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Under any of the dental options, single or family coverage is offered. Your cost depends on the option you choose and whether you select single or family coverage. You have a choice of up to three dental options. Due to availability, your best option may depend on where you live or work. For PPO and Prepaid, please check the availability of dentists carefully.
- Regular - For all employees.
- Preferred Provider Option - For employees who live in the metropolitan Atlanta, Augusta, Columbus, Macon, and Savannah areas.*
- Prepaid - Specifically for employees who live or work in the metropolitan Atlanta area.*
* If a PPO dentist or a Prepaid dentist is available in the area where you live or work, you may choose the applicable option. Under the PPO, you have the freedom to go to any dentist, but, there are benefits of using a PPO participating dentist. If your dentist leaves the Prepaid plan during the plan year, you must select another participating dentist.
* It is important that you consider your particular needs and be aware of the potential lack of convenience by choosing a dental option that does not have a dental provider in close proximity to where you live. In this case, you will not be able to change or drop your option.
Contact your personnel/payroll representative if you need assistance
in choosing the PPO or Prepaid option.
Consider the following:
- If you select the Dental PPO and choose to use
a non-PPO dentist, you should expect to pay more
out of pocket.
- If you select the Dental Prepaid option you must visit a dentist within the CIGNA Dental Care network to receive benefits. You will not receive benefits if you visit a dentist outside the network. You will have limited ability to change dental plans until the following Open Enrollment.
Your Dental Plan Choices (Please review carefully)
Regular Dental Option
Benefits are determined using the 90th percentile rates for procedures.
You may use any dentist you choose.
You may choose a dentist in the available PPO network with benefits based on the maximum allowable charge (MAC). This may result in lower out of pocket costs.
A non-network dentist is entitled to collect from you the difference between the amount of benefits payable by United Concordia and the dentist charge for that service.
Preferred Provider Option (PPO)
PPO Option
Benefits are based on the MAC determined by United Concordia and accepted by the PPO dentist.
Enrollment in the PPO is with the PPO Program, not with a particular dentist. PPO dentists can discontinue their arrangement with the Program at any time.
If you require the services of a specialist, ask your dentist to refer you to a PPO specialist.
If you use the services of a non-PPO dentist:
The dentist is entitled to charge you the difference between the amount of benefits payable by United Concordia and the dentist's charge. This means you could pay more out-of-pocket expense for using a non-PPO dentist, because the payment will reflect the lower PPO scheduled fee.
Some Important Features Of The Regular and PPO Dental Options
There are some features to keep in mind when you use the dental options, Regular or PPO.
The options of the State Health Benefit Plan (PPO, Indemnity, and HMO) provide limited, if any, coverage for dental treatment. See your SPD, UPDATERs and Health Plan Decision Guide for more information. For more detailed HMO information, contact the HMO directly.
The PPO dentists have agreed to provide quality services at reduced rates. This means you save money if you use a PPO dentist. If you enroll in the dental PPO, receiving dental care from a non-PPOdentist can result in an increased out-of-pocket expense for you, as shown in the example on the following page.
United Concordia uses the American Dental Association (ADA) procedure codes in effect at the time a claim is handled to determine benefits.
Pre-Determination of Benefits
Under the Regular and PPO Dental Options, for any service of more than $300, the service should be reviewed by United Concordia before receiving treatment. This is called a "pre-determination of benefits." If treatment occurs without a predetermination of benefits and the service is denied, you may experience unexpected out-of-pocket costs
Some Exclusions For Regular and PPO Dental Options
Items and services that are not covered by the Regular and PPO Options are set forth in the Summary Plan Description for those options. Some examples include:
charges for oral hygiene, plaque control programs, and dietary instruction;
the initial placement of full or partial dentures or bridges, if the prosthesis includes teeth that were missing before you were covered by the dental option.
Late Entrant Provisions for Regular and PPO
Late Entrant Limitations result in delayed benefits. This means you won't receive some benefits until you have participated in the dental plan for a specified period of time.
Late Entrant Limitations will apply to:
current employees who are enrolling in either the Regular or PPO Options for the first time; or
employees who fail to pay premiums when they are on an unpaid leave.
current employees who choose not to continue coverage and re-enroll at a later date.
