Page 10 - 2020 Oremor OOS_EE Benefits Guide

Benefits

Dental Insurance

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.

Principal Financial Group
Plan Name DPOS Plan

Network Name EPO Network PPO Network Non-Network

Dental Benefits

Calendar Year Maximum $2,000 $1,500 $1,000

Deductible (Annual)
- Individual $50
- Family Limit $150

Preventive No Charge No Charge No Charge
Exams, X-Rays, Cleanings

Basic Services Deductible, 20% Deductible, 20% Deductible, 30%
Fillings, Oral Surgery,
Endodontics, Periodontics

Major Services Deductible, 50% Deductible, 50% Deductible, 60%
Crowns, Prosthetics

Orthodontia
- Covered Members Children & Adults Children & Adults Children & Adults
- Copay N/A N/A N/A
- Coinsurance 50% 50% 50%
- Lifetime Benefit Maximum $1,500 $1,500 $1,000

Principal Financial Group: Provider Finder Instructions
Website: Go to https://c3.go2dental.com/member/dental_search/searchprov.cgi. Click on “Search the directory”
• Enter a state and select the “Principal POS Plan”.
• Telephone: Call (800) 247-4695

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