Page 16 - 2020 Barrister Employee Benefits Book

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
In-Network: 100%
dental professionals within the Cigna Dental PPO Services 1 Out-of-Network: 70% 4
SA network. You’ll have access to thousands of (No deductible)
providers within the network. In-Network: 80%
Basic Services 2 Out-of-Network: 60% 4
There are no waiting periods for your dental
coverage! The day your medical coverage starts, In-Network: 50%
you can start using your dental benefits, too. Major Services 3
Out-of-Network: 40% 4

Annual $1,500
Maximum

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.