Page 12 - Murphy Benefits Guide
P. 12
Dental
Murphy Company partners with Cigna to offer you the choice between
two dental plan options: a DPPO and DHMO plan.
The DPPO plan offers two network options—the Cigna DPPO
Advantage Network and the Cigna DPPO Network. Beneits by network
are outlined below.
In-Network
Dental PPO Cigna DPPO In-Network Out-of-Network
Advantage Cigna DPPO
Calendar Year Deductible
Individual $50 per person $50 per person $50 per person
Family $150 per family $150 per family $150 per family
Calendar Year Maximum
$1,000 $750 $750
Coinsurance (Plan pays)
Preventive 100% no 80% no 80% no
deductible deductible deductible
Basic 80% after 60% after 60% after
deductible deductible deductible
Major 50% after 40% after 40% after
deductible deductible deductible
Find an In-Network Orthodontia Not Covered Not Covered Not Covered
Provider
Remember to visit in-network Beneits in the DHMO plan are based on a schedule of beneits and vary
dentists to receive the deepest level by service. Please refer to the beneit summary for more information.
of discount on your services.
To ind a participating in-network Monthly Contributions
dentist in your area go to DPPO DHMO
www.cigna.com and click on “Find Employee $7.76 $4.59
a Doctor, Dentist, or Facility.”
Employee and Spouse $41.41 $25.02
Covered Services Employee and Child(ren) $42.29 $31.44
$75.93
$51.64
Employee and Family
X Preventive—exams, cleanings,
luoride, x-rays, and sealants
This is a high level summary of your beneit coverage. Full coverage details are available in your
X Basic—illings, extractions, summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
periodontics, repairs, an d oral
surgery
X Major—crowns, inlays, dentures,
and dental implants
12 2020 Benefits Guide
Murphy Company partners with Cigna to offer you the choice between
two dental plan options: a DPPO and DHMO plan.
The DPPO plan offers two network options—the Cigna DPPO
Advantage Network and the Cigna DPPO Network. Beneits by network
are outlined below.
In-Network
Dental PPO Cigna DPPO In-Network Out-of-Network
Advantage Cigna DPPO
Calendar Year Deductible
Individual $50 per person $50 per person $50 per person
Family $150 per family $150 per family $150 per family
Calendar Year Maximum
$1,000 $750 $750
Coinsurance (Plan pays)
Preventive 100% no 80% no 80% no
deductible deductible deductible
Basic 80% after 60% after 60% after
deductible deductible deductible
Major 50% after 40% after 40% after
deductible deductible deductible
Find an In-Network Orthodontia Not Covered Not Covered Not Covered
Provider
Remember to visit in-network Beneits in the DHMO plan are based on a schedule of beneits and vary
dentists to receive the deepest level by service. Please refer to the beneit summary for more information.
of discount on your services.
To ind a participating in-network Monthly Contributions
dentist in your area go to DPPO DHMO
www.cigna.com and click on “Find Employee $7.76 $4.59
a Doctor, Dentist, or Facility.”
Employee and Spouse $41.41 $25.02
Covered Services Employee and Child(ren) $42.29 $31.44
$75.93
$51.64
Employee and Family
X Preventive—exams, cleanings,
luoride, x-rays, and sealants
This is a high level summary of your beneit coverage. Full coverage details are available in your
X Basic—illings, extractions, summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
periodontics, repairs, an d oral
surgery
X Major—crowns, inlays, dentures,
and dental implants
12 2020 Benefits Guide
