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SCHEDULE OF BENEFITS (CONTINUED) <br />• Plan 2 - All Active Full -time Employees located outside a PPO service area <br />BENEFITS FOR CLASS 2 <br />Eligible Class: All Full -Time Employees located outside a PPO service area <br />Contributions: Covered Employees are not required to contribute to the cost for Employee Dental Coverage. Covered Employees are <br />required to contribute to the cost for Dependent Dental Coverage. <br />Benefit Waiting Period: <br />Type II Procedures: None <br />Type III Procedures: 6 Months <br />The Benefit Waiting Period(s) shown above for Type III Procedures will not apply to Covered Persons who become covered on the <br />Policy Effective Date; but only if they were covered under the Group Policyholder's prior group dental plan on the day before the <br />Policy Effective Date. <br />Terms of the Prior Carrier Credit Provision apply for persons enrolled on the issue date of the Policy: Yes <br />Late Entrant Limitation (when applicable): <br />Type II Procedures: 12 Months <br />Type III Procedures: 12 Months <br />DENTAL BENEFITS <br />CALENDAR YEAR DEDUCTIBLE <br />Type II and III Procedures (combined) <br />INDIVIDUAL $50 <br />FAMILY $150 <br />PERCENT PAYABLE <br />Type I - Diagnostic & Preventive Services 100% <br />Type II - Basic Services 80% <br />Type III - Major Services 50% <br />CALENDAR YEAR MAXIMUM <br />for Type I, II and III Procedures (combined) $2,000 <br />is <br />GL11 -3 -SB <br />3 -3 09/01/01 <br />