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MY HEAXLXTHX
WHO TO CALL
Cigna
www.Cigna.com www.myCigna.com 800-244-6224
Dental plans
Cigna Dental: Cigna will continue to be the dental provider for 2019. The monthly contribution tiers is changing from 3 tiers to 4 tiers.
Dental Plan Monthly Contribution
Basic Plan
Plus Plan
$34.17
$75.90
$70.53
$123.82
Associate Only
$22.78
Associate + Child(ren)
$32.30
Associate + Spouse
$30.02
Associate + Family
$52.69
Don’t forget Cigna Dental WellnessPlus® rewards you and your family for getting preventive dental care. Cigna Dental participants have a plan feature where each member of the family who recieves preventive service will be rewarded with $200 maximum dental benefit increase in the following year. This lets each family member build their own annual benefit maximum for other future needs. If a family member doesn’t get preventive care, the annual benefit maximum will not increase for that individual. Preventive care includes cleanings, oral exams and x-rays. So make the most of your dental coverage and visit your dentist regularly for exams and cleanings.
2019 Dental Plan Options
Deductible
Individual Family
Annual Maximum
Preventive Services
(x-rays, exams, prophylaxis, fluoride treatment, space maintainers, emergency care)
Basic Services
(fillings, periodontal, oral surgery, root canal, extractions)
Major Services
Dentures
Crowns
Inlays / Onlays
Fixed Bridges / Crowns (when part of a bridge)
Orthodontia (for dependents up to age 19) Orthodontic Lifetime Maximum
$50 $150
BASIC PLAN
$750 per covered person
$50 $150
None
PLUS PLAN
In-Network
Out-of-Network
In-Network
Out-of-Network
$25 $75
$1,500 per covered person
$1,000 per covered person*
Plan covers 100%
*Maximum Allowable Charge
Plan covers 100%
*Maximum Allowable Charge
20% after deductible
50% after deductible
10%
20% after deductible
Not Covered
Not Covered
40%
50% after deductible
Not Covered
Not Covered
50%
50% after deductible
Not Covered
Not Covered
$1,000 per covered person
$750 per covered person*
*NOTE: Out of Network Reimbursement
Reimbursement for out of network benefits is based on maximum allowable charge that dentists in your area charge for each procedure, non contracted amounts agreed upon by network dentists. Out-of-network dentists would still have the option to charge you the balance of the bill for the remaining costs not covered.
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Applied Choices – 2019 17