Dental Benefits Extension An expense incurred in connection with a Dental Service that is completed after a person's benefits cease will be deemed to be incurred while he is insured if: for fixed bridgework and full or partial dentures, the first impressions are taken and/or abutment teeth fully prepared while he is insured and the device installed or delivered to him within 3 calendar months after his insurance ceases. for a crown, inlay or onlay, the tooth is prepared while he is insured and the crown, inlay or onlay installed within 3 calendar months after his insurance ceases. for root canal therapy, the pulp chamber of the tooth is opened while he is insured and the treatment is completed within 3 calendar months after his insurance ceases. There is no extension for any Dental Service not shown above.
Termination of Insurance
Employees Your insurance will cease on the earliest date below: the last day of the calendar month in which you cease to be in a Class of Eligible Employees or cease to qualify for the insurance. the last day of the calendar month in which you have made any required contribution for the insurance. the date the policy is cancelled. the last day of the calendar month in which your Active Service ends except as described below. Any continuation of insurance must be based on a plan which precludes individual selection. Temporary Layoff or Leave of Absence If your Active Service ends due to temporary layoff or leave of absence, your insurance will be continued until the date as determined by your Employer. Injury or Sickness If your Active Service ends due to an injury or Sickness, your insurance will be continued while you remain totally and continuously disabled as a result of the injury or Sickness. However, your insurance will not continue past the date your Employer cancels your insurance. Dependents Your insurance for all of your Dependents will cease on the earliest date below: the date your insurance ceases. the date you cease to be eligible for Dependent Insurance. the last day for which you have made any required contribution for the insurance. the date Dependent Insurance is cancelled. The insurance for any one of your Dependents will cease on the last day of the calendar month of which the date that Dependent no longer qualifies as a Dependent.
HC-BEX3
04-10
V1
Federal Requirements The following pages explain your rights and responsibilities under federal laws and regulations. Some states may have similar requirements. If a similar provision appears elsewhere in this booklet, the provision which provides the better benefit will apply.
HC-FED1
10-10
Notice of Provider Directory/Networks Notice Regarding Provider Directories and Provider Networks A list of network providers is available to you without charge by visiting the website or by calling the phone number on your ID card. The network consists of dental practitioners, of varied specialties as well as general practice, affiliated or contracted with Cigna or an organization contracting on its behalf.
HC-FED78
10-10
HC-TRM144 M
01-18
18
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