Dental Coverage CADENCE EDUCATION, INC.

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1 key* E V17.0 CADENCE EDUCATION, INC. ALL ELIGIBLE EXECUTIVES NOT LOCATED IN TEXAS Dental Coverage Here is your new coverage. Make sure you are aware of the deadline date for your coverage elections. If you miss the deadline, the coverage may be delayed or you may not be eligible for enrollment this year. PLAN HIGHLIGHTS: l Dental Your Guardian plan number: Learn more about Guardian at

2 We re ready to get working for you If you re like most employees, finding enough time in the day to accomplish your lengthy to-do list can often be no easy task. As your Guardian coverage begins, we want you to know that we re here for you every step of the way and are committed to providing you with the resources to obtain fast, accurate answers to your benefits-related questions. One way in which we do this is through our online member resource, Guardian Anytime sm, which allows you to manage your benefits when it works best for you day or night. Plus, it offers helpful resources to ensure you get access to the quality care you need. We encourage you to take a couple minutes to check out and register for Guardian Anytime sm at We promise it will be time well spent. Welcome to Guardian!

3 Prepared for CADENCE EDUCATION, INC. Guardian Group Plan Number UNDERSTAND YOUR COVERAGE: n n n Review your benefits Complete your enrollment form, if applicable Sign and return form to your plan administrator Plan Details This booklet explains your basic plan options. Your detailed certificate of coverage will be provided to you after you enroll. Welcome Dear CADENCE EDUCATION, INC. Employee, Were pleased to tell you that Guardian will be our dental coverage provider this year. We have chosen Guardian because of its competitive rates, excellent service reputation, and reliable dental claims payment. We have worked hard to negotiate group rates that will be affordable for all employees. All coverage is paid through payroll deduction. CADENCE EDUCATION, INC. Find a network dentist in minutes Use our Provider Online Search at Optional pre-treatment review If you expect your treatment will cost $300 or more, you can find out how much your plan will pay before treatment starts. Understand your benefits Please find a glossary for insurance terms included. Enrollment Kit , 0001, EN 1

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5 Prepared for CADENCE EDUCATION, INC. Guardian Group Plan Number Why Dental Insurance? Good oral hygiene is important, not only for looks, but for general health as well. A routine dental examination can detect symptoms of more than 125 diseases, including heart disease, diabetes, anemia, stomach ulcers, osteoporosis and kidney disease. Regular check ups and cleanings can save you the pain and expense of future problems. Dental insurance will keep these visits affordable and is a cost-effective way to minimize health care costs for you and your family. The American Dental Hygienists Association estimates that for every $1 spent on prevention or oral health care, as much as $8 to $50 is saved on future emergency and restorative procedures. Using your dental insurance for regular dental check ups can improve your health by helping you: 1) Prevent Oral Cancer: According to The Oral Cancer Foundation, someone dies from oral cancer every hour of every day in the United States alone. When you have your dental cleaning, your dentist is also screening you for oral cancer, which is highly curable if diagnosed early. 2) Prevent Gum Disease: Gum disease is an infection in the gum tissues and bone that keep your teeth in place and is one of the leading causes of adult tooth loss. If diagnosed early, it can be treated and reversed. If treatment is not received, a more serious and advanced stage of gum disease may follow. Regular dental cleanings and check ups, flossing daily and brushing twice a day are key factors in preventing gum disease. 3) Help Maintain Good Physical Health: Recent studies have linked heart attacks and strokes to gum disease, resulting from poor oral hygiene. A dental cleaning every six months helps to keep your teeth and gums healthy and could possibly reduce your risk of heart disease and strokes, as well as many other serious conditions. 4) Keep Your Teeth: Since gum disease is one of the leading causes of tooth loss in adults, regular dental check ups and cleanings, brushing and flossing are vital to keeping as many teeth as you can. Keeping your teeth means better chewing function and ultimately, better health. 5) Prevent the Need for Advanced Treatment: Your dentist and hygienist will be able to detect any early signs of problems with your teeth or gums that can be easily treatable. If these problems go untreated, root canals, gum surgery and removal of teeth could become the only treatment options available. 6) Have a Bright and White Smile: Your dental hygienist can remove most tobacco, coffee and tea stains. During your cleaning, your hygienist will also polish your teeth to a beautiful shine. 7) Protect your childrens health: Tooth decay is the most common chronic childhood disease, five times more common than asthma and results in a loss of 51 million school hours each year. Regular check ups can help prevent tooth decay in your children. Sources: American Academy of Pediatrics Enrollment Kit , 0001, EN 3