Late Entrant Limitations will not apply:
if you enroll in the Prepaid Option as a new or current employee*
when you transfer between the dental options (if not currently under Late Entrant);
if you enroll in the PPO or Regular Option plan when you are first eligible as a new employee; or
to employees who fail to pay premiums when they are on unpaid Family Medical Leave or Military Leave (if not currently under Late Entrant)
*New employees are not subject to the Late Entrant Limitations - as long as they enroll when first eligible. If you are a new employee and are interested in the Regular or PPO Options, sign up now to avoid these limitations in the future. Under the Regular and PPO Options, new employees have a six-month waiting period for Major and Orthodontic (dependents under age 19) services.
Example of Regular and PPO Benefit Payments
The example below shows the differences in benefits paid by the Regular and PPO Options for the same expense. In addition, it illustrates the advantages of using PPO dentists, if you choose the PPO option.
For the same $500 charge, an employee would pay:
$100 if covered under the Regular Option;
$35 if covered under the PPO Option and using a PPO dentist;
$185 if covered under the PPO Option but using a non-PPO dentist.
Prepaid Option
> If you plan to select or are continuing the Prepaid Dental Option, please read the Patient Charge Schedule carefully, since it has changed.
The Prepaid option through CIGNA Dental Care is an easy to use plan offering choice, quality, and savings with a focus on preventive care. Choose a general dentist from the CIGNA Dental network. Covered family members can each choose their own dentists, near home, work, or school.
You will receive a Patient Charge Schedule listing all covered services and the corresponding patient charge for each service. For many services, there is no charge at all. Other plan features include: No deductibles to meet. No annual dollar maximums. No claim forms to file and no waiting periods for coverage.
If you choose this option, you must select and use a CIGNA Dental Care Participating General Dentist to receive the benefits the option offers. Each family member you enroll may select a personal Participating General Dentist. If your dentist recommends specialty treatment, he/she will refer you to a participating CIGNA Dental Care Specialist. Whether seeing a general dentist or specialist, you will still only be responsible for the fees listed on your Patient Charge Schedule. Estimate and Plan for dental costs - CIGNA Dental introduces the Dental Treatment Cost Estimator which is a web-based tool that allows enrolled members to estimate and plan for their dental care costs.
To find a participating CIGNA Dental Care network dentist call 1-800-642-5810 or log onto www.cigna.com.
> If a procedure is not listed on your Patient Charge Schedule, it is not covered. A full explanation of plan exclusions and limitations is included in your Patient Charge Schedule. Please read the Patient Charge Schedule carefully, as it has changed for the 2008 Plan Year.
Some Important Information About the Prepaid Option
Once enrolled, you will receive a complete Patient Charge Schedule listing all covered services and associated fees along with your CIGNA Dental Care ID Card. Procedures not listed on the Patient Charge Schedule are not covered.
You do not need your ID card to receive care. CIGNA Dental will send each dentist a monthly listing of all members who have enrolled with their office. You may request a Patient Charge Schedule by calling CIGNA Dental Member Services at 1-800-642-5810 or online at www.cigna.com, then go to mycigna.com. This Patient Charge Schedule will provide a complete list of covered benefits and co-payments.
If you choose the Prepaid Option, you must select and use a CIGNA Dental Care Participating Dentist. Otherwise, you will not be eligible for benefits.
Each enrolled family member may select a different Participating General Dentist.
To select a CIGNA Dental Care dentist for the first time, fill out and send in the Dentist Selection Form included in your enrollment materials. If you enroll in the CIGNA Dental Care plan but do not choose a dentist, one will be chosen for you based on your zip code. You have the option to change network dentists as often as you like by calling 1-800-642-5810, or by logging onto www.cigna.com. Your change will be effective the first day of the following month.
Did You Know
Your dental benefits are not taxed, and most dental expenses that are not paid by dental coverage - such as deductibles and co-payments - can be submitted to your health care spending account, providing a tax savings of 26% - 45% on these expenses.
Certain Restrictions, along with age and frequency limitations, apply to all dental options. For more information on the Regular and PPO Options, call United Concordia toll free at 1-866-215-2356. For more information on the Prepaid option, call CIGNA at 1-800-642-5810.
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