Page 6 - Kagan Benefit Guide Out of CA.pub

Benefits

Dental Insurance

Principal | PPO Dental Plan
With the Principal Preferred Provider Organiza on dental plan, you may visit a PPO den st and benefit from the nego ated rate or
visit a non‐network den st. With PPO, the benefit received is determined at the me of service depending on the type of provider
you visit for care. 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.

Note
We strongly recommend you ask your den st for a predetermina on if total charges are ex‐
pected to exceed $300. Predetermina on enables you and your den st to know in advance what
the payment will be for any service that may be in ques on.

Principal
Plan Features PPO Plan
Network Name PPO Non‐Network
Calendar Year Maximums $2,000 $1,500

Deduc ble (Annual) $50/$150 $50/$150
‐ Individual / Family

Preven ve (Plan Pays) 100% 100%
Exams, X‐Rays, Cleanings Deduc ble waived
Basic Services (Plan Pays) 80% 80%
Fillings, Oral Surgery,
Endodon cs, Periodon cs

Major Services (Plan Pays) 50% 50%
Crowns, Prosthe cs

Orthodon a
Children & Adults
‐ Coinsurance 50%
‐ Life me Benefit Maximum $1,500
Rollover Feature 50% up to $1,000

Finding a Dental Provider
Go to www.principal.com or call (800)
986‐3343. PPO par cipants should refer
to the PPO network .

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