Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392 GP62509-21 1156118 - 10001 Page 2 of 5 02/2026 Who can buy coverage? · You may buy coverage if you’re an active, full-time employee. Seasonal, temporary, or contract employees can’t purchase. o If you’re on regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal time off, you’re still considered actively at work, as long as you’re fulfilling your regular duties and were working the day immediately prior to your time off. o You must enroll within 31 days of being eligible. If you don’t, you’ll have to wait until the next open enrollment period, or qualifying event. Additional eligibility requirements may apply. Which procedures are covered, and how often? Preventive Routine exams Twice per calendar year Routine cleanings Twice per calendar year Bitewing X-rays Once per calendar year Full mouth X-rays Once every 36 months Fluoride Twice per calendar year (covered only for dependent children under age 16) Sealants Covered only for dependent children under age 16 once on first and second permanent molars (1 per each 36 months) Basic Emergency exams Twice per calendar year Periodontal maintenance If three months have passed since active surgical periodontal treatment; twice per calendar year Fillings Replacement fillings every 24 months Oral surgery Simple and complex General anesthesia / IV sedation Covered only for specific procedures Simple endodontics Root canal therapy for anterior teeth Complex endodontics Root canal therapy for molar teeth Non-surgical periodontics, including scaling and root planing Once per quadrant per 24 months Periodontal surgical procedures Once per quadrant per 36 months Harmful habit appliance Covered only for dependent children under age 16