Page 12 - United Capital EE Guide 04-18 PFE

DENTAL INSURANCE DENTAL INSURANCE

CIGNA | DHMO DENTAL PLAN TIPS FOR USING YOUR MEDICAL BENEFITS
AVAILABLE STATES: AR, AZ, CA, CO, CT, DC, FL, GA, IL, IN, LA, MA, MD, MI, NC, NJ, NV, NY, OH, OK, OR, PA, SC, TN, TX, VA, WA
With the Dental Health Maintenance Organization (DHMO) plan through Cigna, you are required to select a general dentist who UNDERSTAND YOUR PLAN.
is a member of the network to provide your dental care. You will contact your general dentist for all of your dental needs, such as Understanding your dental plan’s benefits, including how copays, deductibles, and calendar year maximum benefits work, is key
routine check-ups and emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. For to getting the most value from your plan and avoiding surprises.
covered procedures, you'll pay the pre-set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of
your booklet to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services
that are covered under this plan. TAKE ADVANTAGE OF PREVENTIVE SERVICES OFFERED BY THE PLAN.
The least expensive way to maintain good oral health is to go to your dentist at least twice per year for an exam and cleaning.
Regular dentist visits can help prevent serious health problems such as oral diseases and cancers, and going to the dentist is more
CIGNA | PPO DENTAL PLANS affordable in the long run for those who are insured and take advantage of every service.
With the Cigna Preferred Provider Organization (PPO) dental plans, you may visit a PPO dentist and benefit from the negotiated
rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may also obtain Our dental plans cover most preventive services at no charge to you. As an added bonus, on the PPO plans, the annual deductible
services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the is waived for preventive services when using a network provider.
actual charges and you may be responsible for filing claims.
ASK FOR A PREDETERMINATION OF BENEFITS.
CIGNA CIGNA CIGNA We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300. Predetermination
DHMO LOW PPO HIGH PPO enables you and your dentist to know in advance what the payment will be for any service that may be in question.
Network Name Network Network Non-Network Network Non-Network
DENTAL BENEFITS SCHEDULE YOUR PROCEDURES TO MAKE THE MOST OF YOUR DENTAL COVERAGE.
Office Visit Copay $5 Copay N/A N/A N/A N/A As part of dental planning, you should consult with your dentist and, if possible, delay non-urgent procedures that would push
Calendar Year Maximum Benefit Unlimited $1,000 $1,000 $1,500 $1,200 your out-of-pocket costs over your plan’s calendar year maximum benefit. If possible, plan your procedures in such a way that
your annual maximum renews itself in between stages.
Annual Deductible
• Individual $0 $50 $75 $50 $75
• Family $0 $150 $225 $150 $225 DISCUSS ALTERNATIVE PROCEDURES WHEN NECESSARY.
By letting your dentist know that cost is an issue, he or she may be able to suggest alternative treatments that are less expensive
Preventive Services (Plan Pays) 100% for 100% 80% 100% 100%
• Deductible Waived Most Services Yes No Yes No but just as effective.
Basic Services (Plan Pays) See Schedule 80% 60% 90% 75%
Major Services (Plan Pays) See Schedule 50% 40% 60% 50% EMPLOYEE ASSISTANCE PROGRAM
ORTHODONTIA BENEFITS
Covered Family Members Child | Adult Child Only Child Only Child Only Child Only
Copay $1,460 | $2,160 N/A N/A N/A N/A CIGNA | LIFE ASSISTANCE PROGRAM
Coinsurance N/A 50% 50% 50% 50% The Employee Assistance Program (EAP) provides you and your household members with free, confidential assistance to help with
Lifetime Benefit Maximum N/A $1,000 $1,000 $1,250 $1,250 personal or professional problems that may interfere with work or family responsibilities and obligations. Services are available 24
hours a day, 7 days a week via a toll-free nationwide number. You and your household members can receive up to 3 counseling
sessions per person, per problem, per year.

FINDING A DENTAL PROVIDER:
Go to www.cigna.com or call (800) 244-6224. DHMO participants should refer to the “Cigna Dental Care
HMO” network and PPO participants should refer to the “Cigna Dental PPO or EPO” network when prompted. ACESSING THE EAP:
Go to www.cignabehavioral.com/cgi or call (800) 538-3543 to be connected with an EAP counselor.

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