Page 13 - Vidant Health 2021 Benefit Guide
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Vidant Health Benefits Guide
Dental
You can choose between two dental options In 2021, Cigna is offering new capabilities within their
administered by Cigna. While you can visit any licensed app that provides information about dental care and
dentist, your cost is lower when you visit a dentist in the hygiene. You can download this app from your app
Cigna network. See the chart below for the differences store (search for MyCigna). Click here for a quick
in coverage and beneit levels for in and out-of-network video overview of dental virtual care.
services. To obtain a list of providers in the network,
visit my.cigna.com or call 800-244-6224.
Vidant Dental Plan
Basic Choice
In Network Out of Network In Network Out of Network
Preventive You pay 20% You pay 20% Covered at 100% Covered at 100%
(deductible waived) (deductible waived) (deductible waived) (deductible waived)
Deductible: Individual/Family $50/$100 $75/$150 $50/$100 $75/$150
Basic You pay 40% after You pay 50% after You pay 20% after You pay 30% after
deductible deductible deductible deductible
Major You pay 40% after You pay 50% after You pay 40% after You pay 50% after
deductible deductible deductible deductible
Annual Maximum Dental Beneit $1,000 per person $750 per person $2,000 per person $1,500 per person
Orthodontia No coverage No coverage You pay 40% You pay 50% after
(Under Age 19) (deductible waived) deductible
Orthodontia Lifetime Maximum No coverage No coverage $1,000 per person $1,000 per person
If you, or any member of your family, are covered by another dental plan in addition to the Vidant Dental Plan, you should advise your dental oice so
that beneits can be coordinated between the plans. For more information, see the Vidant Dental Plan summary plan description on AskPhin.
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Dental
You can choose between two dental options In 2021, Cigna is offering new capabilities within their
administered by Cigna. While you can visit any licensed app that provides information about dental care and
dentist, your cost is lower when you visit a dentist in the hygiene. You can download this app from your app
Cigna network. See the chart below for the differences store (search for MyCigna). Click here for a quick
in coverage and beneit levels for in and out-of-network video overview of dental virtual care.
services. To obtain a list of providers in the network,
visit my.cigna.com or call 800-244-6224.
Vidant Dental Plan
Basic Choice
In Network Out of Network In Network Out of Network
Preventive You pay 20% You pay 20% Covered at 100% Covered at 100%
(deductible waived) (deductible waived) (deductible waived) (deductible waived)
Deductible: Individual/Family $50/$100 $75/$150 $50/$100 $75/$150
Basic You pay 40% after You pay 50% after You pay 20% after You pay 30% after
deductible deductible deductible deductible
Major You pay 40% after You pay 50% after You pay 40% after You pay 50% after
deductible deductible deductible deductible
Annual Maximum Dental Beneit $1,000 per person $750 per person $2,000 per person $1,500 per person
Orthodontia No coverage No coverage You pay 40% You pay 50% after
(Under Age 19) (deductible waived) deductible
Orthodontia Lifetime Maximum No coverage No coverage $1,000 per person $1,000 per person
If you, or any member of your family, are covered by another dental plan in addition to the Vidant Dental Plan, you should advise your dental oice so
that beneits can be coordinated between the plans. For more information, see the Vidant Dental Plan summary plan description on AskPhin.
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