Page 6 - Magnet Employee Benefits Brochure 2021-22 FINAL
P. 6
2021–2022 Employee Benefits Brochure
Dental Plan – Cigna Dental PPO
In-Network**
Annual Benefit Maximum $1,000
(per calendar year)*
Calendar Year Deductible:
Individual / Family $50 / $150
Preventive & Diagnostic:
Office Exams / Cleanings / X-Rays Covered 100% - no deductible
Basic Services:
Fillings / Oral Surgery / Endodontics / 20% coinsurance - deductible applies
Periodontics
Major Services:
Crowns / Bridges / Dentures 50% coinsurance – deductible applies
Orthodontia
$1,000 lifetime maximum 50% coinsurance – no deductible
*Limited to children under the age of 19
*The Maximum Benefit applies separately to you and each of your covered dependents for ALL
dental services, not including orthodontic services, received in any one Calendar Year.
Preventative services are included in your Maximum Benefit.
**Please see detailed summary plan description for information on your out-of-network
benefits.
PAGE 4
