Common use of Web Portal License Clause in Contracts

Web Portal License. ‌ 1. Delta Dental grants to Agency/Agent a limited, non-transferable, non-exclusive, non-sublicensable, temporary license to access and use Delta Dental’s Benefit Manager Toolkit web portal solely for the purpose of administering its clients’ dental plans, provided Agency/Agent has been authorized by its clients to perform such administration. 2. Agency/Agent is solely responsible for managing access to Benefit Manager Toolkit, for securing the usernames and passwords of its, officers, directors, employees, contractors, and agents (“End Users”) who use or access Benefit Manager Toolkit, and for any violation of this Agreement by any such End Users. Delta Dental shall not be liable for Agency/Agent’s or its End Users’ failure to properly secure their usernames or passwords and, unless otherwise exempt by law, Agency/Agent shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of i) Agency/Agent’s, or its End Users’ failure to properly manage access or secure usernames and passwords, ii) any breach of this Agreement by Agency/Agent or its End Users; or (iii) any negligent or willful misuse of Delta Dental’s web portals by Agency/Agent or its End Users. 3. Agency/Agent agrees that, to the extent its End Users will be entering eligibility data into Benefit Manager Toolkit on its clients’ behalf, Agency/Agent shall be solely responsible for the accuracy and completeness of the eligibility data entered. Unless otherwise exempt by law, Agency/Agent shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of any eligibility data entered by Agency/Agent’s End Users. 4. Agency/Agent acknowledges that Benefit Manager Toolkit permits individuals to view and access Protected Health Information (“PHI”), as that term is defined by the Health Insurance Portability and Accountability Act (“HIPAA”). Agency/Agent therefore certifies that, when using Benefit Manager Toolkit, it and its End Users will abide by the provisions of HIPAA and all other applicable laws. As such, Agency/Agent agrees that it and its End Users shall access and use Delta Dental’s web portals for the sole purpose of performing plan administration functions on behalf of its clients. 5. Agency/Agent recognizes and agrees that Delta Dental retains sole title, right and interest in the intellectual property rights in Benefit Manager Toolkit including, but not limited to, any applicable patents, trademarks and/or copyrights. Agency/Agent understands that the license granted herein transfers neither title nor proprietary rights to Agency/Agent with respect to any web portals. As such, neither Agency/Agent nor any of its End Users shall attempt to reproduce, modify, reverse assemble, reverse compile or reverse engineer the source code of Benefit Manager Toolkit. 6. Delta Dental reserves the right to terminate this license grant at any time with or without cause. This license grant shall terminate immediately upon termination of the Agreement.

Web Portal License. ‌ 1. Delta Dental grants to Agency/Agent a limited, non-transferable, non-exclusive, non-sublicensable, temporary license Contractor the License to access and use Delta Dental’s Benefit Manager Toolkit web portal portals solely for the purpose of administering and/or viewing Member Benefits as set forth in this Contract, subject to any additional terms and conditions appearing on such web portals. Under this license grant, Contractor’s Members are permitted to access and use Member Portal, and Contractor and its clients’ officers, directors, employees, contractors and agents are permitted to access and use Benefit Manager Toolkit as necessary solely for the purposes of administering Contractor’s dental plans, provided Agency/Agent has been authorized by its clients to perform such administrationplan. 2. Agency/Agent Contractor is solely responsible for managing access to Benefit Manager Toolkitthe web portals, for securing the usernames and passwords of its, officers, directors, employees, contractors, agents and agents Members (“End Users”) who use or access Benefit Manager Toolkitsuch web portals, and for any violation of this Agreement Contract by any such End Users. Delta Dental shall not be liable for Agency/AgentContractor’s or its Contractor’s End Users’ failure to properly secure their usernames or passwords and, unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of i) Agency/AgentContractor’s, or its Contractor’s End Users’ ’, failure to properly manage access or secure usernames and passwords, ; ii) any breach of this Agreement Contract by Agency/Agent Contractor or its End Users; or (iii) any negligent or willful misuse of Delta Dental’s web portals by Agency/Agent Contractor or its End Users. 