Page 8 - 2021 Vocon Benefits Guide

Dental

It’s important to have regular dental exams and cleanings
so problems are detected before they become painful—
and expensive. Keeping your teeth and gums clean and
healthy will help prevent most tooth decay and
periodontal disease, and is an important part of
maintaining your medical health.

Vocon’s Dental PPO plan is administered by Principal. The
chart below shows what the plan pays for in-network
benefits only. You may also go out of network; however,
balance-billing may apply which could result in higher out-
of-pocket costs.

While the annual maximum per individual is $1,000, the
Principal allows for unused dollars to roll over to next
year's annual maximum benefit amount. To qualify, a
member must have had a dental service performed within
the calendar year and use less than a maximum threshold.
The threshold is equal to the lesser of 50% of the
maximum benefit or $1000. If you meet this qualification,
50% of the threshold will be carried over to next year's
maximum benefit.

Provision Principal Dental PPO

Annual deductible
$50/$100
Individual/Family

Annual maximum per individual $1,000
Diagnostic and Preventive, to include cleanings,
100%, no deductible
fluoride treatments, sealants and x-rays (two

cleanings per calendar year)
Basic Services to include fillings, periodontics,
simple endodontics, composite fillings, scaling 90%
and root planning, oral surgery
Major Services to include crowns, bridges, full
50%
and partial dentures

Orthodontia (Children only up to age 19) 50%; $1,000 lifetime maximum

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