Page 9 - Recaro North America Benefits Guide

Dental

Principal Network Only Core Plan & In-and-Out of Network Buy-Up Plan

Core (Network Only) Summary (Click here to Buy-Up (In-and-Out of Network) Summary (Click
download) here to download)

Network Non-Network Network Non-Network
Service Service
Coinsurance Coinsurance Coinsurance Coinsurance

Preventative 100% 0% Preventative 100% 100%

Basic 80% 0% Basic 90% 80%

Major 50% 0% Major 60% 50%

Rates

Core Rates Buy-Up Rates

Tier Bi-Weekly Rate Tier Bi-Weekly Rate

Employee $6.11 Employee $9.30

Employee & Employee &
Spouse $12.18 Spouse $17.84
Employee & Employee &
Child(ren) $15.30 Child(ren) $23.04

Family $22.47 Family $33.24

9