Page 15 - GSF Sample Guide

Dental Plan Highlights

Principal | EPO Network
With the Principal Financial Group dental POS plan, you may visit an EPO dentist, a PPO dentist. When you utilize an
EPO dentist, your out-of-pocket expenses will be less. However, the EPO network provides the most significant
discounts. If you obtain services using a non-network dentist, you will incur much higher out-of-pocket expenses, and
you may be responsible for filing claims.

Principal | PPO Network
With the Principal Preferred Provider Organization (PPO) dental network, you may visit a PPO dentist and benefit from
the negotiated rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be
less. You may also obtain services using a non-network dentist; however, you will be responsible for the difference
between the covered amount and the actual charges and you may be responsible for filing claims.

Principal
POS Plan
In-Network EPO In-Network PPO Non-Network PPO

Dental Benefits
Calendar Year Maximum $2,000 $2,000 $2,000
Ded (Annual)
− Preventive $0 $0 $0
− Basic $50 $50 $50
− Major $50 $50 $50
Preventive (Plan Pays) 100% Covered 100% Covered 100% Covered
Exams, X-Rays, Cleanings

Basic Services (Plan Pays) Ded, 90% Ded, 90% Ded, 80%
Fillings, Oral Surgery
Major Services (Plan Pays) Ded, 60% Ded, 60% Ded, 50%
Crowns, Prosthetics
− Orthodontia
− Covered Members Children Children Children
− Coinsurance 50% 50% 50%
− Lifetime Benefit Maximum $1,000 $1,000 $1,000
Tier You Pay Per Paycheck
Employee $5.64
Employee + spouse $35.73
Employee + child(ren) $49.61
Employee + family
$84.98

Note:
We strongly recommend you ask your dentist for a
predetermination if total charges are expected to Finding a Dental Provider
exceed $300. Predetermination enables you and • For Principal, go to www.principal.com/
your dentist to know in advance what the providers/dental-providers
payment will be for any service that may be in or call (800) 247-4695
question.

Employee Benefits 15