Page 10 - Oremor Benefits Flipbook
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Benefits






         Dental Insurance

         DHMO Dental Plan | California Dental Network
         With the Dental Health Maintenance Organization (DHMO) plan through California Dental Network, you are required to select a
         general dentist to provide your dental care. You will contact your general dentist for all of your dental needs, such as routine check‐
         ups and emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. For covered
         procedures, you'll pay the pre‐set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of your
         booklet to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services that
         are covered under this plan.

         DPOS Dental Plan | Principal Financial Group
         With  the  Principal  Financial Group  Dental  Preferred  Provider  Organization  (DPOS)  dental  plan,  you  may  visit  an  EPO  or  a  PPO
         dentist and benefit from the negotiated rate or visit a non‐network dentist. When you utilize an EPO or 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.


                                      CA Dental Network                     Principal Financial Group
         Plan Name                       DHMO Plan                                 DPOS Plan

         Network Name                      Network              EPO Network        PPO Network        Non-Network
         Dental Benefits
         Calendar Year Maximum             Unlimited               $2,000             $1,500            $1,000

         Deductible (Annual)
          - Individual                        $0                                       $50
          - Family Limit                      $0                                      $150
         Preventive                        No Charge              No Charge         No Charge          No Charge
         Exams, X-Rays, Cleanings       for Most Services

         Basic Services                See Copay Schedule      Deductible, 20%    Deductible, 20%    Deductible, 30%
         Fillings, Oral Surgery,
         Endodontics, Periodontics
         Major Services                See Copay Schedule      Deductible, 50%    Deductible, 50%    Deductible, 60%
         Crowns, Prosthetics
         Orthodontia
          - Covered Members             Children & Adults      Children & Adults   Children & Adults   Children & Adults
          - Copay                   $1,775 Child / $1,975 Adult     N/A                N/A                N/A
          - Coinsurance                      N/A                    50%                50%               50%
          - Lifetime Benefit Maximum         N/A                   $1,500             $1,500            $1,000


                         California Dental Network: Provider Finder Instructions
                            Website: Go to www.caldental.net. Select “Find a Dentist” and enter a zip code for the area you would
                             like to search.
                            Telephone: Call (877) 433-6825

                         Principal Financial Group: Provider Finder Instructions
                            Website: Go to www.principal.com. Select “Provider Finder” and select “Search for a Dental Provider.”
                             Enter a state and select the “Principal POS Plan”.
                            Telephone: Call (800) 247-4695


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