The Plan offers three dental care plans for active employees:
The Cigna Dental
Dental Health Maintenance Organization (DHMO) is a network of dentists and dental care providers. If you elect dental coverage through the Cigna Dental DHMO, you must select a dental care provider from within the DHMO network to receive benefits. This dentist will serve as your primary dental provider and coordinate your care. The DHMO provides preventive services, like exams and cleanings, at no charge. Other procedures require a Co-payment (refer to the “Patient Charge Schedule” in your Cigna DHMO booklet for exact amounts). Also, there are no claim forms to file- your network dentist will submit your claims for you.
There is no annual limit (annual benefit maximum) on the services you can receive when using the DHMO. The DHMO provides orthodontia benefits for both children and adults. Adults are responsible for a Co-payment of $2,328 for a 24-month treatment plan. For children, the Co-payment is $1,584 for a 24-month treatment plan. Retainers and related Orthodontic expenses are covered according to the Patient Charge Schedule.
| Annual Deductible | None |
| Annual Benefit Maximum | $0 |
| Preventive Services (Exams Cleanings) | $0 |
| Basic Restorative Services | $0 |
| Major Restorative Services (Crowns Porcelain/Ceramic) | $245 |
| Root Canal Bicuspid | $31 |
| Extraction Single Tooth Partial Bony Impaction |
Single Tooth$12 Partial Bony Impaction $21 |
| Dentures | Co-Pay |
| Orthodontia 24-month treatment Adult/Child | Adult $2,328 -Child $1,584 |
| Crown and Bridges | 5-year replacement |
The CareFirst Dental plan offers you the freedom to visit any dental care provider you would like and still receive benefits for covered services. However, if you take advantage of the network and use a participating CareFirst dental provider, your savings will be more significant.*Non-participating dentist, you pay any amount in excess of reasonable and customary allowance.
Limitation and Exclusions
Covered services must be medically necessary as determined under the carrier’s rules. Cosmetic procedures and experimental procedures are generally not covered. In addition, specific procedures and appliances may be subject to prior authorization for medical necessity or to limitations or exclusions. For example, dentures or other devices can typically only be replace after a certain number of years, depending on the reason for the replacement. Up to two routine dental exams are generally covered per year. Experimental procedures are also generally excluded. Refer to the benefits booklet from your carrier or contact your carrier for more details.