Page 12 - 2020FCSBenefitsGuide
P. 12
Dental—New Options!
Maintaining healthy teeth and gums, and seeking professional treatment
when dental problems arise, is important to your overall health.
The dental plan provider is Cigna. This year you are offered two dental
plans to choose from. To search for providers visit www.mycigna.com.
When searching for dental providers please look for the DPPO
Advantage Network.
Cigna DPPO Advantage (In-Network)
Base Plan Buy Up Plan
(low option) (high option)
Preventive Expenses Beneit 100% 100%
Basic Expenses Beneit 80% 80%
Major Expenses Beneit 50% 50%
Deductible (single/family) $75/$225 $50/$150
Calendar Year Maximum $1,500 $2,500
Orthodontia Not covered 100%—eligible to age 19,
$1,500 lifetime maximum
* Composite ilings are covered under basic beneit
For additional information please visit the FCS intranet.
Note: when seeing an out-of-network provider you will be held liable for charges over the allowed
amount which is called balance billing.
Dental Payroll Deductions
Base Plan Bi-Weekly Base Plan Monthly
(low option) (low option)
Employee Only $12.32 $26.70
Employee and Spouse/DP $25.89 $56.10
Employee and Child(ren) $23.42 $50.74
Family Coverage $36.98 $80.12
Buy Up Plan Bi-Weekly Buy Up Plan Monthly
(high option) (high option)
Employee Only $14.41 $31.23
Employee and Spouse/DP $30.28 $65.61
Employee and Child(ren) $27.39 $59.35
Family Coverage $43.25 $93.71
Important for new enrollees! If you do not enroll in dental coverage
when you first become eligible, you will be subject to a 12–month waiting
period for some benefits.
12 2020 Benefits Guide
Maintaining healthy teeth and gums, and seeking professional treatment
when dental problems arise, is important to your overall health.
The dental plan provider is Cigna. This year you are offered two dental
plans to choose from. To search for providers visit www.mycigna.com.
When searching for dental providers please look for the DPPO
Advantage Network.
Cigna DPPO Advantage (In-Network)
Base Plan Buy Up Plan
(low option) (high option)
Preventive Expenses Beneit 100% 100%
Basic Expenses Beneit 80% 80%
Major Expenses Beneit 50% 50%
Deductible (single/family) $75/$225 $50/$150
Calendar Year Maximum $1,500 $2,500
Orthodontia Not covered 100%—eligible to age 19,
$1,500 lifetime maximum
* Composite ilings are covered under basic beneit
For additional information please visit the FCS intranet.
Note: when seeing an out-of-network provider you will be held liable for charges over the allowed
amount which is called balance billing.
Dental Payroll Deductions
Base Plan Bi-Weekly Base Plan Monthly
(low option) (low option)
Employee Only $12.32 $26.70
Employee and Spouse/DP $25.89 $56.10
Employee and Child(ren) $23.42 $50.74
Family Coverage $36.98 $80.12
Buy Up Plan Bi-Weekly Buy Up Plan Monthly
(high option) (high option)
Employee Only $14.41 $31.23
Employee and Spouse/DP $30.28 $65.61
Employee and Child(ren) $27.39 $59.35
Family Coverage $43.25 $93.71
Important for new enrollees! If you do not enroll in dental coverage
when you first become eligible, you will be subject to a 12–month waiting
period for some benefits.
12 2020 Benefits Guide
