We'll Give You an Edgesm

WE'LL GIVE YOU AN EDGESM

Principal Life Insurance Company
We understand selecting the right medical design is important so, we’ve included additional options for you to consider. We offer a wide variety of designs and price points, one just right to meet your needs. This illustration is designed to give an estimate of the base rate savings for several alternate medical designs. Additional medical designs are available. This illustration assumes all other factors remain constant, including but not limited to area factor, industry, census, PPO network, etc.
Some benefit designs include additional contractual changes beyond the deductible and coinsurance amounts shown here. The amounts given here are preliminary. This is not an invitation to contract. Savings are not guaranteed. Before making your final buying decision, please review a full proposal for your selected benefit design. If you are interested in seeing other medical designs, please contact your representative for information.

• Principal Reimbursement Arrangement (listed as Principal Reim. Arr. PPO) is a benefit that reimburses a percent of the insured’s medical calendar year deductible and coinsurance expenses up to the single or family benefit listed. Unused benefits can roll over to future calendar years, up to a total benefit amount equal to the PPO out-of-pocket expense limit. The Principal Reimbursement Arrangement is not available in all states.
• For HDHP designs, the prescription drug coverage design listed does not apply. Calendar year deductible and coinsurance apply to covered prescription drugs. HDHP designs are not available in all states.
• If you currently have a High Deductible Health Plan (HDHP) which does not include a separate prescription drug design, prescription drug design 91 (in NE 92) was used in the calculation of alternate rates. A different prescription drug design may be selected if you choose to purchase a non-HDHP design.

• HDHP Common Family Deductible designs (listed as HDHP Common Family Ded) have calendar year deductibles and out-of-pocket expense limit maximums based on enrollment. If enrolled as a single individual, the self amounts apply. If enrolled with one or more dependents, the family amounts apply.
• HDHP Individual Deductible with Family Maximum designs (listed as HDHP Ind Ded w/ Fam Max) have two levels of calendar year deductibles and out-of-pocket expense limit maximums. A single member can satisfy the individual amount or one or more family members can satisfy the family amount.
• Not all of the alternates shown below meet HRA requirements. Contact your representative for information.

• For Comprehensive Medical Insurance without PPO, the references to PPO and non-PPO do not apply.

