Okaloosa County BOCC — August 5, 2014 — RFP #44-14 - Dental Insurance - MetLife Proposal - Exhibit B

Exhibit B Met Lite Summary of Benefits Dental insurance - Dental Option 3 Employer Sponsored Dental’ ; : = Class Description All Active Futl Hows) ees (30 Retirees In-Network Out-of-Network In-Network Out-of-Network ' Negotiated Fee R&C Negotiated Fee R&C Reimbursement Scheduls 90th Percentile Schedule 90th Percentile Type A— Preventive 100% 100% 100% 100% Type B — Basic 80% 80% 80% 80% Type C - Major 50% 50% 50% 50% Calendar Year Bac B&C B&C Bac Deductible applies to: $50 $50 $50 $80 * Individual $450 $150 $150 $150 « Family Aggregate Aggregate Aggregate Aggregate Calendar Year Maximum (applies to A,B,C $1,200 $1,200 $1,200 $1,200 services} Orthodontia 50% 50% 50% 50% Orthodontia Lifetime Maximum $1,000 $1,000 $1,000 $1,000 * Out of Network benefits are payable for services rendered by a dentist who is not a participating provider. The Reasonable and Customary charge ts based on the lowest of (1) the dentist's actual charge (the ‘Actual Charge’), (2) the dentist's usual charge for the same or similar services (the ‘Usual Charge’) or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife (the ‘Customary Charge’). Services must be necessary in terms of generally accepted dental standards. MetLife ® Employee Only $20.84 526 «» Employee + Family $60.45 359 = Total 885 $32,663 $391,064 Rates are guaranteed from October 1, 2014 - Sepiember 30, 2015 (12 months) rates. 2™ year Rate Cap: The first year’s renewal rates will not be increased by more than 5.0% above the current