3. Agency/Agent Contractor agrees that, to the extent its End Users will be entering eligibility data into Benefit Manager Toolkit on its clients’ Contractor’s behalf, Agency/Agent Contractor shall be solely responsible for the accuracy and completeness of the eligibility data entered. Unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of any eligibility data entered by Agency/AgentContractor’s End Users. 4. Agency/Agent Contractor acknowledges that Benefit Manager Toolkit permits Delta Dental’s web portals permit individuals to view and access Protected Health Information (“PHI”), as that term is defined by the Health Insurance Portability and Accountability Act (“HIPAA”). Agency/Agent Contractor therefore certifies that, when using Benefit Manager Toolkitthe web portals, it and its End Users will abide by the provisions of HIPAA and all other applicable laws. As such, Agency/Agent Contractor agrees that it and its End Users shall access and use Delta Dental’s web portals for the sole purpose of viewing their own Benefits and/or performing plan administration functions on behalf of its clientsContractor. 5. Agency/Agent Contractor recognizes and agrees that Delta Dental retains sole title, right and interest in the intellectual property rights in Benefit Manager Toolkit of its web portals including, but not limited to, any applicable patents, trademarks and/or copyrights. Agency/Agent Contractor understands that the license granted herein transfers neither title nor proprietary rights to Agency/Agent Contractor with respect to any web portals. As such, neither Agency/Agent Contractor nor any of its End Users shall attempt to reproduce, modify, reverse assemble, reverse compile or reverse engineer the source code of Benefit Manager ToolkitDelta Dental’s web portals. 6. Delta Dental reserves the right to terminate this license grant at any time with or without cause. This license grant shall terminate immediately upon termination of the Agreementcontract.

Web Portal License. ‌ 1. Delta Dental grants to Agency/Agent a limited, non-transferable, non-exclusive, non-sublicensable, temporary license Contractor the License to access and use Delta Dental’s Benefit Manager Toolkit web portal portals solely for the purpose of administering and/or viewing Member Benefits as set forth in this Contract, subject to any additional terms and conditions appearing on such web portals. Under this license grant, Contractor’s Members are permitted to access and use Member Portal, and Contractor and its clients’ officers, directors, employees, contractors and agents are permitted to access and use Benefit Manager Toolkit as necessary solely for the purposes of administering Contractor’s dental plans, provided Agency/Agent has been authorized by its clients to perform such administrationplan. 2. Agency/Agent Contractor is solely responsible for managing access to Benefit Manager Toolkitthe web portals, for securing the usernames and passwords of its, officers, directors, employees, contractors, agents and agents Members (“End Users”) who use or access Benefit Manager Toolkitsuch web portals, and for any violation of this Agreement Contract by any such End Users. Delta Dental shall not be liable for Agency/AgentContractor’s or its Contractor’s End Users’ failure to properly secure their usernames or passwords and, unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of i) Agency/AgentContractor’s, or its Contractor’s End Users’ ’, failure to properly manage access or secure usernames and passwords, ii) any breach of this Agreement Contract by Agency/Agent Contractor or its End Users; or (iii) any negligent or willful misuse of Delta Dental’s web portals by Agency/Agent Contractor or its End Users. 3. Agency/Agent Contractor agrees that, to the extent its End Users will be entering eligibility data into Benefit Manager Toolkit on its clients’ Contractor’s behalf, Agency/Agent Contractor shall be solely responsible for the accuracy and completeness of the eligibility data entered. Unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of any eligibility data entered by Agency/AgentContractor’s End Users. 