Employer The term Employer means the plan sponsor self-insuring the benefits described in this booklet, on whose behalf Cigna is providing claim administration services.
Participating Provider The term Participating Provider means: a dentist, or a professional corporation, professional association, partnership, or other entity which is entered into a contract with Cigna to provide dental services at predetermined fees. The providers qualifying as Participating Providers may change from time to time. A list of the current Participating Providers will be provided by your Employer.
HC-DFS8
04-10
V1
Maximum Reimbursable Charge - Dental The Maximum Reimbursable Charge for covered services is determined based on the lesser of: the provider’s normal charge for a similar service or supply; or the policyholder-selected percentile of charges made by providers of such service or supply in the geographic area where it is received as compiled in a database selected by Cigna. The percentile used to determine the Maximum Reimbursable Charge is listed in The Schedule. The Maximum Reimbursable Charge is subject to all other benefit limitations and applicable coding and payment methodologies determined by Cigna. Additional information about how Cigna determines the Maximum Reimbursable Charge is available upon request.
HC-DFS136
04-10
V1
HC-DFS752
07-14
V5
Medicaid The term Medicaid means a state program of medical aid for needy persons established under Title XIX of the Social Security Act of 1965 as amended.
HC-DFS16
04-10
V1
Medicare The term Medicare means the program of medical care benefits provided under Title XVIII of the Social Security Act of 1965 as amended.
HC-DFS17
04-10
V1
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