A GUIDE TO YOUR CIGNA DENTAL PPO

Transcription

1 A GUIDE TO YOUR CIGNA DENTAL PPO Offered by Cigna Health and Life Insurance Company or Connecticut General Life Insurance Company d 03/16 (DPPO Incentive Plan)

2 To Dental Plan Participants: YMCA Employee Benefits is committed continuously providing high-quality health care through its various plan offerings and vendor partnerships. With the Cigna Dental PPO (DPPO) plan, you can visit any dentist in- or out-of-network -- and you never need a referral see a specialist. Enclosed you ll find a summary of the dental benefits available you, along with a guide your Cigna DPPO help you get the most out of your coverage. How the Cigna DPPO plan works: You can visit any dentist, but you will pay less for covered services if you use dentists in the Cigna DPPO Advantage network Before you re enrolled, search for participating dental professionals using the online direcry at Once enrolled, register at mycigna.com for information specific your dental plan. Simply choose a dentist, and schedule an office visit. Be sure identify yourself as a member of Cigna s DPPO plan when you make your appointment and show your ID card when you arrive A predetermination of benefits should be obtained by your dentist for any services over $200 when using either network or non-network dentists. Typically the dentist will advise you of recommended work during a routine exam and then schedule a follow-up appointment. Simply ask your dentist work with Cigna directly obtain your predetermination of benefits, helping you make a more informed decision. You can also find additional information on the YMCA Employee Benefits page on Exchange, by visiting yexchange.org/ymcaemployeebenefits. Please note: you will need log in your YMCA Exchange account view this information. If you have questions regarding this dental plan, you can call our ll-free number 24 hours a day, 7 days a week at 877-BEN-YMCA ( ). Choose the option for Cigna Dental and you will be directed a live specialist who can assist you with your enrollment questions. YMCA Employee Benefits 101 N Wacker Dr, Chicago IL P E EmployeeBenefits@ymca.net

3 Routine dental care does more than just brighten your smile. Research shows that receiving regular dental care can help detect minor problems before they become major and expensive treat. 1 Also, routine dental exams can help catch serious health problems, such as diabetes, leukemia, heart disease and kidney disease. 1 In fact, some diseases produce oral signs and sympms. 1 So a healthier mouth may help you have a healthier life. The Total Cigna Dental PPO (DPPO) network makes it easy protect your health and your smile with the right dental care at the right price. You can choose a dentist from one large network direcry that is easily accessible and searchable online. In addition, we offer online ols that allow you make more informed decisions about your dentist and your dental care. Understand how your plan works When you choose a network dentist, your coverage includes a wide range of eligible services after you satisfy any waiting period and meet your. Your plan includes coverage for preventive dental care services, including cleanings, x-rays and more, at no additional cost or at a reduced cost you.* * Most plans limit cleanings and bitewing x-rays two per calendar year, and full mouth/ panorex x-rays one every three calendar years. See your plan documents for a list of covered and non-covered services under your specific plan. Additional considerations: Many diagnostic and preventive care procedures are covered at no additional cost or a reduced cost you. For other services, you will usually pay a percentage of the cost or coinsurance amount the dentist at the time of service. You don t need an ID card receive dental care. You don t need select a primary care dentist. You don t need a referral receive care from a specialist. Your access thousands of dentists, one direcry The Total Cigna DPPO network provides access the largest network of dentists contracted discounted fee arrangements. 2 We expect have a tal of 148,000 3 unique dentists available at 384,000 4 office locations. This means more convenience and more ways for you save. Within Total Cigna DPPO, we offer two levels: Cigna DPPO Advantage Highest benefit level may result in a lower cost you 95,000 dentists 235,000 locations Cigna DPPO Lower benefit level than DPPO Advantage 50,000 dentists 127,500 locations All participating dentists are consolidated in one direcry, which you can easily search online at Cigna.com and mycigna.com. Additional programs for our DPPO cusmers Enjoy discounts on health-related products and services through Cigna Healthy Rewards. 6 The Cigna Dental Oral Health Integration Program offers enhanced dental coverage and more for dental cusmers with any of the following medical conditions: Diabetes, heart disease, stroke, maternity, head and neck cancer radiation, organ transplants and chronic kidney disease. There s no additional charge for the program those who qualify get reimbursed 100% of coinsurance for certain related dental procedures** and are eligible for other perks! ** Deductible does not apply. Reimbursement counts ward and is subject annual benefits maximum for DPPO plans. Review your enrollment materials for complete details and a list of covered services.

