Page 9 - 2020AONBenefitGuide
P. 9
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
Base Plan Buy Up Plan
(low option) (high option)
In-Network
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
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
irst become eligible, you will be subject to a 12–month waiting period for some
beneits.
American Oncology Network 9
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
Base Plan Buy Up Plan
(low option) (high option)
In-Network
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
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
irst become eligible, you will be subject to a 12–month waiting period for some
beneits.
American Oncology Network 9
