Page 9 - Guide
P. 9
2017 BENEFITS ENROLLMENT
Dental
Voluntary Dental Insurance
The dental plan provider is CIGNA. You may elect dental coverage even
if you do not elect medical coverage. To search for a dental provider visit
mycigna.com and select the DPPO network. Please see your summary
plan description the for full beneits description. Please note the below
beneit summary is for in-network beneits only.
Services In-Network Beneits
Preventive services 100%
(Exams, cleanings, x-rays)
Calendar year deductible $50 per member not to
(Applies to major and basic services only) exceed $150 per family
Basic services 80%
(Fillings, simple extractions, periodontics)
Major services 50%
(Inlays, onlays, crowns, bridges, dentures)
Dental services maximum annual beneit $2,000
Orthodontia services (children 18 and under 50%
only)
Orthodontia services maximum lifetime beneit $2,000
Employee Semi-Monthly Dental Cost
Employee $3 .00
Employee + spouse $11 .00
Employee + child(ren) $9 .00
Family $18 .00
ALCO MANAGEMENT 9
Dental
Voluntary Dental Insurance
The dental plan provider is CIGNA. You may elect dental coverage even
if you do not elect medical coverage. To search for a dental provider visit
mycigna.com and select the DPPO network. Please see your summary
plan description the for full beneits description. Please note the below
beneit summary is for in-network beneits only.
Services In-Network Beneits
Preventive services 100%
(Exams, cleanings, x-rays)
Calendar year deductible $50 per member not to
(Applies to major and basic services only) exceed $150 per family
Basic services 80%
(Fillings, simple extractions, periodontics)
Major services 50%
(Inlays, onlays, crowns, bridges, dentures)
Dental services maximum annual beneit $2,000
Orthodontia services (children 18 and under 50%
only)
Orthodontia services maximum lifetime beneit $2,000
Employee Semi-Monthly Dental Cost
Employee $3 .00
Employee + spouse $11 .00
Employee + child(ren) $9 .00
Family $18 .00
ALCO MANAGEMENT 9
