Dental Insurance
The County Dental Insurance is provided through The Principal Financial Group
Send claims to:
The Principal Life Insurance Company
P.O. Box 39710
Colorado Springs, CO 80949-3910
Account Number: 1001742
Payor Number: 61271
For customer service call: 1-800-247-4695
The below chart indicates the levels of coverage provided:
| Diagnostic & Preventive |
Basic Services |
Major Services | Orthodontics | Annual Maximum Per Person |
|
100% |
80% |
50% |
$1,000 per child |
$1,000 |
Basic and major services have a $50 annual deductible per person; $150 family maximum per calendar year.
- The annual maximum per person applies to all expenses except orthodontia. Orthodontia expenses have a separate lifetime limit.
- Only dependent children under the age of 19 are eligible for orthodontia
Benefit rollover
For Preventive, Basic and/or Major services, at the end of each calendar year, if you or your dependent(s) have:
- received at least one procedure performed during that calendar year; and
- used $500 or less of benefits during the calendar years;
the balance of any unused benefits or any difference between paid claims and up to 50% of $500 for each insured person will carry-over ("roll-over") into the next calendar year. These benefits will be combined with the Maximum Payment Limit for the current calendar year and will be payable at the same level up to a maximum amount of $1,000. In the event that an insured person does not receive at least one procedure in any year, any current or previous amount carried over for that insured person would be forfeited.
Diagnostic & Preventive:
- Examinations
(Oral, Periodic or Office Visit) Covered once in any 12 consecutive month period. - Radiographs
- Routine Cleaning
Limited to two in any 12 consecutive month period. - Flouride Treatments
Applicable only to dependent children under the age of 16. Only two applications will be covered in any 12 consecutive month period. - Sealants
Applicable only to first and second permanent molars for dependent children under age 16. Covered once each tooth in any 36 consecutive month period. - Other Services
Harmful Habit Appliance, limited to one time per person under age 16.
Space Maintainers, applicable to dependent children under age 16.
Basic Services:
- Restorations
Fillings, Anterior and Posterior restorations, Replacement of existing fillings if at least 24 consecutive months have passed since replacement of prior fillings, composite restorations of molar teeth, Crowns. - Endodontic Services
Vital pupotomy, Root canal therapy. - Periodontic Services
Scaling, root planing (covered once each quadrante in any 24 consecutive month period), full mouth debridement (covered once per lifetime), periodontal prophylaxis. - Periodontal Surgical Procedures
Gingival flap procedure, gingivectomy, osseus surgery. - Oral Surgery
Simple extraction, surgical removal of erupted tooth, root removal, incision and drainage of dental abscess, soft tissue biopsy. - Other Oral Surgical Procedures
Extraction of impacted teeth, surgical root removal, removal of dental cysts and tumors. - Anesthesia
General anesthesia, IV sedation. - Other Services
Emergency examination, consultation with specialist, antibiotic drug injection, palliative treatment.
Major procedures:
- Restorations
Inlays, onlays, crowns. -
Prosthodontics
Fixed bridges, initial placement or replacement, complete or partial dentures.
Orthodontia:
- For children under the age of 19 when appliance or bands are initially placed.
- Formal, full-banded retention and treatment, including x-rays and other diagnostic procedures.
- Removable or fixed appliances for tooth or bony structure guidance or retention.
