VOLUNTARY DENTAL PLAN OPTION - DHMO Plan year: 7/1/2019 862420 d Offered by Cigna Health and Life Insurance Company or its affiliates City of Waterbury
VOLUNTARY DENTAL PLAN OPTION - DHMO
Plan year: 7/1/2019
862420 d
Offered by Cigna Health and Life Insurance Company or its affiliates
City of Waterbury
A New Voluntary Dental Benefit Plan - DHMO
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Cigna offers a Fully Insured Alternative Dental Plan
• The Plan provides Basic Protection PLUS Coverage
for treatments & care that are otherwise excluded from
the Basic Flex2 Dental Plan in place currently
• This plan is offered as a choice to employees who may
need greater protection and a plan that will pay for
expensive treatments as well as regular, basic care
• Employees can choose between the Flex2 or DHMO
Plan (Can’t enroll in both; and no dental only coverage.)
• Will be offered this open enrollment beginning in May
.
2
* The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including, but not
limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) product
availability varies by state and is subject to change.
** There are no out-of-network benefits with a Cigna Dental Care plan except in the case of emergencies. For residents of
MN and OK coverage is available out-of-network. See Appendix A for details.
What is a Dental Health Maintenance Organization?
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• A DHMO offers services through a narrower network of dentists
• The plan is able to offer covered members much greater
benefits because of deeper discounts
• There are no deductibles and no calendar year maximums
• Members must choose a primary care dentist in the Cigna Dental
Care network
• Members can change a network dentist at any time; changes
become effective the month after a change is requested
• Members pay the charge for each service listed on the Patient
Charge Schedule
• There is no out-of-network coverage (except in emergencies)**
Cigna Dental
Care® Dental
Health
Maintenance
Organization
(DHMO)*
.
3
* The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including, but not
limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) product
availability varies by state and is subject to change.
** There are no out-of-network benefits with a Cigna Dental Care plan except in the case of emergencies. For residents of
MN and OK coverage is available out-of-network. See Appendix A for details.
What is a Dental Health Maintenance Organization? (Cont’d.)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• A “Narrower Network” means the choice of dentists is more
limited than in regular, broad network plans with limited coverage
• Members will need to weigh the value of richer reimbursements
from the plan against possibly changing dentists for a limited time
• If a member decides to enroll in the DHMO, they can switch
back to the Flex2 Plan next open enrollment after the
expensive care is complete
• The DHMO premium is lower than Flex2 premium and members
will pay the same cost share; so less premium comes out of each
paycheck
• Oral Health Integration Program all charges paid in full, no annual
maximums.
Cigna Dental
Care® Dental
Health
Maintenance
Organization
(DHMO)*
.
4
5Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• DHMO network is a subset of the current Flex2
network that you use today.
• You must go “In-network” to use the DHMO plan
• Plan name is: Cigna Dental Care Access Plus
• To find a DHMO provider call 1.855.511.6366
or go to www.cigna.com (see brochure)
Cigna Dental
Care® Dental
Health
Maintenance
Organization
(DHMO)*
What is a Dental Health Maintenance Organization? (Cont’d.)
Cigna Dental – Voluntary DHMO & Current Flex2 - Overview
DHMO
In-network coverage only
Flex2
In & Out-of-Network
Deductible
Individual
Family (Aggregate)No Deductible
No Deductible
$50 Annual Deductible
$150 Annual Deductible
Annual Maximum No Plan Maximum
(There is no annual limit for any
member annually)
$1,000 per member Maximum (Each
Family Member is limited to $1,000
annually)
Cleaning – Adult (D1110) 100% (2 per calendar year)
Additional cleanings $40 copay
100% (2 per calendar year)
No additional cleanings
Cleaning – Child (D1120) 100% (2 per calendar year)
Additional cleanings $30 copay
100% (2 per calendar year)
No additional cleanings
Basic Services100%
100%
After Deductible
Major Services60%
50%
After Deductible
DHMO
In-network coverage only
Flex2
In & Out-of-Network
Orthodontics Adult & Child - 60%
No lifetime maximum
1 treatment per lifetime
No Coverage
Temporomandibular Joint Syndrome (TMJ)60%
No Coverage
Surgical Implants60%
No Coverage
General Anesthesia/IV sedation 100% No Coverage
External Bleaching $165 patient charge
No Coverage
Occlusal guards 60%
No Coverage
Sealants 100%
No age limits No Coverage
Cigna Dental – Voluntary DHMO & Current Flex2 Overview - (cont’d.)
7Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Dental Rates
8Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Monthly Rates Flex2 DHMO
Single $37.55 $28.68
2-Party $97.61 $74.56
Family $120.11 $91.76
Note: Employer and Employee % cost shares for the DHMO will match cost shares in place for the Flex2 Plan.
CARE PROVIDED
Scenario 1
Orthodontics : (treatment is done within 24 months)
AMOUNT BILLED
Dentist Bills the Plan
CIGNA’S DISCOUNT - DHMO
Net Payable to In-network Dentist &
Patient Share
Flex 2
No Coverage
Orthodontics(includes records, banding, treatment, retention)
$6,000 ($3,754.96 is contracted fee)Cigna will pay 60 % of $3,754.96 =
$2,252.98 Patient will pay 40% of $3,754.96 =
$1,501.98
Patient will pay = $6,000
Examples - Illustrative purposes only
9
Data provided is based on average charges for care rendered in CT for City of Waterbury enrollees. The above is for illustrative purpose only.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Note: If orthodontic treatment is already in progress on 7/1, bills for treatment incurred after 7/1 only are eligible if coverage is elected.
CARE PROVIDED
Scenario 4Crown
AMOUNT BILLED
Dentist Bills the Plan
CIGNA’S DISCOUNT - DHMONet Payable to In-network Dentist
& Patient Share
($584 contracted fees)
Flex 2Net Payable to In-network Dentist
& Patient Share
($796 contracted fees)
Crown $840Cigna will pay 60 % of $584 =
$350.40
Patient will pay 40% of $584 = $233.60
Cigna will pay 50 % of $796 (after deductible of $50) = $373.00
Patient will pay 50% of $796 plus deductible $50 = $423.00
Examples - Illustrative purposes only
10Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Data provided is based on average charges for care rendered in CT for City of Waterbury enrollees. The above is for illustrative purpose only.
CARE PROVIDED
Scenario 3
Implant
AMOUNT BILLED
Dentist Bills the Plan
CIGNA’S DISCOUNT - DHMO
Net Payable to In-network Dentist &
Patient Share
Flex 2
Net Payable to In-network Dentist &
Patient Share
Implant $1,300 ($794 contracted fee)
Cigna will pay 60 % of $794 = $476.50 Patient will pay 40% of $794 = $317.60
Not covered Patient will pay = $1,300
Examples - Illustrative purposes only
11Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Data provided is based on average charges for care rendered in CT for City of Waterbury enrollees. The above is for illustrative purpose only.
Note: If orthodontic treatment is already in progress on 7/1, bills for treatment incurred after 7/1 only are eligible if coverage is elected.