4. Agency/Agent Contractor acknowledges that Benefit Manager Toolkit permits Delta Dental’s web portals permit individuals to view and access Protected Health Information (“PHI”), as that term is defined by the Health Insurance Portability and Accountability Act (“HIPAA”). Agency/Agent Contractor therefore certifies that, when using Benefit Manager Toolkitthe web portals, it and its End Users will abide by the provisions of HIPAA and all other applicable laws. As such, Agency/Agent Contractor agrees that it and its End Users shall access and use Delta Dental’s web portals for the sole purpose of viewing their own Benefits and/or performing plan administration functions on behalf of its clientsContractor. 5. Agency/Agent Contractor recognizes and agrees that Delta Dental retains sole title, right and interest in the intellectual property rights in Benefit Manager Toolkit of its web portals including, but not limited to, any applicable patents, trademarks and/or copyrights. Agency/Agent Contractor understands that the license granted herein transfers neither title nor proprietary rights to Agency/Agent Contractor with respect to any web portals. As such, neither Agency/Agent Contractor nor any of its End Users shall attempt to reproduce, modify, reverse assemble, reverse compile or reverse engineer the source code of Benefit Manager ToolkitDelta Dental’s web portals. 6. Delta Dental reserves the right to terminate this license grant at any time with or without cause. This license grant shall terminate immediately upon termination of the AgreementContract. This Summary of Dental Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your Delta Dental plan, including information about plan exclusions and limitations. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's Maximum Approved Fee for each service and it may vary due to the Dentist's network participation.* Dentist Delta Dental Premier® Dentist Nonparticipating Dentist Diagnostic and Preventive Services – exams, cleanings, fluoride, and space maintainers 80/90/100%** 80/90/100%** 80/90/100%** Emergency Palliative Treatment – to temporarily relieve pain 80/90/100%** 80/90/100%** 80/90/100%** Sealants – to prevent decay of permanent teeth 80/90/100%** 80/90/100%** 80/90/100%** Brush Biopsy – to detect oral cancer 80/90/100%** 80/90/100%** 80/90/100%** Radiographs – X-rays 80/90/100%** 80/90/100%** 80/90/100%** Minor Restorative Services – fillings and crown repair 80/90/100%** 80/90/100%** 80/90/100%** Periodontic Services – to treat gum disease 80/90/100%** 80/90/100%** 80/90/100%** Simple Extractions – extractions of erupted teeth 80/90/100%** 80/90/100%** 80/90/100%** Other Basic Services – misc. services 80/90/100%** 80/90/100%** 80/90/100%** Relines and Repairs – to bridges, implants, and dentures 80/90/100%** 80/90/100%** 80/90/100%** Endodontic Services – root canals 50% 50% 50% Oral Surgery Services – extractions and dental surgery 50% 50% 50% Major Restorative Services – crowns 50% 50% 50% Prosthodontic Services – bridges, implants, dentures, and crowns over implants 50% 50% 50% Orthodontic Services – braces 50% 50% 50% Orthodontic Age Limit – No Age Limit Control Plan – Delta Dental of North Carolina Benefit Year – September 1 through August 31 Covered Services – * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference. ** 80% coinsurance level applies during the First Plan Year the Member is covered. If the Covered Person visits a dentist during the Plan Year, 90% coinsurance and 100% level of reimbursement will apply during the second and third Plan Year, respectively. If, during any Plan Year, the Covered Person fails to visit a dentist, the 80% level will automatically reapply during the following Plan Year, and the Covered Person must advance as if the Covered Person is a new enrollee. The explanation and sample calculation of how these services will be paid can be found in Section VI - How Payment is Made in your Certificate. ⮚ Oral exams (including evaluations by a specialist) are payable twice per benefit year. ⮚ Two prophylaxes (cleanings) and/or up to four periodontal maintenance are payable per benefit year, not to exceed a total of four procedures in any benefit year. ⮚ People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. ⮚ Fluoride treatments are payable once per benefit year for people age 18 and under. ⮚ Space maintainers are payable once per area per lifetime for people age 18 and under. ⮚ Bitewing X-rays are payable twice per Benefit Year for people age 18 and under and once per benefit year for people age 19 and older. Full mouth X-rays (which include bitewing X-rays) or a panorex are payable once in any