Your Health & Welfare Plan offers dental benefits for you and your family. In order to elect dental coverage, you must be enrolled in one of the Plan’s medical plan options. The Plan offers three dental care plans for active employees:
Retirees are provided dental coverage through Delta Dental if they remain enrolled in a medical plan.
The CIGNA 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 the DHMO network in order to receive benefits. This dentist will serve as your primary dental care provider and will coordinate your care.
Preventive services, like exams and cleanings, are provided at no charge. Other procedures require a co-payment. There are no claim forms to file—your network dentist will submit your claims for you. There is no annual limit on the services you can receive.
The DHMO provides orthodontia benefits for both children and adults. Retainers and related orthodontic expenses are covered.
For exact co-payment amounts, refer to the Patient Charge Schedule in your Cigna DHMO booklet. Visit CIGNA's website to find out more about the CIGNA DHMO plan.
Need to Find a Provider in the DHMO?
The Health & Welfare Plan can provide you with a directory of DHMO providers. Or, you can visit CIGNA's website to find a provider online.
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 greater.
Most covered services are paid at 80% of the negotiated price established by CareFirst with its providers. You pay the 20% difference. If you use a non-participating dentist, you are also responsible for charges above the network allowance.
The Plan will pay up to $1,500 per individual each year for dental services. If you reach that limit, you will be fully responsible for the remainder of charges you incur for the rest of the year.
CareFirst Dental with Orthodontia
You have the option to elect coverage for orthodontia through CareFirst Dental. CareFirst pays 50% with a separate $1,000 lifetime maximum benefit per participant.
If you are a retiree and remain enrolled in medical coverage from the Health and Welfare Plan, you will be automaitcallty enrolled in the retiree dental plan. A monthly deduction ($7 for individual coverage) will be taken from your pension check for your coverage. If you would like to add family coverage, please contact the Health & Welfare Plan office.
Please notify the the Health & Welfare Plan office if you would like to opt out of the retiree dental plan.
The plan has a $100 annual individual deductible and $300 annual family deductible. There is also a $1,500 annual benefit limit. Most covered services are paid at 60%.
|Your Dental Benefits|
|CIGNA Dental DHMO (Employees)||CareFirst Dental (Employees)||CareFirst Dental with Orthodontia (Employees)||Delta Dental (Retirees Only)|
|Annual Deductible||None||None||None||$100 per individual; $300 per family (maximum)|
|Annual Maximum Benefit||None||$1,500 individual||$1,500 individual||$1,500|
|Preventive Services (Exams and Cleanings)||No charge||No charge when you visit a participating dentist||No charge when you visit a participating dentist||Plan pays 60% of Allowance|
|Basic Restorative Services (Fillings)||No charge or co-pay*, depending on type of procedure||Plan pays 100% of Allowance||Plan pays 100% of Allowance||Plan pays 60% of Allowance|
|Major Restorative Services (Stainless Steel Crowns)||Co-pay*||Plan pays 80% of Allowance||Plan pays 80% of Allowance||Plan pays 30% of Allowance|
|Root Canal||Co-pay*||Plan pays 80% of Allowance||Plan pays 80% of Allowance||Plan pays 50% of Allowance|
|Extractions Single Tooth||Co-pay*||Plan pays 80% of Allowance||Plan pays 80% of Allowance||Plan pays 50% of Allowance|
|Partial Bony Impaction||Co-pay*||Plan pays 80% of Allowance once every ten years||Plan pays 80% of Allowance once every ten years||Plan pays 30% of Allowance|
|Complete Mandibular Dentures||Adult: $3,122 for a 24-month treatment plan||Not covered||Plan pays 50% of Allowance to a lifetime maximum of $1,000||Not covered|
|Orthodontia||Child: $2,450 for a 24-month treatment plan||
Plan pays 30% of Allowance
*Co-payments apply to certain services. Refer to your CIGNA DHMO Patient Charge Schedule for exact Co-payment amounts.
Covered services must be medically necessary as determined under the rules of the carrier. Cosmetic procedures and experimental procedures are generally not covered. In addition, certain procedures and appliances may require prior authorization for medical necessity, or be limited or excluded. For example, dentures or other appliances can typically only be replaced after a certain number of years, depending on the reason for replacement. Up to two routine dental exams are generally covered per year. Experimental procedures are also generally excluded. Refer to the benefit booklet from your carrier or contact your carrier for more details.
On the other hand, retirees can elect medical and dental coverage together, or just medical coverage.