Page 9 - Rampart EE Guide 01-20.pub
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BENEFITS
DENTAL INSURANCE
Cigna | Advantage PPO Dental Plan
With the Cigna Advantage Preferred Provider Organiza on (PPO) dental plan, you may visit an Advantage PPO den st and benefit
from the nego ated rate or visit a non‐network den st. When you u lize an Advantage PPO den st, your out‐of‐pocket expenses
will be less. You may also obtain services using a non‐network den st; however, you will be responsible for the difference between
the covered amount and the actual charges and you may be responsible for filing claims.
Cigna
Plan Name ADVANTAGE PPO
Network Name Cigna ADVANTAGE PPO Network Cigna DPPO & Non‐Network
Dental Benefits Reimbursement based on maximum
allowable charge
Deduc ble (Annual)
‐ Individual $50 $50
‐ Family $150 $150
Calendar Year Maximum $1,500 Reimbursement from Cigna is based on
“allowed charges” which means Cigna
Preven ve (Plan Pays) 100% sets a cap on how much they will
Exams, X‐Rays, Cleanings reimburse a Cigna DPPO or a
Basic Services (Plan Pays) Deduc ble, 80% Non‐Network den st. You will be
Fillings, Oral Surgery, Endodon cs, Periodon cs responsible for any charges in excess of
Major Services (Plan Pays) Deduc ble, 50% this cap. This will result in a much higher
Crowns, Prosthe cs level of out of pocket costs to you
Orthodon a
‐ Covered Members Children & Adults
‐ Coinsurance 50%
‐ Life me Benefit Maximum $1,500
Finding a Dental Provider
Go to MyCigna.com or if not enrolled, www.cigna.com and click on “Find a Doctor”. Click on the “Plans
through your Employer” or call (800) 244‐6224. Click on the Cigna DPPO Advantage/Cigna DPPO network
when prompted. IMPORTANT: ADVANTAGE den sts are In‐Network. If you choose a den st coded like this:
you may be balanced billed as you would using an out‐of‐network den st.
Tips for Using Your Dental Benefits
Understand your plan.
Understanding your dental plan’s benefits, including how copays, deduc bles, and calendar year maximum benefits work, is
key to ge ng the most value from your plan and avoiding surprises.
Take advantage of preventive services offered by the plan.
The least expensive way to maintain good oral health is to go to your den st at least twice each year for an exam and
cleaning. Regular den st visits can help prevent serious health problems such as oral diseases and cancers, and going to the
den st is more affordable in the long run for those who are insured and take advantage of every service.
Ask for a predetermination of benefits.
We recommend you ask your den st for a predetermina on if total charges are expected to exceed $300. Predetermina on
enables you and your den st to know in advance what the payment will be for any service that may be in ques on.
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