UnitedHealthcare

Options PPO/covered dental services

Periodic Oral Evaluation 100%

Radiographs 100%

Lab and Other Diagnostic Tests 100%

PREVENTIVE SERVICES

Prophylaxis (Cleanings) 100%

Fluoride Treatment (Preventive) 100%

Sealants 100%

Space Maintainers 100%

BASIC SERVICES

Restorations (Amalgam or Anterior Composite)* 100%

Emergency Treatment I General Services 100%

Simple Extractions 100%

Oral Surgery (includes surgical extractions) 100%

Periodontics 100'4

Endodontics 100%

MAJOR SERVICES lnla s/Onla s/Crowns* 60%

Dentures and other Removable Prosthetics 60%

Fixed Partial Dentures Brid es ' 60%

ORTHODONTIC SERVICES

Diagnose or correct misalignment of the teeth or bite 50%

100%

100%

100%

100%

100%

100%

100%

80%

80'r.

80%

80%

80%

80%

50%

50%

50%

50%

dental plan

Custom P8779 /U90

Limited to 2 times per consecutive 12 months.

Bite-wing: Limited to 1 series of films per Calendar Year. Comptete/Panorex: Limited to 1 time per consecutive 36 months.

Limited to 2 times per consecutive 12 months.

Limited to Covered Persons under the age of 16 years, and limited to 2 times per consecutive 12 months.

Limited to Covered Persons under the age of 16 years and once per first or second ermanent molar eve consecutive 36 months. For Covered Persons under the age of 16 years, limited to 1 per consecutive 60 months.

Mult iple restorations on one surface will be treated as a single filling.

Palliative Treatment: Covered as a separate benefit only if no other service was done during the visit other than X-rays. General Anesthesia: When clinicall necessa

Limited to 1 time per tooth per lifetime.

Perie Surgery: Limited to 1 quadrant or site per consecutive 36 months per surgical area. Scaling and Root Planing: Limited to 1 time per quadrant per consecutive 24 months. Periodontal Maintenance: Limited to 2 times per consecutive 12 months following active and adjunctive periodontal therapy, exclusive of gross debridement

Root Canal Therapy: Limited to 1 time per tooth per lifetime.

Limited to 1 time per tooth per consecutive 60 months. Full Denture/Partial Denture: Limited to 1 per consecutive 60 months. No additional allowances for recision or semi- redsion attachments. Once per tooth per consecutive 60 months.

Course of treatment is typically 24 months, with the initial payment at banding of 20% and remainin a ment s read over the course of the treatment

• Your dental plan 11rovidcs that where two or more professionally acceptable denial trcatmcnl!i for a dental condition exist, your plan b<1ses reimbursement on the least costly trca1mcnt nltema1ivc. If you and your dentis1 agrcctl on tt 1rcat111cn1 which is more costly than 1hc treatment on which the phm benefit is b:1scd, you will be responsible for the tlirferencc between 1hc fee for service rcntlcrcc.J anti the fe<:: covered by the plan. In addition, a prc-trcannent estimll.lt is recommended for nny scn•ice estimated 10 cosl over SSOO; Jllcase consult your tlcntist. .. '"The 11c1work pcrc~·ntasc of Ocni.:lics is busctl nn 1he discounted fees negotiated wi1h 1hc 1)rov1cler. ·• •The non-network pcrccntngc ofbcnclits is based on the usual and cus1omary fees in 1hc geographic areas in which the expenses arc incurred.

In uccur<l;im:c with lhc lllinrns Sl<lll! rcquirl!ment, a rartncr in a Civil Uniun is im; lu<lc<l in thc lldi11i11on nf Ot:pt:mlc:nt. Fur u cnmplt:k descript ion of Dcpcmlcnl Covcrugc. plcusc re fer lo your Ccrlific:.itc of Coverage.

