Page 12 - 2016 Open Enrollment
P. 12
Open Enrollment
Dental Insurance
Pericient understands dental health is important to your overall
health which is why we offer a comprehensive dental plan through
CIGNA. You do not need to use a speciic network of dentists to
receive dental services. However, if a CIGNA network provider is
used, you will receive better discounts on services and you can avoid
balance billing. CIGNA offers employees access to a large national
network of dentists. Visit www.CIGNA.com to access their in-
network provider list or reach out to your current dental provider to
ensure you are receiving in-network discounts through CIGNA. You
will not receive a dental card in the mail from Cigna. Cards can be
located on the beneits tab on mypericient.com.
The following chart summarizes the key features of the plan. Refer to
the Summary Plan Description for additional details about coverage
and exclusions.
Network Non-Network
Annual deductible—individual $50 $50
Annual deductible—family $150 $150
Deductible waived for preventive Yes
Annual plan maximum $1,500
Preventive Services
Cleanings, exams, x-rays 100% 100%
Balance Billing is the practice of out-of- Basic and Restorative Services
network dentists billing the patient for Fillings, extractions, root canals 80% 80%
amounts which exceed the maximum Major Restorative Services
reimbursement amount under a patient’s Crowns, dentures 50% 50%
dental plan. The patient is responsible for Orthodontia
the additional amounts charged.
Children to age 19 only 50%
Orthodontia lifetime maximum $1,000
Employee Contributions per Pay Period Dental
Employee Only $4.95
Employee + Spouse $9.88
Employee + Child(ren) $12.35
Employee + Family $19.76
12
Dental Insurance
Pericient understands dental health is important to your overall
health which is why we offer a comprehensive dental plan through
CIGNA. You do not need to use a speciic network of dentists to
receive dental services. However, if a CIGNA network provider is
used, you will receive better discounts on services and you can avoid
balance billing. CIGNA offers employees access to a large national
network of dentists. Visit www.CIGNA.com to access their in-
network provider list or reach out to your current dental provider to
ensure you are receiving in-network discounts through CIGNA. You
will not receive a dental card in the mail from Cigna. Cards can be
located on the beneits tab on mypericient.com.
The following chart summarizes the key features of the plan. Refer to
the Summary Plan Description for additional details about coverage
and exclusions.
Network Non-Network
Annual deductible—individual $50 $50
Annual deductible—family $150 $150
Deductible waived for preventive Yes
Annual plan maximum $1,500
Preventive Services
Cleanings, exams, x-rays 100% 100%
Balance Billing is the practice of out-of- Basic and Restorative Services
network dentists billing the patient for Fillings, extractions, root canals 80% 80%
amounts which exceed the maximum Major Restorative Services
reimbursement amount under a patient’s Crowns, dentures 50% 50%
dental plan. The patient is responsible for Orthodontia
the additional amounts charged.
Children to age 19 only 50%
Orthodontia lifetime maximum $1,000
Employee Contributions per Pay Period Dental
Employee Only $4.95
Employee + Spouse $9.88
Employee + Child(ren) $12.35
Employee + Family $19.76
12
