02/18/2021 (2) - Laserfiche WebLink

Home Browse Search

• City of Cocoa I Employee Benefit Highlights 12020-2021 Dental Insurance Cigna Dental PPO Plan The City offers dental insurance through Cigna to benefit-eligible employees. Out-of-Network Benefits The costs per pay period for coverage are listed in the premium table below Out-of-network benefits are used when member receives services by a non- and a brief summary of benefits is provided on the following page.For more participating Cigna Total DPPO provider. Cigna reimburses out-of-network detailed information about the dental plan, please refer to the carrier's services based on what it determines as the Maximum Reimbursable Charge summary plan document or contact Cigna's customer service. (MRC).The MRC is defined as the most common charge for a particular dental procedure performed in a specific geographic area.If services are received from Dental Insurance—Cigna Dental PPO Plan an out-of-network dentist,the member may be responsible for balance billing. 24 Bi-Weekly Deductions-Per Pay Period Cost Balance billing is the difference between Cigna's MRC and the amount charged Tier of Coverage Employee Cost by the out-of-network dental provider.Balance billing is in addition to any Employee Only $0 - applicable plan deductible or coinsurance responsibility. $ Employee+One $11.40 Calendar Year Deductible Employee+Family ' $18.46 The Dental PPO plan requires a$25 individual or a$50 family deductible to be met for in-network or out-of-network services before most benefits will begin. Default Benefits The deductible is waived for preventive services. Benefit-eligible employees will automatically be enrolled in employee.only Calendar Year Benefit Maximum dental coverage, unless a different tier of coverage is selected. Changes The maximum benefit(coinsurance)the Dental PPO plan will pay for each to default benefits will not be permitted until the next applicable Open covered member is $1,500 for in-network and out-of-network services Enrollment period unless employee experiences a qualifying family status combined.All services,including preventive,accumulate towards the benefit change(Qualifying Event). maximum. Once the plan's benefit maximum is met,the member will be In-Network Benefits responsible for future charges until next calendar year. The Dental PPO plan provides benefits for services received from in-network Cigna I Customer Service:(800)244-62241 www.mycigna.com and out-of-network providers. It is also an open-access plan which allows for services to be received from any dental provider without having to select a Primary Dental Provider(PDP)or obtain a referral to a specialist.The network of participating dental providers the plan utilizes is the Cigna Total DPPO.These participating dental providers have contractually agreed to accept Cigna's contracted fee or"allowed amount:'This fee is the maximum amount a Cigna dental provider can charge a member for a service.The member is responsible for a Calendar Year Deductible(CYD)and then coinsurance based on the plan's charge limitations. Please Note: Total DPPO dental members have the option to utilize a dentist that participates in either Cigna's Advantage network or DPPO network.However,members that use the Cigna Advantage network will see additional cost savings from the added discount that is allowed for using an Advantage network provider. Members are responsible for verifying whether the treating dentist is an Advantage Dentist or a DPPO Dentist. 17 9 ©2016,Gehring Group,Inc.,All Rights Reserved