five-year period. ⮚ Sealants are payable once per tooth per lifetime for first and second permanent molars and bicuspids for people age 12 and under. The surface must be free from decay and restorations. ⮚ Crowns, inlays, onlays, gold foil restorations, and substructures are payable once per tooth in any ten-year period. ⮚ Composite resin (white) restorations are payable on posterior teeth. ⮚ Inlays (any material) are Covered Services. ⮚ Gold foils are Covered Services. ⮚ Porcelain and resin facings on crowns are payable on posterior teeth. ⮚ Pulp caps are a Covered Service. ⮚ Vestibuloplasty is a Covered Service. ⮚ Full and partial dentures are payable once in any 10-year period. ⮚ Bridges are payable once in any 10-year period. Precision attachments are payable. ⮚ Implants are payable once per tooth in any 10-year period. Implant related services are Covered Services. ⮚ Crowns over implants are payable once per tooth in any 10-year period. Services related to crowns over implants are Covered Services. ⮚ Occlusal guards are not Covered Services. Antibiotic drug injections are Covered Services. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet. Maximum Payment – $1,250 per person total per Benefit Year on all services, except cephalometric films, photos, diagnostic casts and orthodontic services. $1,000 per person total per lifetime on cephalometric films, photos, diagnostic casts, and orthodontic services. Payment for Orthodontic Service – When orthodontic treatment begins, your Dentist will submit a payment plan to Delta Dental based upon your projected course of treatment. In accordance with the agreed upon payment plan, Delta Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. Delta Dental will make additional payments as follows: Delta Dental will pay 50% of the per monthly fee charged by your Dentist based upon the agreed upon payment plan provided by your Dentist to Delta Dental. Deductible – $50 Deductible per person total per Benefit Year limited to a maximum Deductible of $150 per family per Benefit Year. The Deductible does not apply to diagnostic and preventive services, emergency palliative treatment, brush biopsy, X-rays, sealants, minor restorative, periodontics, relines and repairs, simple extractions, other basic services, pulp capping, and orthodontic services. Waiting Period – Employees who are eligible for dental benefits are covered on the first of the month following the date of hire. Eligible People – All full-time employees working at least 30 hours per week who choose the High option 10 month dental plan (0002) and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees (0099). The Subscriber pays the full cost of this plan. Also eligible are your Spouse and your Children to the end of the month in which they turn 26, including your Children who are married, who no longer live with you, who are not your Dependents for Federal income tax purposes, and/or who are not permanently disabled. Enrollees and their Dependents choosing either dental plan are required to remain enrolled for a period of 12 months. Should an Enrollee or Dependent choose to drop dental coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. Dependents may enroll if the Enrollee is enrolled (except under COBRA) and must be enrolled in the same plan as the Enrollee. An election may be revoked or changed at any time if such change is the result of a qualifying event as defined under Internal Revenue Code Section 125. If you and your Spouse are both eligible to enroll in This Plan as Enrollees, you may be enrolled together on one application or separately on individual applications, but not both. Your Dependent Children may only be enrolled on one application. Delta Dental will not coordinate Benefits between your coverage and your Spouse's coverage if you and your Spouse are both covered as Enrollees under This Plan. Benefits will cease on the last day of the month following termination. Welcome! Your dental program is administered by Delta Dental of North Carolina, a North Carolina nonprofit health service plan corporation. Delta Dental of North Carolina is the state’s dental benefits specialist. Good oral health is a vital part of good general health, and your Delta Dental program is designed to promote regular dental visits. We encourage you to take advantage of this program by calling your Dentist today for an appointment. This Certificate, along with your Summary of Dental Plan Benefits, describes the specific benefits of your Delta Dental program and