Dental Insurance
CIGNA Dental
View 2013 Dental Insurance information
View this flier to learn more about Cigna’s program and services that can help you make the most of your Cigna dental Plan. Do you have diabetes, heart disease, at risk of a stroke or pregnant? If so there is an enhanced level of preventive dental benefits available through Cigna. Learn why its important!
Looking for a network dentist? The most up-to-date information can be found on your www.mycigna.com web-site. This directory is current as of 02/12/12 – you should call the dentist’s office to verify participation at time of service. Remember you can see any dentist, if you visit a Cigna participating dentist you know they accept Cigna’s reimbursement rates. See below for an overview of your dental benefits.
Bates College Dental Benefit Plan Overview
This is not a contract, it is a benefit overview. If there are discrepancies between this overview and the Certificate of Coverage, the Certificate will govern. PDF version of Benefits Overview. Effective January 1, 2012
|
SERVICES
|
LEVEL OF BENEFITS
|
| Calendar Year Deductible (Applies to Class II & III, i.e. Basic and Major Restorative Care only) |
$ 50 Individual $150 Family |
| Annual Maximum (Preventive/Class I, Basic Care/Class II, Major Care/Class III) |
Plan pays $1,000 per person |
| Reimbursement Level You do not need to visit a network dentist in order to have coverage but if you do you know you will not be balance billed |
In-Network: Based on reduced contracted fees Out-of-Network: 90th Percentile of reasonable and customary charges |
|
DIAGNOSTIC/PREVENTIVE CLASS I
|
|
Diagnostic and Services (Preventive – No Deductible)
|
You pay 0% and the plan pays 100%, up to the maximum allowance No deductible applies |
|
GENERAL/RESTORATIVE CLASS II
|
|
|
Plan pays 80%, and you pay 20%, up to the maximum allowanceYou pay a $50/$150 annual deductible |
|
MAJOR/RESTORATIVE CLASS III
|
|
|
Plan pays 50%, and you pay 50%, up to the maximum allowanceYou pay a $50/$150 annual deductible |
(Note: Missing Tooth Limitation: The amount payable is 50% of the amount otherwise payable until insured for 24 months; thereafter, considered a Class III expense.
Monthly Rates 01/01/12-12/31/12
Full-Time Benefits Eligible
|
Employee Cost
|
|
| Single Rate: |
No Cost
|
| 2 Adults Rate: |
$34.00
|
| Adult with child(ren) |
$32.00
|
| Full Family: |
$67.00
|
Three-Quarter-Time Benefits Eligible
|
Employee Cost
|
|
| Single Rate: |
$ 9.00
|
| 2 Adults Rate: |
$38.00
|
| Adult with child(ren) |
$36.00
|
| Full Family: |
$71.00
|
Half-Time Benefits Eligible
|
Employee Cost
|
|
| Single Rate: |
$17.00
|
| 2 Adults Rate: |
$44.00
|
| Adult with child(ren) |
$42.00
|
| Full Family: |
$78.00
|
Special Features:
- A separate deductible is required for each member receiving services. However, if during the calendar year the total family expenses for covered services exceed three times the individual deductible, then no additional deductible will be required for other family members.
- Method of Payment is based on an allowed fee established by Cigna.
Important Information About Your Dental Plan
From Coverage…to Claims…to Customer Service: What you need to know about your dental plan
CIGNA wants to make it as easy as possible for you to use your dental plan. That’s why we’ve put together the following list of answers to the Frequently Asked Questions we receive from our members. We hope they are helpful to you!
1. Quick Reference Information:
- What is the Customer Service telephone number?
For assistance, call 1-800-244-6224.
- Where should I mail my dental claim forms?
-
How do I find a participating dental provider?
At www.mycigna.com you will find the most up-to-date listing of dentists participating in the Radius Network. Remember you do not need to visit a network dentist to receive benefits, but if your dentist does participate in the Cigna Radius network you know they have agreed to a contracted rate.
-
What is the difference between a deductible and coinsurance?
Typically, a deductible is a fixed dollar amount that you have to pay before an insurance policy begins to pay benefits. Coinsurance is the percentage of health care expenses that you are responsible for paying after your deductible has been met. You should check your Schedule of Benefits or Certificate of Coverage to see how these terms are defined and whether or not they apply to your dental coverage.
-
When I visit my dentist, is my coinsurance and deductible due at the time of my appointment?
Yes, if your dental plan includes coinsurance and/or a deductible, it is due at the time of your (or your covered dependent’s) office visit.
-
What is assignment of benefits?
You can choose to have dental claim reimbursements mailed directly to the dental provider. Simply, sign the assignment of benefits box on your claim form. Aetna Dental will, in turn, mail any applicable payments directly to the provider which may eliminate your having to pay for services up front. Please discuss payment options directly with the provider.
3. Claims
- How do I file a dental claim?
If your provider does not file the claim on your behalf, you must file a Dental claim form. Your dental provider can assist you in filling in the appropriate information on the claim form. Mail your completed form to Cigna Dental, PO Box 188037, Chattanooga, TN 37422-8037.
- What is a dental pre-determination of benefits and how do I request one?
A pre-determination of benefits allows your dental provider to determine your benefit prior to rendering services. Most dental providers will handle that pre-determination for you. If not, you’ll need to obtain a Dental claim form and check the “request for predetermination/preauthorization” box at the top of the form. Your dental provider can assist you in filling in the appropriate information on the claim form. Mail your completed form to Cigna Dental, PO Box 188037, Chattanooga, TN 37422-8037.
- Does my plan include orthodontic coverage?
No, but you may use the Bates Healthcare Reimbursement Account for orthodontia charges.
- How long do I have to file a claim?
You have 12 months from the date of service to file a claim.
- A provider has billed me. How do I know how much of the bill I have to pay?
You are responsible for any cost shares (deductibles, coinsurance, etc.) plus, you may be responsible for the difference between the amount billed and the maximum amount allowed by your CIGNA Dental plan.
To verify any outstanding amounts you may owe, please refer to your Schedule of Benefits or Certificate of Coverage.
- How can I check the status of my claim?
It’s easy! Sign up for mycigna.com and view your claims on-line.
4. Customer Service:
- Where can I find more information about my dental plan or benefits?
Your Schedule of Benefits or Certificate of Coverage describes your plan and benefits. You can also call Customer Service at 1-800-244-6224.
- What type of information can I receive from Customer Service?
Our Customer Service Representatives can tell you about your benefits, claims and eligibility for services.
5. Cigna Dental Member ID Cards:
- How do I order additional ID cards?
Call Customer Services at 1-800-244-6224 or order through your personal account established at www.mycigna.com.
Please note: The benefits information contained in these Frequently Asked Questions is for general information only. For more specific benefits information please consult your Schedule of Benefits or Certificate of Coverage.
To view the Summary Annual Reports Click Here.
Latest update: 02/12/12