Group Name: AFGE
DeltaCare EPO Group# 8116-0004 Delta Care EPO, which is similar to an HMO, treated only by dentist in the network

Delta Care Rates (which do NOT include your $15.00 union dues) are as follows:

                         Single -              $17.00
                         Single + 1 -       $27.00
                         Family -             $37.00

Go to: www.deltadentalmi.com to locate network dentist or click on the image below "Dental Office Toolkit" or or

Group Name: AFGE

Delta Premiere Group# 2116-0004

Delta Premiere - Allows you to go to any dentist

Delta Premiere Rates (which do NOT include your $13.00 union dues) are as follows:

Single — $23.00
Family— $59.00

To Enroll:
Contact Garland-Hill Agency

Phone: (313) 965-1777 or (866) 582-1777

Fax: (313) 965-1696

EMail: dental@garlandhill.com

Questions about Premium Payments:

Contact Professional Benefit Administrators (PBA)

1000 Hurricne Shoals Rd NE, Suite C-370, Lawrenceville, GA 30043

Phone: (800) 578-2082

Fax: (770) 963-6126 or (888) 264-6975

To Withdraw:
      We ask that you remain a member for at least 1 year before you
      are eligible for a withdrawal from any plan in order to keep our
      premium cost at a minimun.
      Members are asked to contact PBA to process withdrawals

For Benefit Information go to www.deltadentalmi.com
Create a Username & Password,
Note when Registering, Your Member ID is your SSN

***** In order to receive Delta Dental Benefits, you must be an Member in good standing with AFGE 3239 ****

Click on the above image to link to the Consumer Toolkit to find out more about your benefits

Retirees:
Pay monthly thru Direct payment from personal Bank account or credit card

2018 DeltaCare

                       Single-           $ 31.44
                       Single + 1       $ 52.70
                       Family -       $ 73.24

2018 DeltaPremiere

Single - $ 44.55
Family- $ 119.06

To enroll in Delta Premiere
Contact Garland-Hill Agency

(313) 965-1777 or (866) 582-1777

FAX ALL ENROLLMENT FORMS TO

Professional Benefits Administrators

(770) 963-6126 or (888) 264-6975

BENEFIT DETAILS

Students & IRS Dependents may be included in the policy till age 25

With DeltaCare EPO Only - you have the freedom to visit any DeltaCare EPO dentist.
Their is no longer a requirement to choose a primary dental office location. Referrals are not necessary to visit DeltaCare EPO specialists.

With Delta Premiere Only - Major oral surgery, periodontics, endodontics, major restorative, prosthetic and orthodontic services will not be covered until after a person is enrolled in the dental plan for 12 consecutive
months.

In the event that treatment is rendered from a dentist that does not participate in any of Delta Dental's programs, the patient may be responsible for more than the percentage indicated below.

(2016 Changes refkected in RED)

DELTA PREMIER DELTA CARE (EPO)

Preventive - - - - - - - -                             100%                                  100%
X-rays     - - - - - - - -                                100%                                  100%
Bitewings X-Rays- - - - --                        100%                                  100%
Basic   - - - - - - - - - - --                             65%
Endodontics- - - - - - - -                             65%
Periodontics- - - - - - - - -                        65%
Oral Surgery - - - - - - - -                        65%
Simple Restorative- - - -                         65%
Major Restorative - - - -                          50%
Prosthetics - - - - - - -                                50%*
Orthodontics    - - - - - -    50%
Ortho Age Limit- - - - - - -                       26

* Benefit levels may vary for procedures that fall within this category. To determine the benefits
available for procedures performed or to be performed, submission of a pre-treatment estimate is
advised.

For some of the covered services,the patient may be required to satisfy a waiting period.


Participating Premier or Non Participating
Maximums

Family Program Maximum      GENMAX0001     $MAXIMUM REMOVED/year
Individual Program Maximum GENMAX0001     $1250.00/year
Individual Lifetime Maximum ORTHOMAX0001 $1250.00/year

* Maximum available and used apply to all services regardless of the dentist's participating status.

Routine Time Limitations: (Time limitations for other procedures may apply)

Crowns: 1 per tooth in 60 months.
Exams, cleanings and fluorides: 2 in 12 months; Fluoride up to age 19.
Root planing and scaling: 1 per quadrant in 24 months; occlusal guard - 1 in a lifetime.
Bitewings: 1 per 12 months.
Full mouth x-rays: 1 per 60 months.
Orthodontics: The age limitation is noted above.
Bridges and dentures: 60 month replacement limit.
Coordination of Benefits:
Internal (within the same Delta group): Coordination of benefits is not allowed when the other member is covered within this group.
External (with another Delta group or carrier): Coordination of benefits is allowed when the other member is covered within another dental plan.

Every effort is made to provide accurate information. However, this is not a guarantee of payment.
If treatment will be rendered based on Delta Dental's payment liability, we recommend you predetermine your treatment plan.