how to use them. If you have any questions about this program, please call our Customer Service department at (000) 000-0000 or access our website at xxx.xxxxxxxxxxxxx.xxx. You can easily verify your own benefit, Claims and eligibility information online 24 hours a day, seven days a week by visiting xxx.xxxxxxxxxxxxx.xxx and selecting the link for our Consumer Toolkit. The Consumer Toolkit will also allow you to print Claim forms and ID cards, select paperless Explanation of Benefits statements (EOBs), search our Dentist directories, and read oral health tips. We look forward to serving you! I. Delta Dental PPO Certificate 2 II. Definitions 2 III. Enrolling in this Plan 4 IV. Selecting a Dentist 4 V. Accessing Your Benefits 4 VI. How Payment is Made 5 VII. Benefit Categories 5 VIII. Exclusions and Limitations 5 IX. Coordination of Benefits 10 X. Reconsideration and Claims Appeal Procedure 11 XI. Termination of Coverage 12 XII. Continuation of Coverage 12

Web Portal License. ‌ 1. Delta Dental grants to Agency/Agent a limited, non-transferable, non-exclusive, non-sublicensable, temporary license Contractor the License to access and use Delta Dental’s Benefit Manager Toolkit web portal portals solely for the purpose of administering and/or viewing Member Benefits as set forth in this Contract, subject to any additional terms and conditions appearing on such web portals. Under this license grant, Contractor’s Members are permitted to access and use Member Portal, and Contractor and its clients’ officers, directors, employees, contractors and agents are permitted to access and use Benefit Manager Toolkit as necessary solely for the purposes of administering Contractor’s dental plans, provided Agency/Agent has been authorized by its clients to perform such administrationplan. 2. Agency/Agent Contractor is solely responsible for managing access to Benefit Manager Toolkitthe web portals, for securing the usernames and passwords of its, officers, directors, employees, contractors, agents and agents Members (“End Users”) who use or access Benefit Manager Toolkitsuch web portals, and for any violation of this Agreement Contract by any such End Users. Delta Dental shall not be liable for Agency/AgentContractor’s or its Contractor’s End Users’ failure to properly secure their usernames or passwords and, unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of i) Agency/AgentContractor’s, or its Contractor’s End Users’ ’, failure to properly manage access or secure usernames and passwords, ii) any breach of this Agreement Contract by Agency/Agent Contractor or its End Users; or (iii) any negligent or willful misuse of Delta Dental’s web portals by Agency/Agent Contractor or its End Users. 3. Agency/Agent Contractor agrees that, to the extent its End Users will be entering eligibility data into Benefit Manager Toolkit on its clients’ Contractor’s behalf, Agency/Agent Contractor shall be solely responsible for the accuracy and completeness of the eligibility data entered. Unless otherwise exempt by law, Agency/Agent Contractor shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of any eligibility data entered by Agency/AgentContractor’s End Users. 4. Agency/Agent Contractor acknowledges that Benefit Manager Toolkit permits Delta Dental’s web portals permit individuals to view and access Protected Health Information (“PHI”), as that term is defined by the Health Insurance Portability and Accountability Act (“HIPAA”). Agency/Agent Contractor therefore certifies that, when using Benefit Manager Toolkitthe web portals, it and its End Users will abide by the provisions of HIPAA and all other applicable laws. As such, Agency/Agent Contractor agrees that it and its End Users shall access and use Delta Dental’s web portals for the sole purpose of viewing their own Benefits and/or performing plan administration functions on behalf of its clientsContractor. 5. Agency/Agent Contractor recognizes and agrees that Delta Dental retains sole title, right and interest in the intellectual property rights in Benefit Manager Toolkit of its web portals including, but not limited to, any applicable patents, trademarks and/or copyrights. Agency/Agent Contractor understands that the license granted herein transfers neither title nor proprietary rights to Agency/Agent Contractor with respect to any web portals. As such, neither Agency/Agent Contractor nor any of its End Users shall attempt to reproduce, modify, reverse assemble, reverse compile or reverse engineer the source code of Benefit Manager ToolkitDelta Dental’s web portals. 