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UNDERSTANDING
YOUR
DENTAL
PLAN
Dental Questions? Need to Locate a Provider?
Contact Principal
1-800-986-3343 or
www.prinicpal.com9
Type of Plan
Out-of-Network
(*Subject to 90th Percentile of
Reasonable and Customary)
Deductible
Single: $25
Family: $75
Annual Maximum Benefit
(per member enrolled)
Unit 1-Preventive Services
(oral exam, cleaning, x-rays)
100%*
Unit 2-Basic Services
(fillings, root canal, oral surgery, periodontics)
80% after Deductible*
Unit 3-Major Services
(crowns, dentures, bridges)
50% after Deductible*
Orthodontia Services
Contribution
Monthly
Semi-Monthly
Bi-Weekly
Employee
$17.07
$8.54
$7.88
Employee + Spouse
$57.94
$28.97
$26.74
Employee + Child(ren)
$62.56
$31.28
$28.87
Employee + Family
$107.48
$53.74
$49.60
Type of Plan
Out-of-Network
(*Subject to 90th Percentile of
Reasonable and Customary)
Deductible
Single: $25
Family: $75
Annual Maximum Benefit
(per member enrolled)
Unit 1-Preventive Services
(oral exam, cleaning, x-rays)
100%*
Unit 2-Basic Services
(fillings, root canal, oral surgery, periodontics)
80% after Deductible*
Unit 3-Major Services
(crowns, dentures, bridges)
50% after Deductible*
Unit 4-Orthodontia Services
(child and adult)
Contribution
Monthly
Semi-Monthly
Bi-Weekly
Employee
$19.72
$9.86
$9.10
Employee + Spouse
$63.46
$31.74
$29.29
Employee + Child(ren)
$68.27
$34.14
$31.51
Employee + Family
$116.36
$58.18
$53.70
50% after Deductible
80% after Deductible
100%
Single: $25
Family: $75
In-Network
Dental Coverage
Principal - Low Option PPO
$1,000
Not Covered
Principal - High Option PPO
$1,000
Plan pays 50%, $1,000 Lifetime Benefit
50% after Deductible
80% after Deductible
100%
Single: $25
Family: $75
In-Network