6 Dental Plans With your PPO plan, you can visit any dentist; but you pay less out-of-pocket when you choose a PPO dentist. Out-of-network benefits are limited to our PPO fee schedule. Your Dental Plan Network PPO DentalGuard Preferred Calendar year deductible In-Network Out-Network Individual $50 $50 Family limit 3 per family Waived for Preventive Preventive Charges covered for you (co-insurance) In-Network Out-Network Preventive Care 100% 100% Basic Care 80% 80% Major Care 50% 50% Orthodontia Not Covered Annual Maximum Benefit $1500 $1500 Maximum Rollover Yes Rollover Threshold $700 Rollover Amount $350 Rollover In-network Amount $500 Rollover Account Limit $1250 Lifetime Orthodontia Maximum Dependent Age Limits 26 Not Applicable YOUR GUARDIAN PLAN OFFERS: No charge for preventive care (subject to plan limits) Coverage of ViziLite Plus early cancer detection screening exams Maximum rollover If a member submits at least one claim and stays under the claims threshold, a part of the unused maximum will be rolled over for use in future years. Great selection of dentists convenient to you - yours is likely in our network! Reliable claims payment four days on average Find out if your dentist is in Guardians network at Let Guardian put its 30-plus years of dental benefits experience to work for you and your family. Benefit information illustrated within this material reflects the plan covered by Guardian as of 02/16/2016 4

7 CATEGORY PLAN DETAILS PPO Plan pays (on average) In-network Out-of-network Preventive Care Cleaning (prophylaxis) 100% 100% Frequency: Once Every 6 Months Fluoride Treatments 100% 100% Limits: Under Age 14 Oral Exams 100% 100% Sealants (per tooth) 100% 100% X-rays 100% 100% Basic Care Anesthesia* 80% 80% Fillings 80% 80% Perio Surgery 80% 80% Periodontal Maintenance 80% 80% Frequency: Once Every 6 Months (Standard) Repair & Maintenance of Crowns, Bridges & Dentures 80% 80% Root Canal 80% 80% Scaling & Root Planing (per quadrant) 80% 80% Simple Extractions 80% 80% Surgical Extractions 80% 80% Major Care Bridges and Dentures 50% 50% Dental Implants 50% 50% Inlays, Onlays, Veneers** 50% 50% Single Crowns 50% 50% This is only a partial list of dental services. Your certificate of benefits will show exactly what is covered and excluded. **For PPO and or Indemnity members, Crowns, Inlays, Onlays and Labial Veneers are covered only when needed because of decay or injury or other pathology when the tooth cannot be restored with amalgam or composite filing material. When Orthodontia coverage is for "Child(ren)" only, the orthodontic appliance must be placed prior to the age limit set by your plan; If full-time status is required by your in order to remain insured after a certain age; then orthodontic maintenance may continue as long as full-time student status is maintained. If Orthodontia coverage is for "Adults and Child(ren)" this limitation does not apply. The total number of cleanings and periodontal maintenance procedures are combined in a 12 month period.*general Anesthesia - restrictions apply. For PPO and or Indemnity members, Fillingsrestrictions may apply to composite fillings. Please note: The plan details listed here are some of the most common services related to dental coverage. The coinsurance percentages for the PPO plan options correspond to the coverage categories of Preventive, Basic, Major and Orthodontia listed in the table above. Your cleanings are covered even after your annual maximum amount is reached. This handout is for illustrative purposes only and is an approximation. If any discrepancies between this handout and your paycheck stub exist, your paycheck stub prevails. EXCLUSIONS AND LIMITATIONS n Important Information about Guardians DentalGuard Indemnity and DentalGuard Preferred PPO plans: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments (unless they are expressly provided for), any treatments to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic, and prosthodontic services. The services, exclusions and limitations listed above do not n constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract # GP-1-DG2000 et al. For PPO and or Indemnity Special Limitation: Teeth lost or missing before a covered person becomes insured by this plan. A covered person may have one or more congenitally missing teeth or have lost one or more teeth before he became insured by this plan. We wont pay for a prosthetic device which replaces such teeth unless the device also replaces one or more natural teeth lost or extracted after the covered person became insured by this plan. R3 DG2000 5