4 The benefits of network care network Select a dentist or specialist from the network list You use your plan receive dental care out-of-network Select any dentist or specialist By choosing a DPPO Advantage dentist, you receive a higher network benefit coverage than you would with a DPPO dentist. This may result in lower out-of-pocket expenses. Pay less for covered services because network dentists have agreed offer services at lower negotiated rates. You may save on out-of-pocket costs for many services not covered under your plan. Network dentists have agreed offer our cusmers discounted fees for all procedures on their fee schedules. (Not available in all states.) Network dentists will submit claims for you. All network dentists have met Cigna credentialing requirements based on national standards, and we repeat the process every three years. Your out-of-pocket expenses will generally be higher because out of network dentists have not agreed offer Cigna plan cusmers negotiated rates. Depending on your plan design, out-of-network dentists may bill you for the difference between the payment they receive from Cigna and their usual fees. You may have file your own claims. Please refer your Summary of Benefits for: Specific plan details Any age and frequency limitations A complete list of exclusions and limitations Enroll day Make sure that you don t miss your opportunity enroll for this important benefit. All you need do is: 1. Review your plan materials and consider your family s needs. 2. Complete and sign the enrollment form and return it your employer. If your employer has a different process, follow those instructions. Cusmer service 800.Cigna24 ( ) We offer live cusmer service 24/7/365 with translation services in 150 languages and dialects mycigna.com Information about dental coverage Claim status Dental office locations Eligibility and plan verification, and much more

5 Convenience at your fingertips At Cigna, we think that dental care should be easy. It should offer the same experience that you expect in other parts of life. Convenient, online scheduling Insightful cusmer reviews guide smart choices Clear pricing avoid surprise charges We have online ols make these, and other, services possible. They re easy and intuitive, built with best practices from the online shopping world. The ols include: Brighter Score TM.*** Use this scoring method compare dentists. The score is based on things like affordability, patient experience and professional hisry. Dental office reviews and comparisons.*** Find information compare dental offices. View dentist profiles with phos and videos. Read verified patient reviews. Online appointment scheduling.*** With dental offices that offer this service, you can make an appointment right from your lapp or mobile device 5, and even receive appointment reminders. Enhanced search and clear pricing. Search for a dentist by service. Information is personalized for your specific plan. Shows price with coinsurance and s. Easy access. Use these features anytime, anywhere. 24/7 access on the go on mobile phones or tablets. Use mycigna.com or our mobile app. 5 These ols can help you make better care and cost choices for your family. After you enroll Visit mycigna.com for more information such as: Plan information Oral Health assessments and quizzes ID Card info Claim information Discounts on a variety of health and wellness products and services 6 We are dedicated providing better savings, better health, and a better experience Our goal is support you and your health. With Cigna, you benefit from a large network of dentists, discounted prices on quality dental care, and the ols you need help you make informed decisions about your dental health. Enroll day and say yes plans designed provide better savings, better health and a better cusmer experience. *** Actual features may vary by dentist and Cigna Dental plan type. Experience, ratings, reviews, and appointment scheduling features are provided through Brighter, Inc., an independent company. These and other dentist direcry features are for educational purposes only and should not be the sole basis for decision-making. They are not a guarantee of the quality of care that will be delivered individual cusmers. Cusmers are encouraged consider all relevant facrs and speak with their treating dentist when choosing where receive dental care. 1. Urse, Geraldine N. Systemic Disease Manifestations in the Oral Cavity Osteopathic Family Physician. Vol. 6, No. 3, June NetMinder. DPPO data as of September 2015, reflecting Total Cigna DPPO counts of unique dentists. Data is subject change. The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using. 3. Projected unique dentists for Year End. 139,962 tal DPPO unique dentists as of 09/21/ Projected 2016 Year End access points. 359,671 tal DPPO access points as of 09/21/ The downloading and use of the mycigna Mobile App is subject the terms and conditions of the App and the online sres from which it is downloaded. Standard mobile phone carrier and data usage charges apply. 6. Healthy Rewards is a discount program. If your plan includes coverage for any of these services, this program is in addition, not instead of, your plan benefits. Healthy Rewards programs are separate from your plan benefits. A discount program is NOT insurance, and you must pay the entire discounted charge. Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. The dentists who participate in the Cigna network are independent contracrs solely responsible for the treatment provided their patients. They are not agents of Cigna. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan materials. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental PPO plans are insured or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC), with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network. Policy forms: OK - HP-POL99 (CHLIC), GM6000 ELI288 et al (CGLIC); TN HP-POL69/HC-CER2V1 et al (CHLIC). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc d 03/16 (DPPO Incentive Plan) 2016 Cigna. Some content provided under license.

