Page 11 - Ideal Option 2020 New Hire Guide
P. 11
2020
Ideal Option Enrollment Guide
DENTAL Finding In-Network
We partner with Cigna to offer you and your family members dental Providers
insurance. Visit www.mycigna.com to ind in-network providers and Remember to visit in-network
access a variety of online tools and programs. dentists to receive the deepest
level of discount on your
Ideal Option offers an indemnity Base and Buy-Up plan through Cigna services. Services provided by
for employees living in Juneau, Alaska or in zip code 99901. Due to the non-PPO dentists are reimbursed
at the 50th percentile and you
lack of contracted providers in these geographic areas these plans allow may be balance billed.
you to visit any dentist you would like. Cigna will reimburse the provider
based on the 80th percentile of reasonable and customary charges. In the To ind a participating in-
network dentist in your
event the provider you seek services from charges more than this amount, area, go to mycigna.com or
you may be balance billed. Feel free to reach out to the Cigna One Guide call 866 .494 .2111 .
resource for more details on reimbursement levels.
Base Buy-Up Examples of
Calendar Year Deductible Services
Individual $50 $50 Preventive—exams,
Family $100 $100 cleanings, luoride, x-rays,
Calendar Year Maximum and sealants
$1,500 $1,500
Coinsurance Basic—illings, extractions,
Preventive 100% no deductible 100% no deductible periodontics, repairs, and
Basic 80% after deductible 80% after deductible oral surgery
Major 50% after deductible 50% after deductible Major—crowns,
Orthodontia
Coinsurance Not covered 50% deductible does not apply inlays, dentures, and
Lifetime Maximum Not covered $1,500 dental impacts
Beneit Applies to Not covered Children to age 19
This is a high level summary of your beneit coverage. Full coverage details are available in your
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.
Employee Bi-Weekly Dental Contributions
Base Buy-Up
Employee Only $9 .22 $10 .28
Employee + Spouse $18 .27 $20 .37
Employee + Child(ren) $25 .64 $26 .31
Family $38 .04 $39 .72
Orthodontia Services Note
The lifetime maximum illustrated is different from the calendar year
maximum. For orthodontia services, this limit does not reset each year,
this is the most your plan will cover for your services for the lifetime of
your dependent child to age 19 in this program. 11
Ideal Option Enrollment Guide
DENTAL Finding In-Network
We partner with Cigna to offer you and your family members dental Providers
insurance. Visit www.mycigna.com to ind in-network providers and Remember to visit in-network
access a variety of online tools and programs. dentists to receive the deepest
level of discount on your
Ideal Option offers an indemnity Base and Buy-Up plan through Cigna services. Services provided by
for employees living in Juneau, Alaska or in zip code 99901. Due to the non-PPO dentists are reimbursed
at the 50th percentile and you
lack of contracted providers in these geographic areas these plans allow may be balance billed.
you to visit any dentist you would like. Cigna will reimburse the provider
based on the 80th percentile of reasonable and customary charges. In the To ind a participating in-
network dentist in your
event the provider you seek services from charges more than this amount, area, go to mycigna.com or
you may be balance billed. Feel free to reach out to the Cigna One Guide call 866 .494 .2111 .
resource for more details on reimbursement levels.
Base Buy-Up Examples of
Calendar Year Deductible Services
Individual $50 $50 Preventive—exams,
Family $100 $100 cleanings, luoride, x-rays,
Calendar Year Maximum and sealants
$1,500 $1,500
Coinsurance Basic—illings, extractions,
Preventive 100% no deductible 100% no deductible periodontics, repairs, and
Basic 80% after deductible 80% after deductible oral surgery
Major 50% after deductible 50% after deductible Major—crowns,
Orthodontia
Coinsurance Not covered 50% deductible does not apply inlays, dentures, and
Lifetime Maximum Not covered $1,500 dental impacts
Beneit Applies to Not covered Children to age 19
This is a high level summary of your beneit coverage. Full coverage details are available in your
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.
Employee Bi-Weekly Dental Contributions
Base Buy-Up
Employee Only $9 .22 $10 .28
Employee + Spouse $18 .27 $20 .37
Employee + Child(ren) $25 .64 $26 .31
Family $38 .04 $39 .72
Orthodontia Services Note
The lifetime maximum illustrated is different from the calendar year
maximum. For orthodontia services, this limit does not reset each year,
this is the most your plan will cover for your services for the lifetime of
your dependent child to age 19 in this program. 11
