Page 12 - 2022 Clari Open Enrollment Benefits Guide

Dental

Cigna Dental PPO CIGNA DENTAL PPO PLAN

(Group # 0623765)
BENEFIT IN-NETWORK OUT-OF-NETWORK
Love your smile! Your dental plan
pays for preventive care, but it also Annual Deductible Individual $50 / Family $150 max
pays for a significant portion of
additional dental care. You can save Diagnostic & Preventive Care Covered at 100%, deductible waived
money and receive higher benefits Basic Care You pay 10%, after deductible You pay 20%, after deductible
with preferred, in-network dentists.
Major Care You pay 40%, after deductible You pay 50%, after deductible
You can download the myCigna app $2,000
and have your dental ID card always Calendar Year Benefit Maximum Combined in/out-of-network
at your fingertips, wherever you are, Costs the plan pays towards Diagnostic and Preventive care apply to the Maximum
whenever you need it. Orthodontic Care
(Coverage: Adult & Child) You pay 50%
Otherwise, you can contact Human
$1,500
Resources to receive a dental-only Lifetime Orthodontia Maximum Combined in/out-of-network
ID card. Dental ID cards are
non-personalized. Commonly used benefit attributes are listed above; additional benefit information is available in your plan summary. Benefits vary slightly in Texas.

Here’s the difference between in-network and out-of-network dentist costs

• In-network dentists have agreed to limit their fees, which is why it is very important to confirm your selected dentist is in the Cigna
network. If your dentist’s bill is higher than the agreed upon amount for a covered service, you are not responsible for paying the
extra charges.
• Out-of-network dentists, on the other hand, have not agreed to limit their fees. Cigna decides how much they will pay based on UCR
(usual, customary and reasonable) dentist charges in your area. The difference from using an in-network dentist is that you will be
responsible for paying any extra charges.

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