8 UNDERSTANDING YOUR BENEFITSDENTAL Basic care Co-insurance Claims Payment Basis Deductible Family limit In-network charges Major care Out-of-network charges Plan year PPO (Preferred Provider Organization) Moderately complex dental services. Most plans consider fillings and extractions to be basic care. The portion of the covered charge paid by Guardian. Value In-Network: You receive regular contracted savings, and no balance billing. Out-of-Network: Charges will be paid for only up to the maximum fee level established with our contracted network dentists; any amount that is charged over the fee schedule is the responsibility of the patient. The amount of charges you and your family must pay each plan year before the plan pays you any benefits. Maximum number of deductibles your family must pay in each plan year before this plan starts paying benefits for all covered family members for the rest of the plan year. Charges for services provided by dentists who are a member of your plan's network. More complex dental services. Most plans consider crowns and dentures to be major care. Charges for services provided by dentists who are not members of your plan's network. The 12 month period used to apply this plan's deductible and annual maximum. Your plan's plan year is the calendar year. Plan that lets you visit any dentist, but usually provides better benefits for the services of PPO network dentists. PPO dentists have agreed to accept discounted fees as payment in full. Pre-determination Review Guardian will gladly assist you and your dentist by determining what benefits could be payable for services and procedures over $300. Have your dentist fax your treatment plan to Guardian, note that it is a pre-determination review and we will let your dentist know what benefits would be payable. This includes orthodontic treatment if your plan includes it. Pre-determination applies to PPO and Indemnity plans only. Preventive care Most routine dental services. Most plans consider checkups and cleanings to be preventive care. 6

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11 Dental Maximum Rollover Save Your Unused Claims Dollars For When You Need Them Most Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you reach your Plan Annual Maximum in future years, you can use money from your MRA. To qualify for an MRA, you must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year. Your MRA may not exceed the MRA limit. You can view your annual MRA statement detailing your account and those of your dependents on Please note that actual maximum limitations and thresholds vary by plan. Your plan may vary from the one used below as an example to illustrate how the Maximum Rollover functions. Plan Annual Maximum* Threshold Maximum Rollover Amount In-Network Only Rollover Amount Maximum Rollover Account Limit $1500 $700 $350 $500 $1250 Maximum claims reimbursement Claims amount that determines rollover eligibility Additional dollars added to Plan Annual Maximum for future years Additional dollars added to Plan Annual Maximum for future years if only innetwork providers were used during the benefit year * If a plan has a different annual maximum for PPO benefits vs. non-ppo benefits, ($1500 PPO/$1000 non-ppo for example) the non-ppo maximum determines the Maximum Rollover plan. Here s how the benefits work: YEAR ONE: Jane starts with a $1,500 Plan Annual Maximum. She submits $150 in dental claims. Since she did not reach the $700 Threshold, she receives a $350 rollover that will be applied to Year Two. YEAR TWO: Jane now has an increased Plan Annual Maximum of $1,850. This year, she submits $50 in claims and receives an additional $350 rollover added to her Plan Annual Maximum. YEAR THREE: Jane now has an increased Plan Annual Maximum of $2,200. This year, she submits $2,100 in claims. All claims are paid due to the amount accumulated in her Maximum Rollover Account. YEAR FOUR: Jane s Plan Annual Maximum is $1,600 ($1,500 Plan Annual Maximum + $100 remaining in her Maximum Rollover Account). $2,400 $2,200 $2,000 $1,800 $1,600 $1,400 $1,200 $1,000 $800 For Overview of your Dental Benefits, please see About Your Benefit Section of this Enrollment Booklet. + $350 Plan Annual Maximum plus Maximum Rollover cannot exceed $2,750 in total YEAR ONE YEAR TWO YEAR THREE YEAR FOUR Annual Max + $350 - $600 $1500 $1500 $1500 $1500 Rollover Balance NOTES: You and your insured dependents maintain separate MRAs based on your own claim activity. Each MRA may not exceed the MRA limit. Cases on either a calendar year or policy year accumulation basis qualify for the Maximum Rollover feature. For calendar year cases with an effective date in October, November or December, the Maximum Rollover feature starts as of the first full benefit year. For example, if a plan starts in November of 2013, the claim activity in 2014 will be used and applied to MRAs for use in Under either benefit year set up (calendar year or policy year), Maximum Rollover for new entrants joining with 3 months or less remaining in the benefit year, will not begin until the start of the next full benefit year. Maximum Rollover is deferred for members who have coverage of Major services deferred. For these members, Maximum Rollover starts when coverage of Major services starts, or the start of the next benefit year if 3 months or less remain until the next benefit year. (Actual eligibility timeframe may vary. See your Plan Details for the most accurate information.) Guardian's Dental Insurance is underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. Policy Form #GP-1-DG2000, et al. 9