CARE PROVIDED
Scenario 3Bridge
AMOUNT BILLED
Dentist Bills the Plan
CIGNA’S DISCOUNT - DHMO
Net Payable to In-network Dentist &
Patient Share
Flex 2
Net Payable to In-network Dentist &
Patient Share($1,000 annual benefit maximum)
Bridge: 4 unit bridge for 4 teeth $6,052
($2,136 contracted fee)
Cigna will pay 60 % of $2,136 = $1,281.60
Patient will pay 40% of $2,136 =$854.40
($4,702 contracted fee)
Cigna will pay 50 % of $4,702 after $50 deductible (up to $1,000
lifetime maximum met)= $1,000Patient will pay = $3,702
Examples - Illustrative purposes only
12Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Data provided is based on average charges for care rendered in CT for City of Waterbury enrollees. The above is for illustrative purpose only.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 13
HELP WITH YOUR ORAL HEALTHPrograms and services
Dental servicesHeart
diseaseStroke Diabetes Maternity
Chronic
kidney
disease
Organ
transplants
Head and
neck cancer
radiation
Periodontal treatment and maintenance
(D4341, D4342, D49101)u u u u u u u
Periodontal evaluation (D0180) u
Oral evaluation (D01202, D01402, D01502) u
Cleaning (D11103) u
Scaling in the presence of inflammation – Full
Mouth (D43463) u
Emergency palliative treatment (D91104) u
Topical application of fluoride and topical
application of fluoride varnish (D12065)u u u
Topical application of fluoride – excluding
varnish (D12085)u u u
Sealants (D13515) u u u
Sealant repair – per tooth (D13535) u u u
Cigna Dental Oral Health Integration Program®
Available to ALL Cigna Dental customers
with qualifying condition(s)
Articles on behavioral issues
linked to oral health
Discounts on prescribed mouthwashes, fluoride
gels, and toothpastes from your dentist*
More programs More wellness More discounts
* Pharmacy discounts are available through Cigna Home Delivery Pharmacy only. This is a discount and is NOT insurance. This discount is
separate from your dental benefits and you are required to pay the entire discounted charge. You should check any insurance or other benefits
you have before using these discounts, as those benefits may result in lower costs to you.
1. Four times per year. 2. One additional evaluation. 3. One additional cleaning. 4. No limitations. 5. Age limits removed, all other limitations apply.
PROGRAMS
& SERVICES
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 14
More than just dental benefits
Cigna
Healthy
Rewards®*For DPPO and
Cigna Dental Care
(DHMO)
Cigna Healthy Rewards
Discounts on a full range of
health and wellness programs
and services
Identity Theft
Resolution
Services**
For Cigna Dental
Care (DHMO) only
Help with critical issues like
credit card fraud, or financial
and/or medical identity theft
Dental
Information
Line
For Cigna Dental
Care (DHMO) only
24/7 access to trained professionals
who can help answer your
questions about dental treatment
and clinical symptoms
.
** Cigna’s identity theft services are provided under a contract with General Global Assistance. Presented here are highlights of the identity theft
program. Full terms, conditions and exclusions are contained in applicable service agreement. This program is NOT insurance and does not
provide for reimbursement of financial losses.
* Healthy Rewards is a discount program and is separate from your dental benefits. If your plan includes coverage for any of the services offered
through Healthy Rewards, this program is in addition to, not instead of, your plan benefits. Some Healthy Rewards programs are not available in all
states and may be discontinued at any time. A discount program is NOT insurance, and you must pay the entire discounted charge.
PROGRAMS
& SERVICES
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 15
Cigna Healthy Rewards
Cigna
Healthy
Rewards®*For DPPO and
Cigna Dental Care
(DHMO)
.
* Healthy Rewards is a discount program and is separate from your dental benefits. If your plan includes coverage for any of the services offered
through Healthy Rewards, this program is in addition to, not instead of, your plan benefits. Some Healthy Rewards programs are not available in all
states and may be discontinued at any time. A discount program is NOT insurance, and you must pay the entire discounted charge.
PROGRAMS
& SERVICES
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 16
Identity Theft Resolution Services
Identity Theft
Resolution
Services*
For Cigna Dental
Care (DHMO) only
.
* Cigna’s identity theft services are provided under a contract with General Global Assistance. Presented here are highlights of the identity theft program. Full
terms, conditions and exclusions are contained in applicable service agreement. This program is NOT insurance and does not provide for reimbursement
of financial losses.
PROGRAMS
& SERVICES
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 17
If you suspect you might be a victim of identity theft, call
1.888.226.4567 (U.S. and Canada)or 202.331.7635.
