Understanding Your Principal PPO Dental Plan: Deductible, Copay, Annual Maximum, and Waiting Period
Understanding Your Dental Plan
Dental insurance language can feel confusing, especially if you are trying to plan treatment or avoid surprise bills. Principal PPO dental plans use a few core concepts — deductible, copay/coinsurance, annual maximum, and waiting period — to define how costs are shared between you and the insurance company. Once you understand these terms, it becomes much easier to budget, time your visits, and use your benefits before they expire.
Deductible: Your First Portion of the Bill
A deductible is the amount you pay out of pocket each benefit year before your Principal PPO starts paying for covered services (often for basic and major treatment).
Example:
Your Principal PPO deductible is 50 dollars per person.
You need a filling that costs 200 dollars at the negotiated PPO fee.
You pay the first 50 dollars to meet your deductible.
The plan then applies its coverage (for example, 80 percent on the remaining 150 dollars), so Principal might pay 120 dollars and you pay 30 dollars more.
Some Principal designs waive the deductible for preventive services like cleanings and exams, so you may pay nothing out of pocket for those even if your deductible is not met.
Copay and Coinsurance: Your Share After Insurance Pays
After the deductible, most PPO plans use coinsurance — a percentage split between you and the plan. (Some offices and plans also use the word “copay” for a set dollar amount.)
Example basic service (filling):
PPO fee: 200 dollars
Deductible already met
Plan covers 80 percent for basic services
Principal pays 160 dollars, you pay 40 dollars.
Example major service (crown):
PPO fee: 1,000 dollars
Deductible already met
Plan covers 50 percent for major services
Principal pays 500 dollars, you pay 500 dollars.
Your exact percentages depend on your specific Principal PPO summary, but the idea is the same: the higher the coverage percentage, the lower your share.
Annual Maximum: The “Use It or Lose It” Limit
The annual maximum is the total amount your Principal PPO will pay toward covered services in one plan year. Many dental plans set this somewhere between about 1,000 and 2,000 dollars per person, but your exact number will be listed in your benefit summary.
Example:
Your annual maximum is 1,500 dollars.
Principal has already paid 600 dollars toward your treatment this year.
You still have 900 dollars of benefits available.
If you need additional work and Principal would owe more than 900 dollars based on your coverage, anything beyond that 900 dollars comes fully out of pocket.
Most plans reset on January 1, and unused benefits do not roll over, which is why many practices remind patients in the fall not to let remaining coverage expire.
Waiting Period: When Coverage Starts for Different Services
Some Principal PPO dental plans include a waiting period for certain types of services, especially major procedures. A waiting period is the amount of time you must be covered under the plan before it will pay for those services.
Common patterns in the market include:
No waiting period for preventive services like cleanings and exams.
A few months’ waiting period for basic services such as fillings (varies by plan).
Longer waiting periods for major services such as crowns, root canals, or dentures.
Always check your own Principal PPO documents, because employer groups can customize waiting periods or waive them in some situations.
By understanding how deductible, coinsurance, annual maximum, waiting periods, and in‑network discounts work together in a Principal PPO dental plan, you can make smarter decisions about when and where to schedule treatment. That means fewer surprises, better use of benefits, and a clearer path to maintaining your oral health each year.
Why Patients in the Biltmore and Arcadia Areas, Camelback Rd Choose Us
The Biltmore, Arcedia neighborhoods are known for its upscale, busy lifestyle, so our office is designed to be efficient, comfortable, and easy to reach from nearby homes, offices, and shopping. Patients appreciate that they can fit a cleaning in before work, come by on a lunch break, or stop in after errands without crossing town.
Inside the practice, we focus on a modern approach to care: digital X‑rays, comfortable treatment chairs, and streamlined check‑in so you spend more time with the doctor and less time in the waiting room. Many Biltmore patients tell us they value clear communication about treatment options and insurance, along with a friendly team that remembers their preferences.
For professionals, frequent travelers, and families in the Biltmore area, it’s important to have a dentist who respects their schedule, offers online scheduling and reminders, and can coordinate care around work and school commitments. That combination of convenience, technology, and personalized attention is why so many local patients choose - and stay with - Smile 24 Dentistry.