Please read the following information. You are not required to conduct business electronically or to receive or sign this application electronically. If you wish to apply using a paper application or do not wish to sign your application electronically, you do not need to consent to the terms of this Disclosure and Consent.
By proceeding forward and electronically indicating your acceptance of the terms of this Disclosure and Consent you are agreeing that you have reviewed the following information and voluntarily consent to the terms of this Disclosure and Consent and to conduct business electronically, for the purpose of submitting this application.
Scope of Consent
By electronically indicating your acceptance of the terms of this Disclosure and Consent, you voluntarily consent to submit information and sign electronically all documents relating to your application to be included in The Principal Dental Plan PPO, hereinafter referred to as Principal PPO. You also accept and agree to be bound by the Disclosures and Terms of Use that apply to the websites of Principal Financial Group®. The Disclosures may be viewed by clicking on the link at the bottom of each page on principal.com.
Paper Copies
We recommend that you print or save this Consent to retain a copy for your records. You may also contact Principal PPO using one of the methods shown below to receive a printed copy of the consent or your application.
Contact Information
Please use one of the following methods to contact the Principal Provider Network Management team to request a free paper copy of your electronic application or this consent form:
· Email Address for Specialty Benefits Division: PLICInquiries@principal.com
· Telephone: 1-800-247-4695
· Postal Address: Specialty Benefits Division, Dental Network, Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392-0432
· On Principal’s website at: www.principal.com/contact-us
Computer Hardware and Software Requirements
The computer hardware and software used to electronically access this Disclosure and Consent and the attached application are all you will need to electronically access the Disclosure and Consent and documents and information related to your application to be included in the Principal PPO. This includes your use of a standards-compliant web-browser which supports the HTTPS protocol, HTML, and acceptance of cookies in your security settings. Viewing and retention of PDF documents requires additional software (available free for Download) such as Adobe Reader or similar.
Consent
I agree to do business electronically and to electronically sign documents related to my application to be included in the Principal PPO. I have been able to read this notice using my computer and software. I have access to an account with an internet service provider and I am able to send and receive email.