Personal case manager care standing by to help you.
Please indicate that you are a member of the Cigna
identity theft program and group #57.
Valuable help before and after identity theft.
Our identity theft program provides tools and guidance to help with prevention,
detection and resolution.
› Education on how to identify and avoid identity theft before it happens
An identity theft protection kit that provides the right documents to use and
steps to follow if your identity has been compromised
› Help to complete an identity theft affidavit and cancel lost credit cards
› Guidance to help you replace credit cards, a driver’s license, Social Security
card, passport, etc.
› Assistance with understanding your credit reports to determine if identity theft
has occurred, and help with reporting an identity theft to credit reporting
agencies
› Help with emergencies while traveling, including translation services with
local authorities, filing a police report, and emergency message relay
› Up to $1,000 cash advance if your wallet or purse is stolen when traveling
more than 100 miles from home**
Dental Information Line. PROGRAMS
& SERVICES
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 18
Dental
Information
Line
For Cigna Dental
Care (DHMO) only
We’re there for you, when you need
it most
With your Cigna Dental Care plan,
you get personal support 24/7/365.
Dental Information Line. Trained
professionals can answer your
questions about dental care and
clinical symptoms.
1.855.511.6366
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 19
ENROLLMENT & PLAN INFORMATION
Enrollment in the DHMO is Easy
20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Open Enrollment will run May 13 through June 7
• Each employee remains in the plans they are currently in
UNLESS THEY FILL OUT A FORM AND MAKE A NEW
ELECTION!
• Any employee wishing to enroll in the DHMO will need to fill
out our City enrollment form and “Check that DHMO Box”
it’s that simple!
• You also need to select a dentist when you enroll.
You will need to enter a dentist ID# on the enrollment form.
Call Cigna or go to www.cigna.com to obtain the ID# number.
Look up a Cigna DHMO provider:
21Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Call us at: 855.511.6366
Dentist ID#
Plan Information & Communication
22Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Detailed Plan Information will be made available:
• Via Open Enrollment Notice (postcard) to each Home
• On the City of Waterbury Website; Pension & Benefits
o www.waterburyct.org/benefits
• To Each Union President
• To Each Department Head
• Via P&B’s “Brass Benefits” e-blast
• Via interoffice mail
• If any group requests a presentation Cigna will be happy to
accommodate
• If needed, a Cigna Representative – Will set Office Hours at
City Hall
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna 23
Q&AWhat you want to know
24
Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. The information in this
presentation summarizes the highlights of your plan. For a complete list of both covered and not covered services, including benefits required by your state, see your
employer’s plan booklet, evidence of coverage, insurance certificate, or summary plan description – the official plan documents. If there are any differences between the
information in this presentation and the plan documents, the information in the plan documents takes precedence.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. Cigna Dental Care (DHMO) plans are insured by Cigna
Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health
of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NE), Cigna
Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental
Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of
Virginia, Inc. In other states, Cigna Dental Care plans are insured by Cigna Health and Life Insurance Company (CHLIC), or Cigna HealthCare of Connecticut, Inc., and
administered by Cigna Dental Health, Inc. Dental PPO plans are insured or administered by CHLIC or Connecticut General Life Insurance Company, with network
management services provided by Cigna Dental Health, Inc. and certain of its subsidiaries. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan
uses the national Cigna DPPO network. Policy forms: OK – Dental Indemnity/PPO: HP-POL99 (CHLIC); DHMO: HP-POL115 (CHLIC); OR – Indemnity/DPPO/DEPO: HP-
POL68, DHMO: HP-POL121 04-10; TN – Dental Indemnity/PPO: HP-POL69/HC-CER2V1 et al. DHMO: HP-POL134/HC-CER17V1 et al. (CHLIC). The Cigna name, logo, and
other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.
862420 d 08/18 © 2018 Cigna. Some content provided under license.