6 Cigna Dental Benefit Summary YMCA EMPLOYEE BENEFITS All s, plan maximums, and service specific maximums (dollar & occurrence) cross accumulate between in and out of network. Benefits Cigna Dental PPO Network - Total Cigna DPPO Cigna DPPO Advantage Cigna DPPO Out of Network Calendar Year Maximum (Class I, II and III expenses) $1,500 $1,500 $1,500 Annual Deductible Individual Family $50 per person $150 per family $50 per person $150 per family $50 per person $150 per family Reimbursement Levels** Based on Reduced Contracted Fees Based on Reduced Contracted Fees 80th percentile of Reasonable and Cusmary Allowances Plan Pays You Pay Plan Pays You Pay Plan Pays You Pay Class I - Preventive & Diagnostic Care Oral Exams Routine Cleanings Bitewing X-rays Full Mouth X-rays Panoramic X-rays Fluoride Application Sealants Space Maintainers (non-orthodontic treatment) 100% No Charge 100% No Charge 100% No Charge Class II - Basic Resrative Care Fillings Periapical X-Rays Emergency Care Relieve Pain Periodontal Scaling and Root Planing Occlusal Adjustments Oral Surgery Simple Extractions 85% 15% 80% * 20% * 80% * 20% * Class III - Major Resrative Care Crowns Surgical Extractions of Impacted Teeth Anesthetics Hispathologic Exams Denture Repairs Denture Relines, Rebases and Adjustments Repairs Bridges, Crowns and Inlays Surgical Implants Dentures Bridges Inlays/Onlays Prosthesis Over Implant Osseus Surgery Root Canal Therapy/Endodontics Occlusal Guards 50% * 50% * 50% * 50% * 50% * 50% * Class IV - Orthodontia Dependent children through age 19 50% after $50 lifetime 50% after $100 lifetime 50% after $100 lifetime $1,500 Lifetime Maximum $1,000 Lifetime Maximum $1,000 Lifetime Maximum * Subject annual

