Page 10 - Oremor Benefits Flipbook

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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