6. Delta Dental reserves the right to terminate this license grant at any time with or without cause. This license grant shall terminate immediately upon termination of the AgreementContract. This Summary of Dental Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your Delta Dental plan, including information about plan exclusions and limitations. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's Maximum Approved Fee for each service and it may vary due to the Dentist's network participation.* Dentist Delta Dental Premier® Dentist Nonparticipating Dentist Diagnostic and Preventive Services – exams, cleanings, fluoride, and space maintainers 80/90/100%** 80/90/100%** 0% Emergency Palliative Treatment – to temporarily relieve pain 80/90/100%** 80/90/100%** 0% Sealants – to prevent decay of permanent teeth 80/90/100%** 80/90/100%** 0% Brush Biopsy – to detect oral cancer 80/90/100%** 80/90/100%** 0% Radiographs – X-rays 80/90/100%** 80/90/100%** 0% Minor Restorative Services – fillings and crown repair 80/90/100%** 80/90/100%** 0% Periodontic Services – to treat gum disease 80/90/100%** 80/90/100%** 0% Simple Extractions – extractions of erupted teeth 80/90/100%** 80/90/100%** 0% Other Basic Services – misc. services 80/90/100%** 80/90/100%** 0% Relines and Repairs – to bridges, implants, and dentures 80/90/100%** 80/90/100%** 0% Endodontic Services – root canals 50% 50% 0% Oral Surgery Services – extractions and dental surgery 50% 50% 0% Major Restorative Services – crowns 50% 50% 0% Prosthodontic Services – bridges, implants, dentures, and crowns over implants 50% 50% 0% Orthodontic Services – braces 50% 50% 0% Orthodontic Age Limit – No Age Limit Control Plan – Delta Dental of North Carolina Benefit Year – September 1 through August 31 Covered Services – * When you receive services from a Nonparticipating Dentist, the percentages in this column indicate the portion of Delta Dental's Nonparticipating Dentist Fee that will be paid for those services. This Nonparticipating Dentist Fee may be less than what your dentist charges, which means that you will be responsible for the difference. ** 80% coinsurance level applies during the First Plan Year the Member is covered. If the Covered Person visits a participating dentist during the Plan Year, 90% coinsurance and 100% level of reimbursement will apply during the second and third Plan Year, respectively. If, during any Plan Year, the Covered Person fails to visit a dentist, the 80% level will automatically reapply during the following Plan Year, and the Covered Person must advance as if the Covered Person is a new enrollee. There is no coverage at a Nonparticipating Dentist. The explanation and sample calculation of how these services will be paid can be found in Section VI - How Payment is Made in your Certificate. ⮚ Oral exams (including evaluations by a specialist) are payable twice per benefit year. ⮚ Two prophylaxes (cleanings) and/or up to four periodontal maintenance are payable per benefit year, not to exceed a total of four procedures in any benefit year. ⮚ People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment. The patient should talk with his or her dentist about treatment. ⮚ Fluoride treatments are payable once per benefit year for people age 18 and under. ⮚ Space maintainers are payable once per area per lifetime for people age 18 and under. ⮚ Bitewing X-rays are payable twice per Benefit Year for people age 18 and under and once per benefit year for people age 19 and older. Full mouth X-rays (which include bitewing X-rays) or a panorex are payable once in any five-year period. ⮚ Sealants are payable once per tooth per lifetime for first and second permanent molars and bicuspids for people age 12 and under. The surface must be free from decay and restorations. ⮚ Crowns, inlays, onlays, gold foil restorations, and substructures are payable once per tooth in any ten-year period. ⮚ Composite resin (white) restorations are payable on posterior teeth. ⮚ Inlays (any material) are Covered Services. ⮚ Gold foils are Covered Services. ⮚ Porcelain and resin facings on crowns are payable on posterior teeth. ⮚ Pulp caps are a Covered Service. ⮚ Vestibuloplasty is a Covered Service. ⮚ Full and partial dentures are payable once in any 10-year period. ⮚ Bridges are payable once in any 10-year period. Precision attachments are payable. ⮚ Implants are payable once per tooth in any 10-year period. Implant related services are Covered Services. ⮚ Crowns over