Thc Prcnutul Denial Cure (nm uva il:1hlc in WA) nnd Orn I Cancer Screening progr.uns me cnvcrc<l un<lcr this plnn. Tht• 11wf(•1·1al cm1tuim.:d ;,, the! nlHWt' whit· is for m{m7P1otiun"I pm7HU'C!S on(\' and i.'f 11ur an o(/'i•1· 11/W\'Cr<ll:t'. Ph•a.'f1' 1wtc• tlwr th<! abm'C 1<1/Jlc prm1frlr.'f 11n(1· u brief. gcm:ra/ dcsurptfrm fl{ ('Ol'<'rtl}W um/ docs nfll ('mu'Wttlt' a c:umracr. For a compft•tt• lm111g of )'0111' <'Ol'c•rr1gr. mt'lmlmg t'X< lu.uan<r 1111d hmitr11io11J relmirrg to )'Our C'Ol'!'l'llJ:t'. ph·"s" r1.fl·1· w )'"'"' Ct•r1ific·t1tt' ofC01•emxe or C'Onlllct your bem:fits 11dm ini.flmlor. Jf diQi:r1:11r-t'.\' exm /)('fWIH!ll tlus Smmmuy of 1Je11efi1.v nnd yo11r <.:crtificatr o(Co1·cragclbe11efits admmrstrnlor. t/Jc ccrtificatclbcncjits admimsrrator will gm•t•m. All tcl'ml nml comlit1011s of ,.m'Cragc nrc suhjcc:t to appltcnhle stat~ mulfcdcrnl laws Slnlc 111011Jates rcgarrlmg he11cfir levels and age /imilali1m.f mu\ ,rnpc.1'$t'tlc• plan d1!.ri>:nJi-u11m~"· Umtt•,/Ht'llllht·urt• /Jr11tt1I Optom .. 'f /'/'O 1'/a11 is t'lfhcr 11111/t'nvritlt'n ur prm·itl,·d hy: Unit&·J l-h-lllihCl.11·r hi.rnrm1c" Cumpcmy, Hurtforrl, Comu·c1im1; U11i1cd Jlrol1hCurt' h1.•wram·t• Compt1ny of Nt•w York, Uc111ppt1u}!c'. Nrw York; Ummerlrn ltmmmt t! C:u1111Hmy, .\/iln'tmket'. Wisl'omm; Uninu:rirn life lnnmint t' Cum111my of Ntw fork, N~w YtH'k, New Yol'k ur Um·11:d HeulrhCurc &n•irf!l'. lne.

().1/0~ l"'200R-2009 Uni1cd Hc;allhC'arc Scrvn::cs. Inc

UnitedHealthcare/Dental Exclusions and Limitations

General Limitations

PERIODIC ORAL EVALUATION L1m11ed lo 2 times per consecuhve 12 months,

COMPLETE SERIES OR PANOREX RADIOGRAPHS Limned lo one time per consecul1\le 36 months.Exception 10 this limit wtfl be made for Paronex R&dlograph If taken for diagnosis of molars, Cys1s Of neoplasms

BITEWING RAOIOGRAPHS Limited to 1 series of films per Ca1endarYear

EXTRAORAL RAOIOGRAPHS Umiled lo 2 films per CalendarYea1

DENTAL PROPHYLAXIS Limited lo 2 limos per consecutive 12 months.

FLUORIDE TREATMENTS Limited to Covered Persons under the age ol 16 years, and 1i m11od to 2 llmes per consecutive 12 months.

SEALANTS Llmilod to Covered Persons under the age of 16 years and once per first or second permanent molar every consecutive 36 months.

SPACE MAINTAINERS Limited to Covered Persons under the age of 16 years. L1m11ed to 1 per consecutive 60 months. Benertt includes all adJUStmont within 6 monlhs of installation

RESTORATIONS Multiple reslorations on 1 surface \'AH be lleated as a single fining.

PIN RETENTION Limited to 2 pins per tooth: not covered in addition to cast resloration.

INLAYS ANO ONLAYS Umited to 1 tune per looth per oooseculive 60 months. Covered onty when a fining cannot reslOfe the looth.

CROWNS Limited to 1 time per tooth per consecutive 60 months. Covered only when a fitting c annot restore the tooth.

POST ANO CORES Covered only for teeth that have had roo1 canal therapy.

SEDATIVE Fl.LINGS Covered as a separate benefit only if no other servtce. other than x-rays and e:l!am were perfor med on lhe same toolh dufing tho visit.

SCALING AND ROOT PLANING limited to 1 time per quadrant per consecullve 24 months.

ROOT CANAL TMERAPY Umllod to 1 time per tooth per lifetime.

PERIODONTAL MAINTENANCE Umiled to 2 hmes per consecuClve 12 months folbwmg active or adjunclive poriodonlal therapy, exclusive of gross debndemont.

FULL DENTURES Lim1\ed to 1 lime every consecutive 60 months. No ad<hllonal allowances for precision or semi· preasion altachroonts.

PARTIAL DENTURES l imited to 1 time every consecutive 60 months. No additional alowances for precision or semi· preosion altachments.

