Page 16 - Barrister Global 2020 Benefits Book!
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Select Plan
                                                                                            Cigna Dental PPO SA





                    Welcome to Your Dental Plan





            By signing up for dental, you are taking the first           Plan Benefits             Select Plan
            step to keeping your teeth healthy. Your plan
            covers preventive services like regular cleanings,          Deductible
            exams, and more.                                            Family deductible is three   $100
                                                                        times the individual.
            You can schedule an appointment with any of the
                                                                        Preventive
            dental professionals within the Cigna Dental PPO                                   In-Network: 100%
                                                                        Services 1                              4
            SA network. You’ll have access to thousands of                                    Out-of-Network: 70%
                                                                        (No deductible)
            providers within the network.
                                                                                                In-Network: 80%
                                                                        Basic Services  2
            There are no waiting periods for your dental                                      Out-of-Network: 60% 4
            coverage! The day your medical coverage starts,
            you can start using your dental benefits, too.               Major Services  3       In-Network: 50%
                                                                                              Out-of-Network: 40% 4
                    Per Paycheck Rates
                                                                        Annual                      $1,500

                    Employee Only    $15.18                             Maximum
                    Plus Spouse        $36.43
                    Plus Child(ren)    $29.04
                    Family                  $48.90



            Keep smiling with confidence. We encourage you to take advantage
            of all the benefits provided by your dental plan.




            Orthodontics are not covered by your plan.
            1 Routine exams, cleanings (6 months), fluoride treatments, sealants, and bitewing x-rays.
            2 Minor restorative services, fillings, and extractions.
            3 Dentures, crowns, inlays, endodontic procedures, periodontics procedures, major restorative procedures, and oral surgery.
            4 Maximum Allowable Charge set at the 90th percentile, no network.
            The National General Benefits Solutions (NGBS) Self-Funded Program provides tools for employers owning small- to mid-sized businesses to
            establish a self-funded health benefit plan for their employees. The benefit plan is established by the employer and is not an insurance product.
            Stop-loss insurance for the NGBS Self-Funded Program is underwritten and issued by National Health Insurance Company, Integon National
            Insurance Company, and Integon Indemnity Corporation. NGBS-DENTAL-CIGNA-SA-SELECT-WELCOMELETTER (03/2020) © 2020
            National Health Insurance Company. All rights reserved.
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