Page 11 - TVS 2022 Benefits Guide
P. 11
2022 Benefits Guide
Voluntary Dental To view your weekly pay
Dental insurance is provided through Cigna. Please deductions, please review
see below for a high level description of the plan. the 2022 rate sheet.
More detailed beneit summaries are available
through Human Resources.
Cigna
In-Network Out-of-Network
Calendar Year Deductible*
Individual $50 $50
Family $150 $150
Oice Visit Copay None None
Calendar Year $1,000 $1,000
Maximum**
Usual and Customary N/A 90th
Percentage
Coinsurance
Preventive Covered at 100% Covered at 100%
no deductible
no deductible
Basic 10% after 20% after
deductible
deductible
Major 40% after 50% after
deductible
deductible
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $1,000
Beneit Applies To Children to age 19
* Deductibles do not apply to preventive services.
** Calendar year maximum increases $250 each year if you receive
preventive services to a maximum of $1,750.
Dental Provider Search
1. Go to www.mycigna.com
2. Click on “Find a Doctor” or “Help” at the top of
the page
3. Enter your search word or words and click
“Search,” OR
4. Click on “Dentist” under the “Find a Person”
heading and double-click a specialty dentist
by grouping
11
Voluntary Dental To view your weekly pay
Dental insurance is provided through Cigna. Please deductions, please review
see below for a high level description of the plan. the 2022 rate sheet.
More detailed beneit summaries are available
through Human Resources.
Cigna
In-Network Out-of-Network
Calendar Year Deductible*
Individual $50 $50
Family $150 $150
Oice Visit Copay None None
Calendar Year $1,000 $1,000
Maximum**
Usual and Customary N/A 90th
Percentage
Coinsurance
Preventive Covered at 100% Covered at 100%
no deductible
no deductible
Basic 10% after 20% after
deductible
deductible
Major 40% after 50% after
deductible
deductible
Orthodontia
Coinsurance 50% 50%
Lifetime Maximum $1,000 $1,000
Beneit Applies To Children to age 19
* Deductibles do not apply to preventive services.
** Calendar year maximum increases $250 each year if you receive
preventive services to a maximum of $1,750.
Dental Provider Search
1. Go to www.mycigna.com
2. Click on “Find a Doctor” or “Help” at the top of
the page
3. Enter your search word or words and click
“Search,” OR
4. Click on “Dentist” under the “Find a Person”
heading and double-click a specialty dentist
by grouping
11
