DENTAL

Covered Expenses & Services

The Dental Plans cover or help cover a wide variety of dental services for you and your family. Generally, to be covered, dental expenses must meet the following requirements:

• the services is ordered or prescribed by a Dentist;
• is essential for the necessary care of teeth;
• the service is within the scope of coverage limitations;
• the deductible amount in The Schedule has been met;
• the maximum benefit is The Schedule has not been exceeded;
• the charge does not exceed the amount allowed under the Alternate Benefit Provision;
• for Class I, II, or III the service is started and completed while coverage is in effect, except for services described in the "Benefit Extension" section.

Alternate Benefit Provision: If more than one covered service will treat a dental condition, payment is limited to the least costly service provided it is a professionally accepted, necessary and appropriate treatment. If covered person requests or accepts a more costly covered service, he or she is responsible for expenses that exceed the amount covered for the least costly service. Therefore, Cigna recommends Predetermination of Benefits before major treatment begins.

Preventive and diagnostic services are covered at 100%. Basic services are covered at 50% (Basic) or 80% (Buy-Up) depending on the plan you select. The coverage for major services depends on the plan and the services. Orthodontia is covered at 50% for the Buy-Up plan and per the schedule for the DMO plan. See the Dental Plan Comparison Chart below for details.

Dental Benefits Summary
The chart below allows you to compare summarized coverage levels for each plan option. This summary describes some of the more frequently performed dental procedures. In order for a covered person to be eligible for DMO benefits, covered dental services must be provided or prescribed by a dentist selected from the network of DMO participating dentists (Network General Dentist). Out-of-network benefits under the Basic and Buy-Up Plans are subject to reasonable and customary charge limits.

Note: Frequency and/or age limits may apply to certain services. Please refer to the plan documents.

Orthodontia
The Buy-Up and DMO Plans provide coverage of some orthodontic services for eligible children and adults.

To be covered, services must be outlined in an orthodontic treatment plan. An orthodontic treatment plan is a dentist’s report (on a form provided by Cigna) that explains the nature of the condition to be corrected, recommends and describes treatment, estimates the duration of the treatment and the total charge for treatment and includes supporting evidence.

An orthodontic procedure means the use of appliances to move teeth to correct faulty position or abnormal bite.

Buy-Up Plan Details: Covered expenses include (each month of active treatment is a separate Dental Service):

• Orthodontic work-up including x-rays, diagnostic casts and treatment plan and the first month of active treatment including all active treatment and retention appliances.
• Continued active treatment after the first month.
• Fixed or Removable Appliances - Only one appliance per person for tooth guidance or to control harmful habits.

The total amount payable for all expenses incurred for Orthodontics during a person's lifetime will not be more than the Orthodontia Maximum shown in the Schedule.

Payments for comprehensive full-banded Orthodontic treatment are made in installments. Benefit payments will be made every 3 months. The first payment is due when the appliance is installed. Later payments are due at the end of each 3-month period. The first installment is 25% of the charge for the entire course of treatment. The remainder of the charge is prorated over the estimated duration of treatment. Payments are only made for services provided while a person is insured. If insurance coverage ends or treatment ceases, payment for the last 3-month period will be prorated.

DMO Plan Details: Orthodontia benefits are paid per the schedule. DMO members may visit an orthodontist without first obtaining a referral from their Network General Dentist. Cigna has established direct access for DMO members to orthodontic services to ease the administrative burden on both participating dentists and members.

Emergency Dental Care
Your plans provide for emergency dental care as follows:

• Basic or Buy-Up Plan Details: The Benefit Percentage payable for Emergency Services charges made by a Non-Participating Provider is the same Benefit Percentage as for Participating Provider Charges. Dental Emergency services are required immediately to either alleviate pain or to treat the sudden onset of an acute dental condition. These are usually minor procedures performed in response to serious symptoms, which temporarily relieve significant pain, but do not effective a definitive cure, and which, if not rendered, will likely result in a more serious dental or medical complication.

• DMO Plan Details: An emergency is a dental condition of recent onset and severity which would lead a prudent layperson possessing an average knowledge of dentistry to believe the condition needs immediate dental procedures necessary to control excessive bleeding, relieve severe pain or eliminate acute infection. You should contact your Network General Dentist if you have an emergency in your Service Area.

  If you have an emergency while you are out of your Service Area or you are unable to contact your Network General Dentist, you may receive emergency Covered Services as defined above from any general dentist. Routine restorative procedures or definitive treatment (e.g. root canal) are not considered emergency care. You should return to your Network General Dentist for these procedures. For emergency Covered Services, you will be responsible for the Patient Charges listed on your Patient Charge Schedule. Cigna Dental will reimburse you the difference, if any, between the dentist's Usual Fee for emergency Covered Services and your Patient Charges. To receive reimbursement, send appropriate reports and x-rays to Cigna Dental.

  There is a Patient Charge listed in your Patient Charge Schedule for emergency care rendered after regularly scheduled office hours. This charge will be in addition to other applicable Patient Charges.

Extended Benefits

Basic or Buy-Up Plan Details: Benefits are covered for crowns, root canal treatment, bridges, dentures, and partials if the teeth were fully prepared or the final impressions were taken before the termination of coverage and provided the services are completed within the extension of benefits parameters. Our standard extension of benefits is 90 days; however, other arrangements can be made.

DMO Plan Details: Coverage for a dental procedure that was started before disenrollment from the plan will be extended for 90 days after disenrollment unless it was due to non-payment of premiums. Coverage for orthodontic treatment which was started before enrollment from the DMO Plan will be extended to the end of the quarter or for 60 days after disenrollment if it was due to non-payment of premiums.

	Highlights Eligibility, Enrollment & Cost Plan Options Choosing a Network Dentist Making Changes Covered Expenses & Services Expenses Not Covered Coverage Rules Predetermination of Benefits Filing a Claim Numbers, Addresses & Links

Summary Plan Description
The legal summary of this benefit will be included in the 2008 Benefits Handbook.