RELINING AND REBASING DENTURES Llmoted lo relinlnglrebasing performed m<Jfe than 6 months aher the inihal mseruon. Limited to 1 time per consecutive 12 months.

REPAIRS TO FULL DENTURES, PARTIAL DENTURES. BRIDGES limited to repairs or adjustments performed more than 12 months after lhe initial insertion. limited lo l time per consecu1ive 6 monlhs.

PALLlATIVE TREATMENT Covered as a separale beneri1 only 11 no other service. other than e>cam and radiographs. were performed on tho samo tooth during tne v1s11.

OCCLUSAL GUARDS llm1tod to 1 guard every consecutive 36 months and only II prescribe lo control habitual grinding.

FULL MOUTH OEBRIDMENT Limilod to 1 time ovcry cansecuth1e 36 months.

GENERAL ANESTHESIA Covered only when chnically necessary.

OSSEOUS GRAFTS l 1m11ed lo 1 per quadram or site per conseeulive 36 months.

PERIODONTAL SURGERY Hard tissue and son ttssue periodonlal sLKgory are limited lo 1 per quadranl °' s1le per conseculive 36 months per surgical area

R EPLACEMENT OF COMPLETE DENTURES. FIXED OR REMOVABLE PARTIAL DENTURES. CROWNS. INLAYS OR ONLAVS Replacement of complete dentures. fixed or removable pattJal dcnlures. crowns. inlays or oolays preVK>Usly submitted for payment under lhe plan is limited to t time per consecutive 60 months from imlial °' supplemental placement. Tilis includes retainers. habil appliances, and any fixed or removable in1ercep111ve orthodontic appllances.

General Exclusions TI1e fo llowing are not covered:

I. Dental Services that arc not necessary.

2. Hospitalization or other facility charges.

3. Any dental procedure performed solely for cosmetic/aesthetic reasons. (Cosmetic procedures are those procedures that improve physical appearance.)

4. Rcconstructivc Surgery regardless of whether or not the surgery which is incidental to a dental disease, injury, or Congenital Anomnly when the primary purpose is to improve physiological functioning of the involved pan of the body.

S. Any dental procedure not directly associated with dental disease.

6. Any procedure not perfomied in a dental selling.

7. Procedures that arc considered to be Experimental, lnvcstigational or Unproven. This includes phamrncological regimens not accepted by the American Dental Association (ADA) Council on Dental Therapeutics. The fact that an Experimental, lnvcstigational or Unproven Service, treatment, device or phannacological regimen is the only available treatment for a particular condition will not result in Co,·erage if the procedure is considered to be Experimen1al, lnvesligational or Unproven in the treatment of that particular condition.

8. Services for injuries or conditions covered by Worker's Compensation or employer liability laws. and services that are provided without cost to the Covered Person by any municipali ty, county, or other political subdivision. This exclusion does not apply to any services covered by Medicaid or Medicare.

9. Expenses for dental procedures begun prior to the covered person becoming enrolled under the policy.

10. Dental Services otherwise Covered under the Policy, but rendered after 1he elate incliviclual Coverage under the Policy tenninates. including Dental Services for dental conditions arising prior to the date individual Coverage under the Policy terminates.

11 . Services rendered by a provider with the same legal residence as a Covered Person or who is a member of a Covered Person's family, including spouse, brother, sister, parent or child.

12. Foreign services are not covered unless required as an Emergency.

13. Replacement of crowns. bridges, and fixed or removable prosthetic appliances insened prior to plan coverage unless the patient has been eligible under the plan for 12 continuous months. !floss ofa tooth requires the addition ofa clasp, pantie, and/or abutment(s) within this 12 month period, the plan is responsible only for lhc procedures associated with the addition.

14. Replacement of missing natural teeth lost prior to the onset of plan coverage unti l the patient has been covered under the policy for 12 continuous months.

15. Replacement of complete dentures. fixed and removable panial dentures or crowns if damage or breakage was directly related to provider error. This type of replacement is the responsibility of the Dentist. If replacement is necessary because of patient non-compliance, the patient is liable for lhe cost of replacement.

16. Fixed or removable prosthodomic res toration procedures for complete oral rehabilitation or reconstrnction.

17. Allachmcnts to conventional removable prostheses or fi xed bridgework. This includes semi-precision or precision allachmcnts associated with panial dentures, crown or bridge abutments, full or panial overdentures, any internal attachment associated with an implant prosthesis and any elective endodontic procedure related to a tooth or rool involved in the construction of a prosthesis of this nature.

