Principal Dental
Ursus Inc. offers the choice of two different dental plans to help you maintain your oral health. With the Principal Dental plan, you can keep your teeth and gums healthy by getting a free checkup twice a year. If you need treatment or have a dental emergency, the plan also pays a portion of those costs. If you receive in-network services, you will be responsible for any applicable cost sharing, negotiated charges after benefit maximums are met and costs for non-covered services. If you receive out-of-network services, you will be responsible for any applicable cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount and charges for non-covered services.
Dental PPO | |||
Principal | |||
1500 Basic 99th Ortho | |||
Benefits | In Network | Out of Network | |
Annual Max | $1,500 | $1,250 | |
Orthodontia Lifetime Max | $1,000 | $1,000 | |
Deductible | |||
Waived for Preventative | Yes | Yes | |
Individual | $50 | $75 | |
Family | $150 | $225 | |
Co-Insurance | |||
Preventive | 100% | 80% | |
Basic | 80% | 80% | |
Major | 50% | 50% | |
Periodontal Surgery | Basic | ||
Endodontic Surgery | Basic | ||
Usual & Customary | Fee Schedule | 99th |