The percentage shown in the Estimated Cost Difference column is a comparison to the proposed medical benefit design. These are medical premium amounts and do not reflect the total premium for all coverages, if applicable. A negative Estimated Cost Difference amount represents a SAVINGS in cost. A positive Estimated Cost Difference amount represents an INCREASE in cost.
The estimated monthly premium or illustrated rates do not include Medicare premium. The premium and percentage cost difference includes only the non-Medicare population. A full proposal is needed to both finalize the total premium, as well as to fully understand the benefits and provisions that apply.
PRO indicates the design chosen at proposal
Provision Type / Benefit Design Number / Estimated
Cost Difference / Calendar Year Deductible (CYD) PPO/NonPPO / Out of Pocket
(PPO) Ind/Family
(NonPPO) Ind/Family / Coinsurance % / Physician Copay / Specialist Copay / Monthly
Premium
Estimate / Employee
Rate
Estimate / Employee & Spouse Rate Estimate / Family Rate Estimate / Employee &
Child(ren) Rate Estimate
Prescription Drug Design / 94 / Copay 15 / 35 / 50
Classic Plus PPO / 1775 / -9% / 5000/5000 / 5000/10000
15000/20000 / 100/70 / CYD / $27,759 / $343 / $757 / $1,050 / $636
Classic PPO / 1244 / 20% / 1500/3000 / 7500/10000
15000/20000 / 80/60 / 30/30 / $36,620 / $452 / $999 / $1,385 / $838
Classic PPO / 1290 / 19% / 2500/5000 / 2500/7500
10000/15000 / 100/70 / 30/30 / $36,479 / $450 / $995 / $1,380 / $835
Classic PPO / 1281 / 19% / 1500/3000 / 5000/7500
10000/15000 / 70/50 / 30/30 / $36,449 / $450 / $994 / $1,379 / $835
Classic PPO / 1248 / 18% / 1500/3000 / 3000/6000
6000/12000 / 80/60 / CYD / $36,237 / $447 / $988 / $1,370 / $829
Classic PPO / 1247 / 18% / 1500/3000 / 7500/10000
15000/20000 / 80/60 / 40/40 / $36,231 / $447 / $988 / $1,370 / $829
Classic PPO / 2257 / 17% / 2000/4000 / 2000/6000
8000/12000 / 100/70 / CYD / $35,974 / $444 / $981 / $1,361 / $824
Classic PPO / 2252 / 17% / 2000/4000 / 6000/8000
12000/16000 / 80/60 / 30/30 / $35,775 / $442 / $976 / $1,353 / $819
Classic PPO / 2253 / 17% / 2000/4000 / 5000/7500
10000/15000 / 80/60 / 40/40 / $35,695 / $441 / $974 / $1,351 / $818
Classic PPO / 1283 / 15% / 1500/3000 / 7500/10000
15000/20000 / 70/50 / 30/30 / $35,254 / $435 / $961 / $1,333 / $807
Classic PPO / 1249 / 15% / 1500/3000 / 5000/7500
10000/15000 / 80/60 / CYD / $35,214 / $435 / $961 / $1,333 / $807
Classic PPO / 2278 / 15% / 3000/6000 / 3000/9000
12000/18000 / 100/70 / 30/30 / $35,086 / $433 / $957 / $1,327 / $803
Classic PPO / 1251 / 14% / 2500/5000 / 5000/7500
10000/15000 / 80/60 / 30/30 / $34,975 / $432 / $954 / $1,323 / $801
Classic PPO / 2254 / 13% / 2000/4000 / 7500/10000
15000/20000 / 80/60 / 40/40 / $34,736 / $429 / $948 / $1,314 / $795
Classic PPO / 1253 / 13% / 2500/5000 / 5000/7500
10000/15000 / 80/60 / 40/40 / $34,589 / $427 / $943 / $1,308 / $792
Classic PPO / 2255 / 12% / 2000/4000 / 4000/6000
8000/12000 / 80/60 / CYD / $34,378 / $424 / $937 / $1,300 / $787
Classic PPO / 2259 / 12% / 2000/4000 / 6000/10000
12000/20000 / 70/50 / 30/30 / $34,271 / $423 / $935 / $1,297 / $785
Classic PPO / 1252 / 10% / 2500/5000 / 7500/10000
15000/20000 / 80/60 / 30/30 / $33,793 / $417 / $921 / $1,278 / $774
Classic PPO / 1270 / 9% / 2500/5000 / 2500/7500
