Page 13 - OE Guide
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Dental
Our dental plan makes dental care more affordable for employees and
their families. Taking care of your mouth, teeth, and gums is a big part
of making sure you feel your best. Healthy habits like brushing, lossing,
and seeing your dentist for regular cleanings help prevent problems.
Remember to choose an in-network dentist to ensure you’re receiving the
deepest level of discounted services.
There are no changes to our dental beneits in 2016! Dental coverage
will continue to be administered by Cigna. You are encouraged to seek
services from Cigna dental PPO providers. Non-participating dentists will
be reimbursed at the 90th percentile of usual and customary and you may
be balance billed for the amount above Cigna’s reimbursement.
Core Plan In-
Network High Plan In-Network
Deductible/Maximum
Individual deductible $50 $50
Family deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive services 100% 100%
(Exams, x-rays, cleanings)
Basic services 80% 80%
(Fillings, root canals, oral surgery)
Major services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You on a Pre-Tax
Basis
Coverage Tier Core Plan High Plan
Employee only $4.95 $8.67
Employee + spouse $18.63 $21.60
Employee + child or children $11.28 $17.88
Family $23.16 $31.99
2016 Open Enrollment
Dental
Our dental plan makes dental care more affordable for employees and
their families. Taking care of your mouth, teeth, and gums is a big part
of making sure you feel your best. Healthy habits like brushing, lossing,
and seeing your dentist for regular cleanings help prevent problems.
Remember to choose an in-network dentist to ensure you’re receiving the
deepest level of discounted services.
There are no changes to our dental beneits in 2016! Dental coverage
will continue to be administered by Cigna. You are encouraged to seek
services from Cigna dental PPO providers. Non-participating dentists will
be reimbursed at the 90th percentile of usual and customary and you may
be balance billed for the amount above Cigna’s reimbursement.
Core Plan In-
Network High Plan In-Network
Deductible/Maximum
Individual deductible $50 $50
Family deductible $150 $150
Calendar year maximum $1,250 $2,500
Coinsurance
Preventive services 100% 100%
(Exams, x-rays, cleanings)
Basic services 80% 80%
(Fillings, root canals, oral surgery)
Major services 50% 50%
(Bridges, crowns, dentures)
Orthodontia
Coinsurance 50% 50%
Lifetime maximum $1,000 $2,500
Eligibility Adults and children
Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Dental Bi-Weekly Contributions—Paid By You on a Pre-Tax
Basis
Coverage Tier Core Plan High Plan
Employee only $4.95 $8.67
Employee + spouse $18.63 $21.60
Employee + child or children $11.28 $17.88
Family $23.16 $31.99
2016 Open Enrollment
