Your Dental Benefits and Contributions
Dental Insurance CSHL Dental coverage is provided by Cigna.
Cigna
PPO
DHMO*
Deductible (Calendar Year)
$50 (Individual)/ $150 (Family)
None
Deductible Waived for Preventative Care Progressive Annual Maximum Benefit
Yes
N/A
$3,000**
Unlimited
Dental Services
Amount of Coverage
In-Network
Out-of-Network
DHMO In-Network Copay Range
Preventative (cleanings, x-rays, etc.)
100%
100% of the UCR***
$0
Basic Services (fillings, etc.)
80%
80% of the UCR***
$0-335.00
Major Services (implants, dentures, etc.)
50%
50% of the UCR***
$410.00-$875.00
Orthodontia
50% (for dependents up to age 19)
50% of the UCR*** (for dependents up to age 19)
$2,184 (children)**** $2,904 (adults)****
Orthodontia Lifetime Maximum
$2,500
N/A
Employee Monthly Pre-Tax Contributions
DPPO
DHMO
Full-Time
Part-Time
Full-Time
Part-Time
Employee Only
$8.50
$11.00 $22.50
$0 $0
$2.00 $5.00
Employee + Spouse/ Domestic Partner
$17.00
Employee + Child(ren)
$19.00
$25.00
$0
$5.50
Employee + Family
$28.00
$37.00
$0
$8.50
For more information, or to locate network providers, before you are enrolled in a Cigna dental plan visit www.Cigna.com or call the Cigna dental Pre-Enrollment line at (800) 564-7642. If you utilize a participating Cigna dentist, you just need to provide your Social Security number or your Cigna ID number to the dentist, and the dentist can electronically obtain your eligibility, benefit coverage, and file claims. If you want to obtain a dental ID card or view your claims, register at www.myCigna.com or download the myCigna mobile app. After you are enrolled in a Cigna plan, you can call (800) 244-6224 to gain help in finding an in-network dentist, information on specific plans, and claims questions. Please note: when you enroll in the DHMO plan, you are required to select and visit an in-network general dentist (provider) for your dental care needs. Again, you may visit www.MyCigna.com to select this provider or call Cigna’s 24/7/365 customer service line at (800) 244-6224 *Cigna DHMO provider network is limited. **Regular dental care helps members maintain good oral health and assists in avoiding future major & expensive treatment. DPPO members who go for their annual dental preventive services (oral exam & cleaning), will have $100 added to their Calendar Year Maximum for the following year. This continues year over year, to a maximum increase of $300 per member. ***You are responsible for 100% of the charges that exceed the Usual, Customary and Reasonable (UCR) charges for the geographic and dental services you receive. ****Additional fees may be applied.
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