10000/15000 / 100/70 / CYD / $33,481 / $413 / $913 / $1,266 / $766
Classic PPO / 2271 / 9% / 3000/6000 / 6000/9000
12000/18000 / 80/60 / 30/30 / $33,413 / $413 / $912 / $1,265 / $766
Classic PPO / 1254 / 9% / 2500/5000 / 7500/10000
15000/20000 / 80/60 / 40/40 / $33,407 / $412 / $911 / $1,263 / $764
Classic PPO / 2256 / 8% / 2000/4000 / 6000/8000
12000/16000 / 80/60 / CYD / $33,095 / $409 / $903 / $1,252 / $758
Classic PPO / 1289 / 8% / 2500/5000 / 7500/10000
15000/20000 / 70/50 / 30/30 / $32,929 / $407 / $899 / $1,246 / $754
Classic PPO / 2273 / 6% / 3000/6000 / 7500/10000
15000/20000 / 80/60 / 40/40 / $32,525 / $402 / $887 / $1,230 / $745
Classic PPO / 2272 / 5% / 3000/6000 / 9000/12000
18000/23000 / 80/60 / 30/30 / $32,228 / $398 / $879 / $1,219 / $738
Classic PPO / 1255 / 4% / 2500/5000 / 5000/7500
10000/15000 / 80/60 / CYD / $31,875 / $394 / $870 / $1,206 / $730
Classic PPO / 1271 / 3% / 3000/6000 / 3000/9000
15000/20000 / 100/70 / CYD / $31,511 / $389 / $859 / $1,191 / $721
Classic PPO / 2274 / 2% / 3000/6000 / 10000/15000
20000/30000 / 80/60 / 40/40 / $31,324 / $387 / $855 / $1,185 / $717
Classic PPO / 2277 / 2% / 3000/6000 / 9000/12000
18000/23000 / 70/50 / 30/30 / $31,198 / $385 / $851 / $1,180 / $714
Classic PPO / 2258 / 2% / 2000/4000 / 6000/10000
12000/20000 / 70/50 / CYD / $31,189 / $385 / $851 / $1,180 / $714
Classic PPO / 1256 / 0% / 2500/5000 / 7500/10000
15000/20000 / 80/60 / CYD / $30,693 / $379 / $837 / $1,161 / $703
PRO / Classic PPO / 1295 / 0% / 5000/10000 / 5000/15000
20000/30000 / 100/70 / 30/30 / $30,632 / $378 / $835 / $1,158 / $701
Classic PPO / 1257 / -1% / 5000/10000 / 7500/10000
15000/20000 / 80/60 / 30/30 / $30,439 / $376 / $830 / $1,151 / $697
Classic PPO / 1288 / -4% / 2500/5000 / 7500/10000
15000/20000 / 70/50 / CYD / $29,511 / $364 / $805 / $1,116 / $675
Classic PPO / 2275 / -6% / 3000/6000 / 9000/12000
18000/23000 / 80/60 / CYD / $28,812 / $356 / $786 / $1,090 / $660
Classic PPO / 1258 / -7% / 5000/10000 / 10000/15000
20000/30000 / 80/60 / 30/30 / $28,377 / $350 / $774 / $1,073 / $649
Classic PPO / 1260 / -9% / 5000/10000 / 10000/15000
20000/30000 / 80/60 / 40/40 / $28,001 / $346 / $764 / $1,059 / $641
Classic PPO / 2276 / -10% / 3000/6000 / 9000/12000
18000/23000 / 70/50 / CYD / $27,562 / $340 / $751 / $1,042 / $631
Classic PPO / 1294 / -11% / 5000/10000 / 10000/15000
20000/30000 / 70/50 / 30/30 / $27,379 / $338 / $747 / $1,036 / $627
Classic PPO / 1261 / -15% / 5000/10000 / 7500/10000
15000/20000 / 80/60 / CYD / $26,095 / $322 / $712 / $987 / $597
Classic PPO / 1273 / -16% / 5000/10000 / 5000/15000
20000/30000 / 100/70 / CYD / $25,792 / $318 / $703 / $975 / $590
Classic PPO / 1262 / -22% / 5000/10000 / 10000/15000
20000/30000 / 80/60 / CYD / $24,037 / $297 / $656 / $910 / $551
Classic Value PPO / 1402 / 20% / 1000/2000 / 5000/10000
10000/20000 / 80/50 / 25/40 / $36,804 / $454 / $1,003 / $1,391 / $842
Classic Value PPO / 1403 / 15% / 1000/2000 / 5000/10000
10000/20000 / 70/50 / 25/40 / $35,242 / $435 / $961 / $1,333 / $807
Classic Value PPO / 1404 / 11% / 1500/3000 / 7500/15000
15000/30000 / 80/50 / 35/50 / $33,952 / $419 / $926 / $1,284 / $777
Classic Value PPO / 1405 / 6% / 1500/3000 / 7500/15000
15000/30000 / 70/50 / 35/50 / $32,323 / $399 / $881 / $1,222 / $740