implants are payable once per tooth in any 10-year period. Services related to crowns over implants are Covered Services. ⮚ Occlusal guards are not Covered Services. Antibiotic drug injections are Covered Services. Having Delta Dental coverage makes it easy for you to get dental care almost everywhere in the world! You can now receive expert dental care when you are outside of the United States through our Passport Dental program. This program gives you access to a worldwide network of dentists and dental clinics. English-speaking operators are available around the clock to answer questions and help you schedule care. For more information, check our Web site or contact your benefits representative to get a copy of our Passport Dental information sheet. Maximum Payment – Delta Dental PPO™ Dentist or Delta Dental Premier® Dentist - $1,250 per person total per Benefit Year on all services, except cephalometric films, photos, diagnostic casts and orthodontic services. $1,000 per person total per lifetime on cephalometric films, photos, diagnostic casts, and orthodontic services. Nonparticipating Dentist - None. These are not separate maximums by type of dentist. Payment for Orthodontic Service – When orthodontic treatment begins, your Dentist will submit a payment plan to Delta Dental based upon your projected course of treatment. In accordance with the agreed upon payment plan, Delta Dental will make an initial payment to you or your Participating Dentist equal to Delta Dental's stated Copayment on 30% of the Maximum Payment for Orthodontic Services as set forth in this Summary of Dental Plan Benefits. Delta Dental will make additional payments as follows: Delta Dental PPO™ Dentist - Delta Dental will pay 50% of the per monthly fee charged by your Dentist based upon the agreed upon payment plan provided by your Dentist to Delta Dental. Delta Dental Premier® Dentist - Delta Dental will pay 50% of the per monthly fee charged by your Dentist based upon the agreed upon payment plan provided by your Dentist to Delta Dental. Nonparticipating Dentist - Orthodontic services are not a covered benefit. Deductible – Delta Dental PPO™ Dentist or Delta Dental Premier® Dentist - $50 Deductible per person total per Benefit Year limited to a maximum Deductible of $150 per family per Benefit Year. The Deductible does not apply to diagnostic and preventive services, emergency palliative treatment, brush biopsy, X-rays, sealants, minor restorative, periodontics, relines and repairs, simple extractions, other basic services, pulp capping, and orthodontic services. Nonparticipating Dentist - None. Waiting Period – Employees who are eligible for dental benefits are covered on the first of the month following the date of hire. Eligible People – All full-time employees working at least 30 hours per week who choose the Low option 10 month dental plan (1002) and COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) enrollees (1099). The Subscriber pays the full cost of this plan. Also eligible are your Spouse and your Children to the end of the month in which they turn 26, including your Children who are married, who no longer live with you, who are not your Dependents for Federal income tax purposes, and/or who are not permanently disabled. Enrollees and their Dependents choosing either dental plan are required to remain enrolled for a period of 12 months. Should an Enrollee or Dependent choose to drop dental coverage after that time, he or she may not re-enroll prior to the date on which 12 months have elapsed. Dependents may enroll if the Enrollee is enrolled (except under COBRA) and must be enrolled in the same plan as the Enrollee. An election may be revoked or changed at any time if such change is the result of a qualifying event as defined under Internal Revenue Code Section 125. If you and your Spouse are both eligible to enroll in This Plan as Enrollees, you may be enrolled together on one application or separately on individual applications, but not both. Your Dependent Children may only be enrolled on one application. Delta Dental will not coordinate Benefits between your coverage and your Spouse's coverage if you and your Spouse are both covered as Enrollees under This Plan. Benefits will cease on the last day of the month following termination. Welcome! Your dental program is administered by Delta Dental of North Carolina, a North Carolina nonprofit health service plan corporation. Delta Dental of North Carolina is the state’s dental benefits specialist. Good oral