardian Life insurance Company. © 2006, starmount Life insurance Company. All rights reserved. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a.k.a. The Guardian, Guardian Life.Policy form series NDNiND2005



Plan Options for Individuals (continued)

the following is a partial listing of insured covered dental procedures (and a vision exam allowance), applicable limitations and reimbursement amounts. Benefits will be paid as listed in the schedule of Covered Procedures in your policy, subject to policy year deductible, annual maximum, and limitations and exclusions. Access to discount networks is also included.

a) Maximum of 2 procedure per 12 monthsb) Maximum of 1 procedure per 36 monthsc) Maximum of 1 procedure per 12 monthsd) Applications made to permanent molar teeth onlye) Maximum of 1 each quadrant per 24 monthsf) Maximum of 1 each per quadrant per 36 monthsg) Maximum of 1 per tooth surface per 24 monthsh) Replacement of existing only if in place for 24 monthsi) Maximum 1 time per tooth

j) Limited to 2 oral evaluation procedures per 12-month period in any combination

k) Limited to 1 bitewing x-ray procedure per 12-month period-up to 4 films

l) Limited to dependent children under age 16m) Maximum of 1 per 7-year periodn) Maximum of 1 per lifetime, per quadrant or archo) Limited to patients age 16 and overp) Limited to 1 x-ray procedure in any combination per

5-year period

KEy TO LIMITATIONS:

sAMPLe ReiM iND 3/06

ADA procedure codes copyrighted by American Dental Association.

Sample Reimbursement for Highly Used Procedures


For Individuals

Procedure Code

Description Limitations Schedule AmountsRegion 1 Region 2 Region 3,6 Region 4,7 Region 5,8

Oral EvaluationsD0120 Periodic Oral evaluation j 14 16 18 20 22

D0150 Comprehensive Oral evaluation j 22 24 28 31 34

Prophylaxis (Simple Cleanings)D1110 Prophylaxis-Adult a 28 31 35 39 44

D1120 Prophylaxis-Child a 19 21 24 27 30

RadiographsD0210 intraoral-Complete series

(7 or more films, including Bitewings)p 40 45 50 56 63

D0272 Bitewings-two films k 12 13 15 17 19

D0330 Panoramic film p 32 36 40 45 50

SealantsD1351 sealant-Per tooth b, l, d 12 14 15 17 19

Space MaintainersD1510 space Maintainer-fixed-Unilateral l, n 80 89 100 112 125

FillingsD2140 Amalgam-One surface-Primary or Permanent h, g 30 34 38 43 48

D2150 Amalgam-two surfaces-Primary or Permanent h, g 38 43 48 54 60

D2331 Resin-two surfaces-Anterior h, g 44 48 54 61 68

ExtractionsD7140 extraction-single erupted tooth or exposed Root

(elevation and/or forceps Removal)i 35 39 44 49 55

D7230 Removal of impacted tooth-Partially Bony (6-month waiting period)

60 67 75 84 94

Palliative (Emergency) Treatment D9110 Palliative treatment of Dental Pain-Minor Procedure c 27 30 34 38 43

Endodontics (6 month waiting period)

D3310 Root Canal-Anterior (excluding final Restoration) 114 127 143 160 178

D3330 Root Canal-Molar (excluding final Restoration) 170 189 213 238 266

Periodontics (6 month waiting period)

D4260 Osseous surgery (including flap entry and Closure) Per Quadrant f 180 200 225 252 281

D4341 Periodontal scaling and Root Planing, Per Quadrant e 39 43 49 55 61

Single Tooth Restorations (6 month waiting period)

D2750 Crown-Porcelain fused to high Noble Metal m, o 170 189 213 238 266

D2950 Crown Buildup, including Any Pins m, o 39 43 49 55 61

D2952 Cast Post and Core in Addition to Crown m, o 63 70 79 88 98

Prosthodontics (12 month waiting period)

D5110 Complete Upper Denture m 200 223 250 280 313

D5213 Upper Removable Partial Denture-Cast Metal framework with Resin Denture Bases

m 234 260 293 328 366

Orthodontia

08000-08999 Network Discounts Apply

Visioneye exam (not applicable in WA) c $35 per year

NgL

Underwritten by National guardian Life insurance Company. © 2006, starmount Life insurance Company. All rights reserved. National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America, a.k.a. The Guardian, Guardian Life.Policy form series NDNiND2005

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