Page 17 | Duncan Supply Company, Inc.| Plan Year 2025 Open Enrollment This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract. Dental Plan Dental & Vision Benefit Summary Vision Plan Network –Anthem Dental offers network coverage with balance billing. You may go to any dentist however, if you go to an Anthem Dental in-network provider you will usually pay less. To search for in-network vision providers, visit www.anthem.com or search for providers using the Sydney Health app. Network – Anthem Blue View Vision provides you with the option to go to any eye doctor. However, if you go to an Anthem blue View Vision network provider you will usually pay less. To search for in- network vision providers, visit www.anthem.com or search for providers using the Sydney Health app. In-Network Out-Of- Network Routine Eye Exam - (once every 12 months) $10 copay $42 allowance Frames - (once every 24 months) $130 allowance then 20% off any remaining balance $45 allowance Standard Plastic Lenses - (once every 12 months) Single vision (1 pair) Bifocal lenses (1 pair) Trifocal lenses (1 pair) $25 copay $25 copay $25 copay $40 allowance $60 allowance $80 allowance Contact Lenses - (once every 12 months instead of eye glass lenses) Elective (disposable) Elective (non- disposable) Non-Elective $130 allowance $130 allowance plus 15% off remaining balance Covered in full $105 allowance $105 allowance $210 allowance Provider Directory: www.anthem.com Allowances must be used on transaction Annual Deductible IN-Network/Out-of-Network Individual $50 Family $150 Annual Plan Maximum $1,000 Orthodontia Lifetime Maximum $1,000 Preventive/ Diagnostic Care Includes: routine oral exams, cleanings, fluoride treatment and sealants (through 18), x-rays You Pay 0% / 0% Basic Dental Services Includes: fillings, consultations, space maintainers, brush biopsy, endodontics, extractions You Pay 10% / 20% Major Dental Services Includes:, dentures, bridges, implants, periodontics (surgical & non-surgical) You Pay 40% / 50% Orthodontia for Children up to age 19 You Pay 50% / 50% Provider Directory: www.anthem.com Anthem Dental benefits listed above are shown In- Network. See full plan details for description and Out-of-Network Coverage details.