We’re pleased to be your partner in maintaining great oral health. The Delta Dental PPO* plan makes it easy for you to find a dentist, and easy to control your costs when you visit a network dentist. Here are some of the great things you’ll need to know about enrolling with Delta Dental:

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• Save money with a Delta Dental PPO dentist. Our PPO network dentists accept reduced fees for covered services they provide you, so you’ll usually pay the least when you visit a PPO network dentist. This also ensures Delta Dental PPO dentists won’t balance bill you the difference between the contracted amount and their usual fee.

• Visit the dentist of your choice. Want to visit a non-Delta Dental dentist? No problem. You can visit any licensed dentist, but your costs are usually lowest when you see a PPO dentist.

• Many network dentists to choose from. Since Delta Dental offers access to some of the largest dentist networks in the U.S., chances are there’s a wide choice of network dentists near your home or office. Four out of five dentists nationwide

are contracted Delta Dental dentists, giving more enrollees convenient access to more dentists. Visit us at deltadentalins.com to search our dentist directory by location or specialty.

• Easy to use your benefits. When you visit a Delta Dental dentist, pay only your portion for services. Delta Dental dentists will file claim forms for you and receive payment directly from us. Many non-Delta Dental dentists ask that you pay the entire cost up front and wait for reimbursement.

• Delta Dental’s Online Services make getting information quick and easy. Access your benefits and eligibility, print ID cards and get information about your claims. And check out Delta Dental’s oral health resources for tips and information that can help keep your smile healthy.

* In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan.

WE KEEP YOU SMILING®

Greatest potential savings when you visit a Delta Dental PPO dentist

PPODENTIST

NON-NETWORKDENTIST

AMOUNT YOU SAVE

AMOUNT YOU PAY

OUT-OF-POCKET COSTS

SAVE LESS SAVE MORE

Illustration showing sample enrollee share of cost for information purposes only. Actual dentist fees and contract allowances will vary by region, procedure and by group contract.

A REGISTERED MARK OF DELTA DENTAL PLANS ASSOCIATION

Delta Dental PPOSM — Easy, Friendly, Accessible

We’ll do whatever it takes and then some.

Who’s Eligible? Primary enrollee, spouse or domestic partner (if applicable), and eligible children to age 26.

Deductible (waived for Diagnostic & Preventive services) $50 per person, per calendar year.

Maximum $1,000 per person, per calendar year.

Maximum Waived For Diagnostic & Preventive Services

No

* Limitations and exclusions may apply to some benefits. ** Reimbursement is based on the lesser of the dentist’s submitted fee or Delta Dental’s contracted PPO fees for

PPO dentists, Premier dentists and non-Delta Dental dentists. Delta Dental of California 100 First St. San Francisco, CA 94105

Customer Service 800-765-6003

Claims Address P.O. Box 997330 Sacramento, CA 95899-7330

www.deltadentalins.com

This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage. Please refer to your Evidence of Coverage booklet for a list of benefit limitations and exclusions. If you have specific questions regarding your dental plan, please consult your company’s benefits representative.

DDC HL PPO A (rev. 2-2011)

DELTA DENTAL OF CALIFORNIA

Small Business Program Classic – Plan: PPO A

Benefits and Covered Services* Delta Dental PPO Dentists**

Delta Dental Premier & Non-Delta Dental

Dentists** Diagnostic & Preventive Services Exams, x-rays, cleanings, fluoride treatments, space maintainers

100% 100%

Basic Services Fillings, simple tooth extractions, sealants

80% 80%

Endodontics Services (root canals) & Periodontics Services (gum treatment)

80% 80%

Crowns, Inlays, Onlays and Cast Restorations 50% 50%

Prosthodontics Services Bridges, partial dentures, full dentures, implants

50% 50%

Orthodontic Services Not a benefit Not a benefit

Orthodontic Lifetime Maximum N/A N/A

SVBET and VSP provide you an affordable eyecare plan.

Doctor Network…………………VSP Signature

Your Coverage with a VSP Doctor

$25.00 copay every 12 months

WellVision Exam® focuses on your eye health and overall wellness ...............................every 12 months Prescription Glasses Lenses.............................................every 12 months • Single vision, lined bifocal, and lined trifocal

lenses. • Polycarbonate lenses for dependent children.

Frame ..............................................every 24 months • $130.00 allowance for a wide selection of frames • 20% off the amount over your allowance.

~OR~ Contact Lens Care.........................every 12 months $130.00 allowance for contacts and the contact lens exam (fitting and evaluation). If you choose contact lenses you will be eligible for a frame 24 months from the date the contact lenses were obtained.

Extra Discounts and Savings Glasses and Sunglasses • Average 35 - 40% savings on all non-covered lens

options • 30% off additional glasses and sunglasses, including

lens options, from the same VSP doctor on the same day as your WellVision Exam. Or get 20% off from any VSP doctor within 12 months of your last WellVision Exam

Contacts • 15% off cost of contact lens exam (fitting and

evaluation) Laser Vision Correction • Average 15% off the regular price or 5% off the

promotional price. Discounts only available from contracted facilities.

• After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor

Your Coverage with Other Providers Visit vsp.com for details, if you plan to see a provider other than a VSP doctor. Exam .......................................................Up to $50.00 Single vision lenses .................................Up to $50.00 Lined bifocal lenses .................................Up to $75.00 Lined trifocal lenses...............................Up to $100.00 Frame......................................................Up to $70.00 Contacts ................................................Up to $105.00

VSP guarantees service from VSP doctors only. In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail.

Signature Plan B $25

LPS HR FORM (128)

2010

LEADERSHIP PUBLIC SCHOOLS, INC.

SUMMARY OF DISABILITY & LIFE INSURANCE PLANS

Disability Insurance Plan Overview All employees participate in California State Disability Insurance. The state designated amount is deducted from your paycheck. You are also eligible to enroll in Short Term Disability insurance from Standard Insurance. This program is designed to assist with your income should you become partially or totally disabled after a 7 day waiting period and are unable to perform the essential functions of your job. Benefits are up to 60% of you earnings up to a monthly maximum. This disability insurance is integrated into State Disability (SDI) benefits. Long Term Disability provides up to 60% of your earnings after a 90 day waiting period. Life Insurance Plan Overview Life and Accidental Death and Dismemberment Insurance from Anthem Blue Cross Life Insurance is payable up to $50,000 in the event of your death, in accordance with the policy. You can indicate your beneficiary or beneficiaries by submitting the appropriate documents to Human Resources. You can change beneficiaries by submitting the change in writing.