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| DENTAL |
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| Plan
Options |
DMO Plan
To receive benefits under the DMO, you must have a participating primary
care dentist (PCD) on file with Cigna. Covered services must be provided
or prescribed by your PCD. Plan benefits are based on discounted (negotiated)
fees. You will not have to pay a deductible for care you receive from
participating dentists before plan benefits begin. Services will be
covered at the level outlined on the DMO
Schedule of Benefits.
Basic and Buy-Up Plans
To receive benefits under the Basic
or Buy-Up
Plan, you may receive care from any dentist. The plan will pay benefits
based on the reasonable and customary charges of dental services in
your area, after you have met the annual deductible. You will be responsible
for any fees above reasonable and customary limits, as determined by
Cigna. Services will be covered at the level described in the Basic
Summary of Benefits or the Buy-Up
Summary of Benefits.
 
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