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13 Finding a dentist is easy Go online it just takes minutes! The best way to save money through your dental plan is by seeing a dentist in your plan s network. Guardian s Find a Provider site makes it easy for you to search for a dentist that meets your needs. Guardian s Find a Provider site is available to you 24 hours a day, 7 days a week. Customize your search by specialty, languages spoken and more Get side-by-side comparisons of dentists information (ie. office status, distance) Create a quick-list of favorite dentists for easy reference online Get maps and directions to a dentist s office location View your results online or have them faxed or ed to you Save your search criteria for easy access when you revisit the site Create a customized directory of dentists Nominate a dentist to be included in a network And much more! Just go to and click on Find a Provider. You can also find a dentist on the go from your smart phone simply download our app. 11

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15 The Guardian Life Insurance Company of America And its Affiliates and Subsidiaries Enrollment/Change Form Page 1 of 4 Guardian Life, P.O. Box 14319, Lexington, KY Please print clearly and mark carefully. Employer Name: CADENCE EDUCATION, INC. Group Plan Number: Benefits Effective: PLEASE CHECK APPROPRIATE BOX q Initial Enrollment q Add Employee/Dependents q Drop/Refuse Coverage q Information Change Class: ALL ELIGIBLE EXECUTIVES NOT LOCATED IN TEXAS Division: Subtotal Code: (Please obtain this from your Employer) About You: Social Security Number First, MI, Last Name: - - Address City State Zip Gender: q M q F Date of Birth (mm-dd-yy): - - Phone: ( ) - Address: Are you married or do you have a spouse? q Yes q No Date of marriage/union: - - Do you have children or other dependents? q Yes q No Placement date of adopted child: - - About Your Job: Hours worked per week: Job Title: Work Status: q Active q Retired q Cobra/State Continuation Date of full time hire: - - About Your Family: Please include the names of the dependents you wish to enroll for coverage. A dependent is a person that you, as a taxpayer, claim; who relies on you for financial support; and for whom you qualify for a dependency tax exception. Dependency tax exemptions are subject to IRS rules and regulations. Additional information may be required for non-standard dependents such as a grandchild, a niece or a nephew. Spouse (First, MI, Last Name) Gender q M q F Child/Dependent 1: q Add q Drop Gender q M q F Child/Dependent 2: q Add q Drop Gender q M q F Child/Dependent 3: q Add q Drop Gender q M q F Child/Dependent 4: q Add q Drop Gender q M q F Date of Birth (mm-dd-yyyy) - - Date of Birth (mm-dd-yyyy) Status (check all that apply) - - q Student (post high school) q Disabled q Non standard dependent Date of Birth (mm-dd-yyyy) Status (check all that apply) - - q Student (post high school) q Disabled q Non standard dependent Date of Birth (mm-dd-yyyy) Status (check all that apply) - - q Student (post high school) q Disabled q Non standard dependent Date of Birth (mm-dd-yyyy) Status (check all that apply) - - q Student (post high school) q Disabled q Non standard dependent CEF DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER DATE FORM PUBLISHED: Feb 17, 2016