18. Procedures related to the reconstruction of a patient's correct venical dimension of occlusion (VDO).

19. Placement of dental implants, implants-supponed abutments and prostheses. (Not applicable for plans with implants)

20. Placement of fixed panial dentures solely for the purrosc of achieving periodontal stnbilil)I.

21 . Treatment of benign neoplasms. cysts or other pathology involving benign lesions, except excisional removal. Treatment of malignant neoplasms or Congenital Anomalies of hard or soft tissue, including excision.

22. Selling of facial bony fractures and any treatment associated with the dislocation of facial skeletal hard tissue

23. Services related 10 the temporomandibular joint (TMJ), either bilateral or uni lateral. Upper and lower jawbone surgery (including that rela1ed to the temporomandibular joint). No coverage is provided for orthognarhic surgery, jaw alignment or treatment for the tcmporomandibular joint. (Not Applicable for Plans with TMJ).

24. Acupuncture; acupressure and other fom1s of alternative treatment, whether or not used as anes1hesia

25. Drugs/medications. obtainable with or without a prescription, unless they are dispensed and utilized in the dental office during the patient visit.

26. Charges for failure to keep a scheduled appointment without giving the dental offi ce 24 hours notice.

27. Occlusal guord used as safety items or to affect performance primarily in spans-related activit ies

28. Dental Services received as a result of war or any act of war, whether declared or undeclared or caused during service in the anned forces of any country.

29. Onhodontic coverage docs not include the installation of a space mai11taincr, any treatment related to treatment of the tcmporomandibular joint, any surgical procedure to correct a malocclusion, replacement of lost or broken retainers and/or habit appliances, and any fixed or removable inierceptive orthodontic appliances previously submi11ecl for payment under the plan.

Constellation Schools ~ UnitedHealthcare· Benefit Summary Brochure

Customer Service: 800-638-3120 Provider Locator: 800-839-3242 www.myuhcvision.com

UnitedHealthcare Vision has been trusted for more than 40 years to deliver affordable. innovative vision care solutions to the nation's leading employers through experienced. customer-focused people and the nation's most accessible. diversified vision care network.

In-network, covered-in-full benefits (after applicable copay) include a comprehensive exam. eye glasses with standard single vision, lined bifocal. or lined trifocal lenses, standard scratch-resistant coating' and the frame, or contact lenses in lieu of eye glasses.

Copays for in-network services

Exam $15.00

Materials $15.00

Benefit frequency

Comprehensive Exam Once every 12 months

Spectacle Lenses Once every 12 months

Frames Once every 24 months

Contact Lenses in Lieu of Eye Glasses Once every 12 months

Frame benefit

Private Practice Provider $130.00 retail frame allowance

Retail Chain Provider $130.00 retail frame allowance

Lens options

Standard scratch-resistant coating - covered in full. Other optional lens upgrades may be offered at a discount. (Discount varies by provider.)

Contact lens benefit

Covered-in-full elective contact lenses The fitt ing/evaluation fees, contact lenses. and up to two follow-up visits are covered in full (after copay). If you choose disposable contacts. up to 4 boxes are included when obtained from a network provider.

All ot her elective contact lenses A $105.00 allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside the covered selection (materials copay does not apply). Torie, gas permeable and bifocal contact lenses are examples of contact lenses that are outside of our covered contacts.

Necessary contact lenses' Covered in full after applicable copay.

Out-of-network reimbursement s up to (Copays do not apply)

Exam $40.00

Frames $45.00

Single Vision Lenses $40.00

Bifoca l Lenses $60.00

Trifocal Lenses $80.00

Lenticular Lenses $80.00

Elective Contacts in Lieu of Eye Glasses' $105.00

Necessary Contacts in Lieu of Eye Glasses> $210.00

Laser vision benefit

United Healthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15 % off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at LasikPlus locations. For more information, call 1-888-563-4497 or visit us at www.uhclasik.com.

' On all orders processed through a company owned and contracted Lab network. 'The out--0f-network reimbursement applies to materials only. The fitting/evaluation is not included. ' Necessary contact lenses are determined at the provider's discretion for one or more of the following conditions: Following post cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision

confirming reimbursement that UnitedHealthcare Vision will make before you purchase such contacts.

