Benefit Information:

Dental: Small Group

Please Note: For Spanish benefit information, please contact your CoPower Group Service Representative.

Delta Dental Choice Premier

1,000 Plans

Choice Premier 1,000 w/out Ortho (5-99) Evidence of Coverage05/17/2012

Choice Premier 1,000 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice Premier 1,000 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice Premier 1,000 w/ Ortho (10-99) Plan Highlights05/18/2012

1,500 Plans

Choice Premier 1,500 w/out Ortho (5-99) Evidence of Coverage05/18/2012

Choice Premier 1,500 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice Premier 1,500 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice Premier 1,500 w/ Ortho (10-99) Plan Highlights05/18/2012

2,000 Plans

Choice Premier 2,000 w/out Ortho (5-99) Evidence of Coverage05/18/2012

Choice Premier 2,000 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice Premier 2,000 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice Premier 2,000 w/ Ortho (10-99) Plan Highlights05/18/2012

Delta Dental Choice PPO

1,000 Plans

Choice PPO 1,000 w/out Ortho (5-99) Evidence of Coverage05/18/2012

Choice PPO 1,000 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice PPO 1,000 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice PPO 1,000 w/ Ortho (10-99) Plan Highlights05/18/2012

1,500 Plans

Choice PPO 1,500 w/out Ortho (5-99) Evidence of Coverage05/18/2012

Choice PPO 1,500 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice PPO 1,500 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice PPO 1,500 w/ Ortho (10-99) Plan Highlights05/18/2012

2,000 Plans

Choice PPO 2,000 w/out Ortho (5-99) Evidence of Coverage05/18/2012

Choice PPO 2,000 w/out Ortho (5-99) Plan Highlights05/18/2012

Choice PPO 2,000 w/ Ortho (10-99) Evidence of Coverage05/18/2012

Choice PPO 2,000 w/ Ortho (10-99) Plan Highlights05/18/2012

Delta Dental Choice HMO

CoPower DeltaCare 10B

Choice HMO CoPower DeltaCare 10B Summary05/21/2012

Delta Dental Classic PPO A

1,000 Plans

Classic PPO A 1,000 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,000 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 1,000 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,000 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO A 1,000 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,000 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 1,000 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,000 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

1,500 Plans

Classic PPO A 1,500 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,500 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 1,500 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,500 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO A 1,500 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,500 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 1,500 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 1,500 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

2,000 Plans

Classic PPO A 2,000 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 2,000 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 2,000 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 2,000 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO A 2,000 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO A 2,000 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO A 2,000 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO A 2,000 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

Delta Dental Classic PPO B-12

1,000 Plans

Classic PPO B-12 1,000 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,000 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,000 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,000 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,000 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,000 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,000 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,000 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

1,500 Plans

Classic PPO B-12 1,500 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,500 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,500 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,500 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,500 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,500 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 1,500 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 1,500 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

2,000 Plans

Classic PPO B-12 2,000 w/out Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 2,000 w/out Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 2,000 w/out Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 2,000 w/out Ortho & w/ DPMW Plan Highlights05/18/2012

Classic PPO B-12 2,000 w/ Ortho & w/out DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 2,000 w/ Ortho & w/out DPMW Plan Highlights05/18/2012

Classic PPO B-12 2,000 w/ Ortho & w/ DPMW Evidence of Coverage05/18/2012

Classic PPO B-12 2,000 w/ Ortho & w/ DPMW Plan Highlights05/18/2012

Delta Dental Classic PPO B (Plan No Longer Sold)

1,000 Plans

Classic PPO B 1,000 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,000 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 1,000 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,000 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO B 1,000 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,000 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 1,000 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,000 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

1,500 Plans

Classic PPO B 1,500 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,500 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 1,500 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,500 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO B 1,500 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,500 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 1,500 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 1,500 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

2,000 Plans

Classic PPO B 2,000 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 2,000 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 2,000 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 2,000 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO B 2,000 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO B 2,000 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO B 2,000 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO B 2,000 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

Delta Dental Classic PPO C

1,000 Plans

Classic PPO C 1,000 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,000 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 1,000 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,000 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO C 1,000 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,000 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 1,000 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,000 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

1,500 Plans

Classic PPO C 1,500 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,500 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 1,500 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,500 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO C 1,500 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,500 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 1,500 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 1,500 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

2,000 Plans

Classic PPO C 2,000 w/out Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 2,000 w/out Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 2,000 w/out Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 2,000 w/out Ortho & w/ DPMW Plan Highlights05/21/2012

Classic PPO C 2,000 w/ Ortho & w/out DPMW Evidence of Coverage05/21/2012

Classic PPO C 2,000 w/ Ortho & w/out DPMW Plan Highlights05/21/2012

Classic PPO C 2,000 w/ Ortho & w/ DPMW Evidence of Coverage05/21/2012

Classic PPO C 2,000 w/ Ortho & w/ DPMW Plan Highlights05/21/2012

DeltaCare USA

Plan 10A – Plan 15B

DeltaCare USA Plan 10A05/21/2012

DeltaCare USA Plan 10A (Spanish)05/21/2012

DeltaCare USA Plan 11A05/21/2012

DeltaCare USA Plan 11A (Spanish)05/21/2012

DeltaCare USA Plan 12A05/21/2012

DeltaCare USA Plan 12A (Spanish)05/21/2012

DeltaCare USA Plan 15B05/21/2012

DeltaCare USA Plan 15B (Spanish)05/21/2012