Classic Value PPO / 1406 / -1% / 2500/5000 / 10000/20000
20000/40000 / 80/50 / 35/50 / $30,411 / $375 / $829 / $1,150 / $696
Classic Value PPO / 1407 / -5% / 2500/5000 / 10000/20000
20000/40000 / 70/50 / 35/50 / $28,990 / $358 / $791 / $1,097 / $664
Classic Value PPO / 1408 / -18% / 5000/10000 / 10000/20000
20000/40000 / 70/50 / 35/50 / $25,041 / $309 / $683 / $947 / $573
HDHP Common Family Ded / 1782 / 16% / 1500/3000 / 5000/10000
10000/20000 / 80/60 / CYD / $35,539 / $439 / $969 / $1,344 / $814
HDHP Common Family Ded / 1783 / 14% / 2000/4000 / 3000/6000
6000/12000 / 80/60 / CYD / $34,914 / $431 / $952 / $1,320 / $799
HDHP Common Family Ded / 1785 / 12% / 2500/5000 / 2500/5000
10000/20000 / 100/70 / CYD / $34,271 / $423 / $935 / $1,297 / $785
HDHP Common Family Ded / 1784 / 8% / 2000/4000 / 5000/10000
10000/20000 / 80/60 / CYD / $33,205 / $410 / $906 / $1,256 / $760
HDHP Common Family Ded / 1787 / 5% / 3000/6000 / 3000/6000
10000/20000 / 100/70 / CYD / $32,176 / $397 / $877 / $1,216 / $736
HDHP Common Family Ded / 1786 / 1% / 2500/5000 / 5000/10000
10000/20000 / 80/60 / CYD / $31,070 / $384 / $848 / $1,176 / $712
HDHP Common Family Ded / 1788 / -3% / 3000/6000 / 5000/10000
10000/20000 / 80/60 / CYD / $29,584 / $365 / $807 / $1,119 / $677
HDHP Common Family Ded / 1789 / -17% / 5000/10000 / 5000/10000
15000/30000 / 100/70 / CYD / $25,311 / $312 / $690 / $957 / $579
HDHP Ind Ded W/ Fam Max / 2795 / 13% / 2550/5000 / 2550/5100
10000/20000 / 100/70 / CYD / $34,715 / $429 / $947 / $1,313 / $795
HDHP Ind Ded W/ Fam Max / 2783 / 10% / 2750/5500 / 2750/5500
10000/20000 / 100/70 / CYD / $33,805 / $417 / $922 / $1,279 / $774
HDHP Ind Ded W/ Fam Max / 2785 / 4% / 3250/6500 / 3250/6500
10000/20000 / 100/70 / CYD / $31,860 / $393 / $869 / $1,205 / $729
HDHP Ind Ded W/ Fam Max / 2796 / 2% / 2550/5000 / 5000/10000
10000/20000 / 80/60 / CYD / $31,370 / $387 / $855 / $1,186 / $718
HDHP Ind Ded W/ Fam Max / 2784 / 0% / 2750/5500 / 5000/10000
10000/20000 / 80/60 / CYD / $30,739 / $379 / $838 / $1,162 / $703
HDHP Ind Ded W/ Fam Max / 2786 / -4% / 3250/6500 / 5000/10000
10000/20000 / 80/60 / CYD / $29,373 / $363 / $801 / $1,111 / $673
Principal Reim. Arr. PPO / 1803 / 19% / 2000/4000 / 7500/15000
15000/30000 / 80/60 / CYD / $36,323 / $448 / $990 / $1,373 / $831
Principal Reim. Arr. PPO / 1813 / 17% / 2000/4000 / 7500/15000
15000/30000 / 80/60 / CYD / $35,974 / $444 / $981 / $1,361 / $824
Principal Reim. Arr. PPO / 1816 / 16% / 3000/6000 / 7500/15000
15000/30000 / 80/60 / CYD / $35,643 / $440 / $972 / $1,348 / $816
Principal Reim. Arr. PPO / 1808 / 13% / 2000/4000 / 7500/15000
15000/30000 / 80/60 / CYD / $34,599 / $427 / $943 / $1,308 / $792
Principal Reim. Arr. PPO / 1810 / 12% / 3000/6000 / 7500/15000
15000/30000 / 80/60 / CYD / $34,225 / $423 / $934 / $1,295 / $784
Principal Reim. Arr. PPO / 1804 / 8% / 3000/6000 / 7500/15000
15000/30000 / 80/60 / CYD / $33,033 / $408 / $901 / $1,249 / $756
Principal Reim. Arr. PPO / 1815 / 7% / 3000/6000 / 7500/15000
15000/30000 / 80/60 / CYD / $32,684 / $404 / $892 / $1,237 / $749
Principal Reim. Arr. PPO / 1809 / 2% / 3000/6000 / 7500/15000
15000/30000 / 80/60 / CYD / $31,309 / $387 / $854 / $1,184 / $717

Employee Benefits from Principal Life Insurance Company

GP48422-11 09/2006 11170911485-3 TEXAS QUALITY CARENovember 17, 2009Page 1