Page 12 - Pump Down Specialist Benefit Guide 9-1-2024

Dental Options:

Principal Life Insurance

Semi-Monthly Bi-Weekly Dependent Information
Principal Dental
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We offer our employees and eligible dependents dental
Employee Only $ 0.00 $ 0.00 coverage. Children can join or remain on a parent’s dental
Employee + Spouse $15.30 $14.12 plan until age 26. When a child turns 26, they will lose
Employee + Child(ren) $15.62 $14.41 dental coverage on the last day of their birth month.

Employee + Family $33.00 $30.46

BRIEF OVERVIEW Type of Ser- Amount You Pay

vice Non-Network Dentists Reimbursed at 90th Percentile of U&C

Annual Deductible (CYD) $50 Individual / $150 Family

Preventive Services Covered at 100%; CYD Waived
Basic Services Covered at 80% after CYD

Major Services Covered at 50% after CYD
Annual Maximum $3,000
Annual Maximum Preventive Services Does Not Apply

Max Accumulator allows a portion of unused dollars to roll over to
Max Accumulator next year's maximum benefit amount. If your dental benefits paid
are less than $1,000, you can roll over $500 and accumulate up
(Additional Annual Maximum Benefits) to $2,000. The amount accumulated is added to your annual
maximum for the next year.

Type of Service Benefit Description

See Summary of Benefits and Policy for the age and frequency limitations of benefits.
Routine cleanings, exams, x-rays, oral cancer screenings.
Preventive Services
(Fluoride, sealants, space maintainers under age 16)

Restorations (Amalgam or Composite) fillings, simple extractions,
Basic Services oral surgery. Emergency Treatment/General Services.
Enhanced coverage for Endodontics (root canals),
and Periodontics.
Crowns, implants (no missing tooth clause or waiting period),
Major Services inlays, onlays, fixed partial denture (bridges) dentures and
removable prosthetics

Annual Maximum Applies January 1 to December 31

NOTE: This is only a brief overview. Please see Benefit Summary and policy for more details.
Website: www.principal.com or Customer Service : 800-986-3343

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