Important to Remember: • Benefit frequency based on last date of service. • Your $105.00 contact lens allowance is applied to the fitting/evaluation fees as well as the purchase of contact lenses. For example, if the

fitting/evaluation fee is $30, you w ill have $75.00 toward the purchase of con tact lenses. The allowance may be separated at some retail chain locations between the examining physician and the optical store.

• Medically necessary contact lenses are determined at the provider's discretion for one or more of the fol lowing conditions: Following post cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be corrected with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming how much of a reimbursement you can expect to receive before you purchase such contacts.

• You can log on to our website to print off your personalized ID card. An ID card is not required for service, but is avai lable as a convenience to you should you wish to have an ID card to take to your appointment.

• Out-of-Network Reimbursement, when applicable: Receipts for services and materials purchased on different dates must be submitted together at the same time to receive reimbursement. Receipts must be submitted within 12 months of date of service to the following address: UnitedHealthcare Vision Attn. Claims Department P.O. Box 30978 Salt Lake City, UT 84130 FAX: 248.733.6060.

• UnitedHealthcare Vision offers an Additional Materials Discount Program. At a participating network provider you will receive a 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UnitedHealthcare Vision shall neither pay nor reimburse the provider or member for any funds owed or spent. Not all providers may offer this discount. Please contact your provider to see if they participate. Discounts on contact lenses may vary by provider. Additional materials do not have to be purchased at the time of initial material purchase. Additional materials can be purchased at a discount any time after the insured benefit has been used.

Please note: If there are differences in th is document and the Group Policy, the Group Policy is the governing document. Please consult the applicable policy/certificate of coverage for a full description of benefits, including exclusions and limitations.

The following services and materials are excluded from coverage under the Policy: Post cataract lenses; Non-prescription items; Medical or surgical treatment for eye disease that requires the services of a physician; Worker's Compensation services or materials; Services or materials that the pat ient, without cost, obtains from any governmental organization or program; Services or materials t hat are not specifically covered by the Po licy; Replacement or repair of lenses and/or frames that have been lost or broken; Cosmetic extras, except as stated in the Policy's Table of Benefits.

UnitedHealthcare Vision coverage provided by or through UnitedHealt11care Insurance Company or its affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06 and associated COC form number VCOC. INT.06.TX.

I~ UnitedHealthcare· SBVIS0057SCR 7/1 1©201 1 United HealthCare Services. Inc. OA 1004795·D

.· Vision Benefit Card

UnitedHealthcare Vision"' Constellation Schools

Exam Lenses Frames Contacts' ' (in lieu of lenses & frames)

Exam Copay Materials Copay

Once every 12 months Once every 12 months Once every 24 months Once every 12 months

$15.00 $15.00

To print a personalized ID card, please logon to our website and select 'Print ID card' from the member benefits page.

UnitedHealthcare Vision··

www.myuhcvision.com

Customer Service : 800-638-3120

TDD for Hearing Impai red: 1.800.524.3 157

Provider Locator: 1.800.839.3242

Employer-Paid Basic Life and AD&D Insurance 1 ~~~-t~~~~~4iW--~~

Consteltation Schools Summary of Benefits Effective 7 .1.12

Am I Eligible? You are eligible tf you are an active full time Employee.

How much company-paid Your employer provides, at no cost t o you, Employee Basic Life and AD&D Insurance in Basic Life and AD&D do I an amount of $50,000.

have? What is a beneficiary? Your beneficiary is a person (or persons) or legal entity (entities) who receives a benefit

payment if you die while you are covered under the policy. You, as the employee, must select your beneficiary when you complete your enrollment application; your selection is legally binding.

Are any resources available Beneficiary Services: Provides benefidarles with services for grief consultation, for beneficiaries? financial/legal assistance and referral to community resources. For more information,

call (866)302-4480 (see below for more details).

Are there other limitations You must be Actively at Work with your employer on the day your coverage takes to enrollment? effect.

Does my coverage reduce Yes, Employee Life and AD&D coverage amounts reduce to 65% of the Face amount at as I get older? age 65; to 45% of the original amount at age 70; to 30% at age 75; ·to 2"0% at age 80;

to 15% at age 85.

All coverage terminates upon employee's retirement.

What is Accelerated Death I f you are diagnosed as terminally ill with a 12 month or Jess llfe expectancy, you may Benefit? receive payment of a portion of your Life Insurance. The remaining amount of your Life

Insurance would be paid to your beneficiary when you die.

Can I keep my Life Yes, subject to the contract, you have the option of converting your group Life coverage coverage if I leave my to your own individual policy (policies).

employer?

UniledHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company; Unirnerica Insurance Company; and in Cal ifo rnia by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. Texas Coverage is provided on Porm LASD-POL-T.X (05103), Form UHCLD-POL 2/2008-TX, or UICLD-POL-TX 4/5.

UnitcdHealthcare insurance Company is located in Hartford, CT; Unimerica [nsurancc Company and Unimerica Life Insurance Company in Milwaukee, WI; Unirnerica Life Insurance Company of NY in New York, NY.

This is a summary of benefits only and does not inc lude all plan provisions, exclusions, and iimitations relating to your coverage. Please refer to your Certificate of Coverage. If .differences exist between this summary and your Certificate of

Cov"'"'· th• C• rtifloot• of Covora., will govern. '~ UnitedHealthcare' Rev '> I a. 12

Employer-Paid Basic Life and AD &D Insurance 1t&!·Mf=.::;r.--;,;~~~~z~~~~fif~~~~1

Constellation Schools Summary of Benefits Effective 1 .. 1.12

Important Details

Exclus ions: AD&D Insurance does not cover losses caused by or contributed by:

"'Disease, bodily or mental infirmity, suicide or intentionally self-inflicted injury, commission of an assault or felony, war, use of any drng unless prescribed by physician, driving while intoxicated, engaging in any hazardous activities, or travel in a private aircraft.

Other exclusions may apply depending upon your coverage. Once a group policy is issued to your employer, a certificate of coverage will be available to explain your benefits in detail.

As is standard with most tenn life Insurance, this Insurance coverage includes certain limitations and exclusions: • ~Death by suicide (two years).

• Some state variations may npply

Value-Added Services (All features may not apply. Some stales may have restrictions.)

-· Beneficiary Services: Provides beneficiCll'ies with services for grief consultation, financial/legal assistance and referral to community resources. For more information, call 866-302-4480.

o Toll-free line available 24/7 as well as referrals for face-to-face counseling. Specialists provide in-depth consultation, information Md referral to community resources such as grief support groups. lnclud«s access to a national network of credentialed clinicians for grief and loss counseling. Beneficiaries receive two complimentary sessions.H o Financial and Legal Services. Telephonic access to financial consultants for assistance with financial decision­making. Includes access to a network of22,000 attorneys for either a 30-minute telephonic or an in-person consultation. Clients may retain the same attorney for representation at a discounted rate. Legal services provided by CLC, Inc. <> Communication Support. We provide a "Beneficiary Kit" with informational resources to help beneficiaries with the emotional and financial process that follows the loss ofa loved one.

Wealth Managemeut Account: An enhanced benefit payment process. Life claim proceeds in excess of$5,000 will automatically be deposited into an OptumBank Wealth Management Account (W)VlA). Beneficiaries receive an FDICc insured, beneficiary-owned, interest earning account with convenient access to their claim proceeds via debit card or checkbook.~"'*

•• Beneficiary Services ofTercd thru United Behavioral Health, a company of UnitedHealth Group.

"* *Eligibilily for au1umatic deposit into an OptumHcalth Bank Wealth Management Account is subject 10 qualifying conditions.evaluated by OptumHcallh BMk and Un11cdHeal1hcore Specialty Benefits at the lime. of claim review to include limi1cd availability m ccnain slates. For more information please contact your Specialty Ilene fits representative. OptumHealth Bank, Memhcr FDIC. 1s part of the financial services unit or OptumHealth, a heahh and wellness company serving more then 60 milhon people. OpturnHcal!h Is o UnitedHealth Group (NVSE:UNH) company,

UnitedHealthcare Life and Disability products are provided by UnitedHealthcarc Insurance Company; Unimerica Insurance Company; and in California by Unimerica Life Insurance Company; and in New York by Unimerica Life Insurance Company of New York. Texas Coverage is provided on Form LASD-POL-TX (05/03), Form UHCLD-POL 2/2008-TX, or U1CLD-POL-TX 4/5.

UnitedHealthcare Insurance Company is located in Hartford, CT; Unimerica Insurance Company and Unimerica Life Insurance Company in Milwaukee, WJ ; Unimerica Life Insurance Company ofNY in New York, NY.

This is a s ummary of benefits only and does not Include all plan provisions, exc lusions, and limitations relating to your coverage. Please refer to your Certificate of Coverage. lf differences exist between this s ummary and your Certificate of

covorago. '"' cert1n""' ore°""'' wm govom. ~] UnitedHealthcare'