16 2 Drop Coverage: q Drop Employee q Drop Dependents The date of withdrawal cannot be prior to the date this form is completed and signed. Last Day of Coverage: - - q Termination of Employment q Retirement Last Day Worked: - - q Other Event: Date of Event: - - Coverage Being Dropped: q Dental q Employee q Spouse q Child(ren) Loss Of Other Coverage: I and/or my dependents were previously covered under Loss of coverage was due to: q Termination of Employment: - - q Divorce - - q Death of Spouse - - q Termination/Expiration of Coverage - - Coverage Lost q Dental I have been offered the above coverage(s) and wish to drop enrollment for the following reasons: q Covered under another insurance plan q Other (additional information may be required) Dental Coverage: You must be enrolled to cover your dependents. Check only one box. Employee Only EE & Spouse EE & EE, Spouse & Dependent/Child(ren) Dependent/Child(ren) PPO q q q q q I do not want this coverage. If you do not want this Dental Coverage, please mark all that apply: q I am covered under another Dental plan q My spouse is covered under another Dental plan q My dependents are covered under another Dental plan Signature l I understand that my dependent(s) cannot be enrolled for a coverage if I am not enrolled for that coverage. l Submission of this form does not guarantee coverage. Among other things, coverage is contingent upon underwriting approval and meeting the applicable eligibility requirements as set forth in the applicable benefit booklet. l If coverage is waived and you later decide to enroll, late entrant penalties may apply. You may also have to provide, at your own expense, proof of each person's insurability. Guardian or its designee has the right to reject your request. l Plan design limitations and exclusions may apply. For complete details of coverage, please refer to your benefit booklet. State limitations may apply. l Your coverage will not be effective until approved by a Guardian or its designated underwriter. l I hereby apply for the group benefit(s) that I have chosen above. l I understand that I must meet eligibility requirements for all coverages that I have chosen above. l I agree that my employer may deduct premiums from my pay if they are required for the coverage I have chosen above. l I acknowledge and consent to receiving electronic copies of applicable insurance related documents, in lieu of paper copies, to the extent permitted by applicable law. I may change this election only by providing thirty (30) day prior written notice. l I attest that the information provided above is true and correct to the best of my knowledge. Any person who with intent to defraud any insurance company or other person files an application for insurance or statements of claim containing any materially, false information or conceals for purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and may also be subject to civil penalties, or denial of insurance benefits. The state in which you reside may have a specific state fraud warning. Please refer to the attached Fraud Warning Statements page. The laws of New York require the following statement appear: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. (Does not apply to Life Insurance.) SIGNATURE OF EMPLOYEE X DATE Enrollment Kit , 0001, EN DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

17 Guardian Group Plan Number: Please print employee name: Fraud Warning Statements The laws of several states require the following statements to appear on the enrollment form: Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof. Arizona: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties. California: For your protection California law requires the following to appear on this form: The falsity of any statement in the application shall not bar the right to recovery under the policy unless such false statement was made with actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer. Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Delaware, Indiana and Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Louisiana and Texas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit is guilty of a crime and may be subject to fines and confinements in state prison. Maryland : Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Rhode Island: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in N.H. Rev. Stat. Ann. 638:20 New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. New Mexico: Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties or denial of insurance benefits. Ohio: Any person who with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. 3 DETACH ENTIRE FORM AND RETURN TO YOUR EMPLOYER

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19 Thank You If applicable, return your completed form to your plan administrator. Please remember to: q q q q q q Check the coverage you want Include your social security number (and those of your dependents, if applicable) Include dates of birth Indicate the best way to reach you Include your name on each page of the form Sign and date form Date form submitted:

20 Make the most of your Guardian benefits at Enrolled members and their dependents can access helpful, secure information about their Guardian benefit(s) instantly at Review your benefits Look up amounts and services covered in your plan Check the status of a claim Receive alerts when a response to your dental* claim is available online View and print dental or vision ID cards Print forms and plan materials...and much more To register, go to CADENCE EDUCATION, INC. Dental Benefits Plan 2005 The Guardian Life Insurance Company of America, 7 Hanover Square, New York *Not available to members with Guardian pre-paid Dental/DHMO plans (including FirstCommonwealth and Managed DentalGuard plans). 0001