Regular full-time or regular part-time (75%+) appointments are eligible to enroll in one of two dental plans. Coverage will begin the first day of the month following completion of one full calendar month of employment.
Eligible employees can choose from two voluntary Dental Insurance plans:
- Prepaid Dental Plan (Cigna Dental Health Maintenance Organization — DHMO) provides services at fixed copay amounts paid by the member. A narrow network of participating Cigna General Dentists and Specialists must be used to receive benefits.
- Dental Preferred Provider Organization (DPPO — MetLife) provides services with coinsurance paid by the member and MetLife. Any Dentist may be used to receive benefits, but you will pay less if you use an in-network provider.
Transferring dental plans may be done only during Annual Enrollment Period. This is the only time of the year when participants can make changes in their insurance coverage. Changes in coverage will become effective on January 1.
Prepaid (DHMO) Plan — Cigna
- The network is Cigna Dental Care DHMO.
- You must select a General Dentist from the Prepaid (DHMO) Dental Plan list and let Cigna know of your choice.
- You must use your selected dentist to receive benefits.
- You may select a network Pediatric Dentist as the network General Dentist for your dependent child under age seven. At age seven, you must switch the child to a network General Dentist or pay the full charge from the pediatric dentist.
- You must use your selected General Dentist to receive benefits. There may be some
areas in the state where network General Dentists are limited or not available. Before
enrolling, carefully check the network for your location.
- With the prepaid dental plan, you may be able to cancel this coverage if you enroll and later there are no network General Dentists within 40 miles of your home.
- You pay copays for dental treatments.
- No deductibles to meet, no claims to file, no waiting periods and no annual dollar maximum.
- Preexisting conditions are covered.
- Referrals to Specialists are required.
- Orthodontic treatment is not covered if the treatment plan began prior to the member’s effective date of coverage with Cigna.
DPPO — MetLife
- The network is PDP.
- You can use any Dentist, but you receive maximum benefits when visiting an in-network MetLife DPPO provider. Deductible applies for Basic and Major dental care.
- You pay coinsurance for Basic, Major, Orthodontic and out-of-network covered services.
- You or your Dentist will file claims for covered services.
- Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a six-month Waiting Period from the member’s coverage start date before benefits begin.
- There is a 12-month Waiting Period from the member’s coverage start date for both the replacement of a missing tooth and also Orthodontics.
- Referrals to Specialists are not required.
- Pre-treatment estimates are recommended for more expensive services.
- Dental treatment in progress at time of member’s effective date with MetLife may have pro-rated benefits under the MetLife plan.
You pay coinsurance for many covered services and your share is based on the "maximum allowable charge" (MAC) for a given service. MAC is the lesser of the amount charged by the dentist or the maximum payment amount that in-network dentists have agreed to accept in full for the dental service. When you receive dental services from an out-of-network provider, MetLife will reimburse a percentage of the MAC. You are then responsible for everything over the percentage of MAC reimbursed up to the charge submitted by the out-of-network dentist. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.