health is a vital part of good general health, and your Delta Dental program is designed to promote regular dental visits. We encourage you to take advantage of this program by calling your Dentist today for an appointment. This Certificate, along with your Summary of Dental Plan Benefits, describes the specific benefits of your Delta Dental program and how to use them. If you have any questions about this program, please call our Customer Service department at (000) 000-0000 or access our website at xxx.xxxxxxxxxxxxx.xxx. You can easily verify your own benefit, Claims and eligibility information online 24 hours a day, seven days a week by visiting xxx.xxxxxxxxxxxxx.xxx and selecting the link for our Consumer Toolkit. The Consumer Toolkit will also allow you to print Claim forms and ID cards, select paperless Explanation of Benefits statements (EOBs), search our Dentist directories, and read oral health tips. We look forward to serving you! I. Delta Dental PPO Certificate 2 II. Definitions 2 III. Enrolling in this Plan 4 IV. Selecting a Dentist 4 V. Accessing Your Benefits 4 VI. How Payment is Made 5 VII. Benefit Categories 5 VIII. Exclusions and Limitations 5 IX. Coordination of Benefits 10 X. Reconsideration and Claims Appeal Procedure 11 XI. Termination of Coverage 12 XII. Continuation of Coverage 12

Web Portal License. ‌ 1. Delta Dental grants to Agency/Agent a limited, non-transferable, non-exclusive, non-sublicensable, temporary license to access and use Delta Dental’s Benefit Manager Toolkit web portal solely for the purpose of administering its clients’ dental plans, provided Agency/Agent has been authorized by its clients to perform such administration. 2. Agency/Agent is solely responsible for managing access to Benefit Manager Toolkit, for securing the usernames and passwords of its, officers, directors, employees, contractors, and agents (“End Users”) who use or access Benefit Manager Toolkit, and for any violation of this Agreement by any such End Users. Delta Dental shall not be liable for Agency/Agent’s or its End Users’ failure to properly secure their usernames or passwords and, unless otherwise exempt by law, Agency/Agent shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of i) Agency/Agent’s, or its End Users’ failure to properly manage access or secure usernames and passwords, ii) any breach of this Agreement by Agency/Agent or its End Users; or (iii) any negligent or willful misuse of Delta Dental’s web portals by Agency/Agent or its End Users. 3. Agency/Agent agrees that, to the extent its End Users will be entering eligibility data into Benefit Manager Toolkit on its clients’ behalf, Agency/Agent shall be solely responsible for the accuracy and completeness of the eligibility data entered. Unless otherwise exempt by law, Agency/Agent shall indemnify and hold harmless Delta Dental its affiliates, members, officers, employees and agents from and against any and all losses, claims, damages, liabilities, costs, and expenses (including reasonable attorneys’ fees and expenses related to the defense of any claims) resulting from or arising out of any eligibility data entered by Agency/Agent’s End Users. 4. Agency/Agent acknowledges that Benefit Manager Toolkit permits individuals to view and access Protected Health Information (“PHI”), as that term is defined by the Health Insurance Portability and Accountability Act (“HIPAA”). Agency/Agent therefore certifies that, when using Benefit Manager Toolkit, it and its End Users will abide by the provisions of HIPAA and all other applicable laws. As such, Agency/Agent agrees that it and its End Users shall access and use Delta Dental’s web portals for the sole purpose of performing plan administration functions on behalf of its clients. 5. Agency/Agent recognizes and agrees that Delta Dental retains sole title, right and interest in the intellectual property rights in Benefit Manager Toolkit including, but not limited to, any applicable patents, trademarks and/or copyrights. Agency/Agent understands that the license granted herein transfers neither title nor proprietary rights to Agency/Agent with respect to any web portals. As such, neither Agency/Agent nor any of its End Users shall attempt to reproduce, modify, reverse assemble, reverse compile or reverse engineer the source code of Benefit Manager Toolkit.title 6. Delta Dental reserves the right to terminate this license grant at any time with or without cause. This license grant shall terminate immediately upon termination of the Agreement.