Page 9 - 2018 Metropolitan Development Enrollment
P. 9
Metropolitan Development and Housing Agency
Dental Coverage—Cigna Find an In-Network
Access to good oral healthcare can help keep your overall health costs Provider
down. Regular oral health exams can help detect signiicant medical Remember to visit in-network Cigna
conditions before they become serious. Dental professionals performing Advantage dentists to receive the
checkups can spot symptoms which could indicate serious health deepest level of discount on your
services.
problems elsewhere in the body which need attention. For these reasons,
and many others, we offer a dental insurance beneit to our employees. To ind a participating Cigna
Advantage dentist in your area go
In-Network Out-of-Network to www.mycigna.com or call
Calendar Year Deductible 800.CIGNA24.
Individual $50 $50
Family $150 $150 Examples of Services
Calendar Year Maximum $1,500 $1,500
Coinsurance X Preventive—exams, cleanings,
Preventive 100% no deductible luoride, x-rays, sealants
Basic 20% coinsurance after deductible X Basic—illings, extractions,
Major 50% coinsurance after deductible periodontics, repairs, and oral
Orthodontia Coinsurance 50% after deductible surgery
Lifetime maximum $1,500
Beneit applies to Dependent children up
to age 19 X Major—crowns, inlays, dentures,
Visits and Exams dental implants
Visits for Oral Examination 100% no deductible
Fluoride, Space Maintainers, and Sealants 100% no deductible
X-rays
Bitewing X-Rays 100% no deductible
Full Mouth X-Rays 100% no deductible
Endodontics
Pulpotomy 20% coinsurance after deductible
Root canal 20% coinsurance after deductible
Major Restorations
Inlays/onlays 50% coinsurance after deductible
Crowns 50% coinsurance after deductible
Implants 50% coinsurance after deductible
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Contributions
Employee $3.95
Employee + 1 $8.93
Employee + 2 or More $11.40
9
Dental Coverage—Cigna Find an In-Network
Access to good oral healthcare can help keep your overall health costs Provider
down. Regular oral health exams can help detect signiicant medical Remember to visit in-network Cigna
conditions before they become serious. Dental professionals performing Advantage dentists to receive the
checkups can spot symptoms which could indicate serious health deepest level of discount on your
services.
problems elsewhere in the body which need attention. For these reasons,
and many others, we offer a dental insurance beneit to our employees. To ind a participating Cigna
Advantage dentist in your area go
In-Network Out-of-Network to www.mycigna.com or call
Calendar Year Deductible 800.CIGNA24.
Individual $50 $50
Family $150 $150 Examples of Services
Calendar Year Maximum $1,500 $1,500
Coinsurance X Preventive—exams, cleanings,
Preventive 100% no deductible luoride, x-rays, sealants
Basic 20% coinsurance after deductible X Basic—illings, extractions,
Major 50% coinsurance after deductible periodontics, repairs, and oral
Orthodontia Coinsurance 50% after deductible surgery
Lifetime maximum $1,500
Beneit applies to Dependent children up
to age 19 X Major—crowns, inlays, dentures,
Visits and Exams dental implants
Visits for Oral Examination 100% no deductible
Fluoride, Space Maintainers, and Sealants 100% no deductible
X-rays
Bitewing X-Rays 100% no deductible
Full Mouth X-Rays 100% no deductible
Endodontics
Pulpotomy 20% coinsurance after deductible
Root canal 20% coinsurance after deductible
Major Restorations
Inlays/onlays 50% coinsurance after deductible
Crowns 50% coinsurance after deductible
Implants 50% coinsurance after deductible
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Contributions
Employee $3.95
Employee + 1 $8.93
Employee + 2 or More $11.40
9
