Page 15 - 2022 AEO Benefit Guide

Save with a Dental HMO

• Preventive and diagnostic services covered at low or no additional cost
• No deductibles, no claim forms when using in-network dentists, HEALTH BENEFITS
no waiting periods, no calendar year maximums
• No age limit on sealants, which help prevent tooth decay

Routine Dental Care Does More Than Brighten Your Smile
Research shows that receiving regular dental care can help detect minor problems
before they become major and expensive to treat. Also, routine dental exams
can help catch serious health problems such as diabetes, leukemia, heart disease,
and kidney disease. In fact, some diseases produce oral signs and symptoms. So a
healthier mouth may help you have a healthier life!

Cigna Dental plan participants can earn additional incentives through the Well-Being
program.

Summary of Dental Coverage

DPPO HIGH DPPO LOW CIGNA DENTAL CARE

Out-of- Out-of- (DHMO) *
Plan Details In-Network In-Network
Network Network
You incur no charge
Diagnostic & 100% 90% 100% 90% for the following services:
Preventive routine cleaning, x-rays,
oral exams, topical flouride

Basic The DHMO sets the cost for
Restorative 100% 90% 80% 70% services based on a Patient
Charge Schedule (PCS).
Major The PCS is a list of fees for
Restorative 80% 70% 50% 40% each covered service within
the plan. Call Cigna at
Orthodontia 80% 70% 50% 40% 1.800.CIGNA.24
to receive a copy of the
Implants 80% 70% 50% 40% PCS-K1109
Deductibles and Maximums

$50/Individual $50/Individual $50/Individual $50/Individual
Deductible No Deductible
$150/Family $150/Family $150/Family $150/Family
Calendar Year $1,500 $1,500 $1,250 $1,250 No Maximum
Maximum

Orthodontic
Lifetime Maximum $3,000 $3,000 $1,500 $1,500 No Maximum
COST PER PAY YOU PAY YOU PAY YOU PAY

Associate $14.00 $9.00 $5.00
Associate+1 $30.00 $16.00 $12.00
Associate & Family $45.00 $22.00 $18.00
* Associates will only be eligible to enroll in the Cigna Dental HMO plan if a dentist is in the
HMO network within 25 miles of your home zip code.
FULL TIME BENEFITS — HEALTH BENEFITS 13