The Principal Dental Insurance with First Dental Health’s Exclusive Provider Organization (EPO) gives you access to a network of dental care providers. Benefits are not payable if you see a provider outside of the EPO network unless emergency treatment is required.
Predetermination of Benefits:Before treatment begins for inlays, onlays, single crowns, prosthetics, periodontics, and oral surgery, you may file a dental treatment plan with Principal Life Insurance Company. Principal will provide a written response indicating benefits that may be payable for the proposed treatment.
Network facilities can be found online at:
www.principal.com/dentist
| Principal EPO Dental Plan |
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| Network: First Dental Health EPO Group: 1092308 Member Services: (800) 247-4695 |
EPO Network |
| Annual Max (per person) |
$1,000 |
| Deductible | $50 per person $150 per family |
| Waived for Preventive | Yes |
| Preventive | |
| Preventive and Diagnostic | 100% |
| Basic | |
| Fillings Amalgam | 80% |
| Endodontic Treatment | 80% |
| Periodontic Treatment Oral Surgery: Extractions and Other Surgical Procedures |
80% 80% |
| Major | |
| Crowns, Jackets and Cast Restoration |
50% |
| Prosthodontics Benefits (Fixed Bridges, Partial/Complete Dentures) |
50% |
| Orthodontics | |
| Children (up to age 19) Adults |
50% - $1,000 Lifetime Max Not Available |
The Principal Point of Service (POS) benefit design has three levels of benefits availa-ble:
Using in network providers will result in a greater savings as services are based on reduced fees, which the providers agree to accept as “payment in full”, after payment of your coinsurance, if applicable.
EPO providers agree to accept lower fees than PPO providers, which in turn lowers your out of pocket expenses even further.
Out of network providers bill full service fees and patients are required to pay billed amounts in excess of insurance coverage allowances, commonly referred to as “balance billing”.
To find a network provider, visit:
www.prinicpal.com/dentist
| Blue Shield of CA Gold Full PPO 750/30 OffEx |
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| Group: W0098486 Member Services: (888) 319-5999 |
EPO Network |
PPO Network |
Out of Network |
| Annual Max | $1,500 | ||
| Deductible | $50 Individual/ $150 Family |
||
| Waived for Preventive | Yes | ||
| Preventive | |||
| Annual Max | 100% | 100% | 100% |
| Basic | |||
| Fillings Amalgam | 80% | 80% | 80% |
| Endodontic Treatment | 80% | 80% | 80% |
| Periodontic Treatment Oral Surgery: Extractions and Other Sugical Procedures |
80% 80% |
80% 80% |
80% 80% |
| Major | |||
| Crowns, Jackets and Cast Restoration |
50% | 50% | 50% |
| Prosthodontic Benefits (Fixed Bridges, Partial/Complete Dentures) |
50% | 50% | 50% |
| Major | |||
| Children (up to age 19) Adults |
50% - $1,000 Lifetime Max Not Available |
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