Page 10 - 2017 Benefits Enrollment
P. 10
Find an In-Network Dental
Provider Our dental plan helps you maintain good oral health through affordable
X Visit www.principal.com
options for preventive care and other dental work. Regular oral health
X Select Insure at the top and click exams can help detect signiicant medical conditions before they become
Find A Dentist serious. Coverage is provided through Principal.
X Select your state and specify the
network on your ID card When using an in in-network dentist, your out-of-pocket costs are lower.
This is because the in-network dentists have agreed to charge lower fees.
X Enter the name of your provider
(if known); if you are looking for If you choose to use an out-of-network dentist, while the beneit is the
a nearby dentist, enter the city same, your out-of-pocket costs will be higher, and you are subject to
and state and/or ZIP code charges above reasonable and customary.
X Select the desired specialty or In-Network Out-of-Network
use the No Specialty Preference Calendar Year Deductible
default; click Continue Per Individual $0 $25
Calendar Year Maximum $1,000
Orthodontia Services Coinsurance
The orthodontia lifetime maximum Preventive—Exams, Cleanings, X-Rays, 100% no deductible
Fluoride, Sealants, Space Maintainers
illustrated here is different than Basic—Fillings, Emergency Exams, Simple 80% after deductible
the calendar year maximum. For Extractions, Periodontics, Endodontics
orthodontia services, this limit does Major—Oral Surgery, Crowns, Inlays, Onlays, 50% after deductible
not reset each year, this is the most Bridges, Dentures
your plan will cover for your services Orthodontia
for the lifetime of your participation in Coinsurance 50% after deductible
this program. Lifetime Maximum $1,000
Beneit Applies to Children to age 19
This is a summary of your beneit coverage. Full coverage details are available in the policy or
certiicate of coverage.
Premium Per Pay Period
Employee $5.90
Employee and Spouse $12.93
Employee and Child(ren) $14.86
Family $22.79
10 2017 Benefits Enrollment
Provider Our dental plan helps you maintain good oral health through affordable
X Visit www.principal.com
options for preventive care and other dental work. Regular oral health
X Select Insure at the top and click exams can help detect signiicant medical conditions before they become
Find A Dentist serious. Coverage is provided through Principal.
X Select your state and specify the
network on your ID card When using an in in-network dentist, your out-of-pocket costs are lower.
This is because the in-network dentists have agreed to charge lower fees.
X Enter the name of your provider
(if known); if you are looking for If you choose to use an out-of-network dentist, while the beneit is the
a nearby dentist, enter the city same, your out-of-pocket costs will be higher, and you are subject to
and state and/or ZIP code charges above reasonable and customary.
X Select the desired specialty or In-Network Out-of-Network
use the No Specialty Preference Calendar Year Deductible
default; click Continue Per Individual $0 $25
Calendar Year Maximum $1,000
Orthodontia Services Coinsurance
The orthodontia lifetime maximum Preventive—Exams, Cleanings, X-Rays, 100% no deductible
Fluoride, Sealants, Space Maintainers
illustrated here is different than Basic—Fillings, Emergency Exams, Simple 80% after deductible
the calendar year maximum. For Extractions, Periodontics, Endodontics
orthodontia services, this limit does Major—Oral Surgery, Crowns, Inlays, Onlays, 50% after deductible
not reset each year, this is the most Bridges, Dentures
your plan will cover for your services Orthodontia
for the lifetime of your participation in Coinsurance 50% after deductible
this program. Lifetime Maximum $1,000
Beneit Applies to Children to age 19
This is a summary of your beneit coverage. Full coverage details are available in the policy or
certiicate of coverage.
Premium Per Pay Period
Employee $5.90
Employee and Spouse $12.93
Employee and Child(ren) $14.86
Family $22.79
10 2017 Benefits Enrollment