7 Missing Tooth Limitation Teeth missing prior coverage under the Cigna Dental PPO plan are not covered until insured for 24 months Pretreatment review is recommended when extensive dental work in excess of $200 is proposed. Dental Oral Health Integration Program (OHIP) - All dental cusmers = Clinical research shows an association between oral health and overall health. The Cigna Dental Oral Health Integration Program (OHIP) is designed provide enhanced dental coverage for cusmers with certain eligible medical conditions. Eligible conditions for the program include cardiovascular disease, cerebrovascular disease (stroke), diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation. The program provides: 100% coverage for certain dental procedures guidance on behavioral issues related oral health discounts on prescription and non-prescription dental products For more information and see the complete list of eligible conditions, go or call cusmer service 24/7 at CIGNA24. **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according Reasonable and Cusmary Allowances but the dentist may balance bill up their usual fees. Cigna Dental PPO Exclusions and Limitations Procedure Exclusions and Limitations Late Entrants Limit 50% coverage on Class III and IV for 12 months Exams Two per Calendar year Prophylaxis (Cleanings) Two per Calendar year Fluoride 1 per Calendar year for people under 18 Hispathologic Exams Various limits per Calendar year depending on specific test X-Rays (routine) Bitewings: 2 per Calendar year X-Rays (non-routine) Full mouth: 1 every 36 consecutive months., Panorex: 1 every 36 consecutive months Model Payable only when in conjunction with Ortho workup Minor Perio (non-surgical) Various limitations depending on the service Perio Surgery Various limitations depending on the service Crowns and Inlays Replacement every 5 years Bridges Replacement every 5 years Dentures and Partials Replacement every 5 years Relines, Rebases Covered if more than 6 months after installation Adjustments Covered if more than 6 months after installation Repairs Bridges Reviewed if more than once Repairs Dentures Reviewed if more than once Sealants Limited posterior oth for a person under 16 years old. One treatment per oth every three years Space Maintainers Limited non-orthodontic treatment for prematurely removed or missing teeth Prosthesis Over Implant 1 per 60 consecutive months if unserviceable and cannot be repaired. Benefits are based on the amount payable for non- precious metals. No porcelain or white/oth colored material on molar crowns or bridges Alternate Benefit When more than one covered Dental Service could provide suitable treatment based on common dental standards, Cigna HealthCare will determine the covered Dental Service on which payment will be based and the expenses that will be included as Covered Expenses Benefit Exclusions: Services performed primarily for cosmetic reasons Over the counter medications Replacement of a lost or slen appliance Replacement of a bridge or denture within five years following the date of its original installation Replacement of a bridge or denture which can be made useable according accepted dental standards Procedures, appliances or resrations, other than full dentures, whose main purpose is change vertical dimension, diagnose or treat conditions of TMJ, stabilize periodontally involved teeth, or resre occlusion Veneers of porcelain or acrylic materials on crowns or pontics on or replacing the upper and lower first, second and third molars Bite registrations; precision or semi-precision attachments; splinting Instruction for plaque control, oral hygiene and diet Dental services that do not meet common dental standards Services that are deemed be medical services Services and supplies received from a hospital Charges which the person is not legally required pay Charges made by a hospital which performs services for the U.S. Government if the charges are directly related a condition connected a military service Experimental or investigational procedures and treatments Any injury resulting from, or in the course of, any employment for wage or profit Any sickness covered under any workers compensation or similar law Charges in excess of the reasonable and cusmary allowances To the extent that payment is unlawful where the person resides when the expenses are incurred; Procedures performed by a Dentist who is a member of the covered person s family (covered person s family is limited a spouse, siblings, parents, children, grandparents, and the spouse s siblings and parents); For charges which would not have been made if the person had no insurance; For charges for unnecessary care, treatment or surgery; To the extent that you or any of your Dependents is in any way paid or entitled payment for those expenses by or through a public program, other than Medicaid; To the extent that benefits are paid or payable for those expenses under the mandary part of any au insurance policy written comply with a no-fault insurance law or an uninsured morist insurance law. Cigna HealthCare will take in account any adjustment option chosen under such part by you or any one of your Dependents. In addition, these benefits will be reduced so that the tal payment will not be more than 100% of the charge made for the Dental Service if benefits are provided for that service under this plan and any medical expense plan or prepaid treatment program sponsored or made available by your Employer.

8 This benefit summary highlights some of the benefits available under the proposed plan. A complete description regarding the terms of coverage, exclusions and limitations, including legislated benefits, will be provided in your insurance certificate or plan description. Benefits are insured and/or administered by Connecticut General Life Insurance Company. "Cigna HealthCare" refers various operating subsidiaries of Cigna Corporation. Products and services are provided by these subsidiaries and not by Cigna Corporation. These subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. DPPO insurance coverage is set forth on the following policy form numbers: AR: HP-POL77; CA: HP-POL57; CO: HP-POL78; CT: HP- POL58; DE: HP-POL79; FL: HP-POL60; ID: HP-POL82; IL: HP-POL62; KS: HP-POL84; LA: HP-POL86: MA: HP-POL 63; MI: HP- POL88; MO: HP- POL65; MS: HP-POL90; NC: HP-POL96; NE: HP-POL92; NH: HP-POL94; NM: HP-POL95; NV: HP-POL93; NY: HP- POL67; OH: HP-POL98; OK: HP-POL99; OR: HP-POL68; PA: HP-POL100; RI: HP-POL101; SC: HP-POL102; SD: HP-POL103; TN: HP-POL69; TX: HP-POL70; UT: HP-POL104; VA: HP-POL72; VT: HP-POL71; WA: POL-07/08; WI: HP-POL107; WV: HP-POL106; and WY: HP-POL108. Cigna, the Tree of Life logo and Cigna Dental Care are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries. Cigna Dental PPO plans are underwritten or administered by CGLIC or CHLIC, with network management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Arizona and Louisiana, the insured Dental PPO plan offered by CGLIC is known as the CG Dental PPO. In Texas, the insured dental product offered by CGLIC and CHLIC is referred as the Cigna Dental Choice Plan, and this plan utilizes the national Cigna Dental PPO network. Cigna Dental Care (DHMO) plans are underwritten or administered by Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (Kansas and Nebraska), Cigna Dental Health of Kentucky, Inc. (Kentucky and Illinois), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. In other states, Cigna Dental Care plans are underwritten by CGLIC, CHLIC, or Cigna HealthCare of Connecticut, Inc. and administered by Cigna Dental Health, Inc. BSD Cigna