DENTAL BENEFITS
Dental Plan
You have the option of dental care coverage through Principal, regardless of which medical plan you choose. With this plan you can see any dentist you wish for eligible dental care services. You are not required to choose a Principal network dentist, but when you do, you will have lower out-of-pocket costs. Benefit payments to non-dentists are based on Usual, Customary & Reasonable (UCR) fees as defined by Principal. Please consult the chart below for a summary of the Principal dental plan benefits. You have the option to waive this coverage.
DPPO Plan EPO
PPO Network
Non-Contracted/Out-of-Network
Maximum Contract Allowance
PPO Contracted Fee*
Program Allowance **
*PPO dentists agree to accept PPO Contracted Fees as payment in full. **Program allowance is the amount determined by a set of percentile (90 th ) level of charges for such services by providers with similar professional standing in the same geographical area.
Dental PPO
PPO Network
Non-Network
Annual Deductible (waived for preventive)
$50 individual $150 family
$50 individual $150 family
Calendar Year Annual Maximum Benefits
$1,500
$1,500
Preventive Services (cleanings, exams, x-rays)
100%
100% of UCR
Basic Services (extractions, fillings, periodontics) 80%
80% of UCR
Major Services
50%
50% of UCR
5
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