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Dental insurance is changing for the 2015-16 benefit plan year.  Cigna Dental is replacing the Dental Direct  Reimbursement Plan, which included claim payments processed by HealthSmart. See the Benefit Summary Plan Document  for in-network and out-of-network reimbursement levels.

Cigna DPPO Low Plan

Cigna DPPO Low Benefit Plan Summary          2015-16 Cigna Dental Finding a Network Provider 

  • 100% In-Network and Out-of-Network, Class I Preventative & Diagnostic Care including oral exams, routine cleanings, full mouth x-rays, bitewing x-rays, panoramic x-ray, periapical x-rays, flouride application, sealants, space maintainers, emergency care to relieve pain, histopathologic exams.
  • 80%* In-Network and Out-of-Network, Class II Basic Resorative Care including fillings, root canal therapy/endontics, osseous surgery, periodontal scaling and root planing, denture adjustments and repairs, oral surgery - simple extractions, oral surgery - all except simple extractions, anesthetics, surgical extractions of impacted teeth, repairs to bridges, crowns and inlays. 
  • 50%* In-Network and Out-of-Network, Class III Major Restorative Care including crowns, dentures, bridges, inlays/onlays, prosthesis over implant.
  • Orthodontia is not covered with the Cigna Dental DPPO Low Plan.
  • Calendar year maximum for In-Network and Out-of-Network, Class I, II and III expenses is $1,000.
  • Annual deductibles for In-Network and Out-of-Network, are $50 per person for an individual or $100 per family.
  • For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees.

*subject to annual deductible

Cigna DPPO High Plan with Orthodontia

Cigna DPPO High Benefit Plan Summary              2015-16 Cigna Dental Finding a Network Provider 

Cigna Dental DPPO Orthodontics in Progress 

  • 100% In-Network and Out-of-Network, Class I Preventative & Diagnostic Care including oral exams, routine cleanings, full mouth x-rays, bitewing x-rays, panoramic x-ray, periapical x-rays, flouride application, sealants, space maintainers, emergency care to relieve pain, histopathologic exams.
  • 80%* In-Network and Out-of-Network, Class II Basic Resorative Care including fillings, root canal therapy/endontics, osseous surgery, periodontal scaling and root planing, denture adjustments and repairs, oral surgery - simple extractions, oral surgery - all except simple extractions, anesthetics, surgical extractions of impacted teeth, repairs to bridges, crowns and inlays.
  • 50%* In-Network and Out-of-Network, Class III Major Restorative Care including crowns, dentures, bridges, inlays/onlays, prosthesis over implant.
  • 50% In-Network and Out-of-Network, Class IV Orthodontia. Lifetime maximum is $3,000.
  • Calendar year maximum for Class I, II and III expenses for In-Network and Out-of-Network is $2,000. 
  • Annual deductibles for In-Network and Out-of-Network are $50 per person for an individual or $100 per family.
  • For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees.
  • Covers orthodontics in progress: “Orthodontics in Progress” refers to orthodontic treatment that began under a different carrier and continues into the new Cigna coverage period. Contributions may be available for patients whose teeth are being actively moved by bands or appliances (such as braces) at the time their Cigna dental coverage becomes effective. The Cigna plan covers orthodontics in progress, subject to your specific plan’s limitations. Keep in mind, new benefits do not change the terms of the contract you signed with your orthodontist prior to enrolling with Cigna. You are still responsible for the orthodontist’s total case fee.
  • Cigna will pay your orthodontist quarterly. If you have prepaid your bill, you can request that Cigna pays you directly.

*subject to annual deductible

2014-15 Dental Reimbursement Plans

Littleton Public Schools Dental Direct Reimbursement Plan   is a self-funded benefit plan that reimburses eligible employees and their eligible dependents for covered dental expenses. There are two options: 1) High Option with a $2,000 annual benefit which includes orthodontia; and 2) Low Option with a $1,000 annual benefit; the low option does NOT cover orthodontia.

LPS is the Plan's administrator and HealthSmart administers the dental claims. Participants may use any dentist of their choice, however, network discounts apply when using a Connection Network   dentist. If you have any dental questions please contact Becky Sherwood, Benefits Technician, at 303-347-3371 or HealthSmart at 1-888-745-3274.

 

 

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