Brandywine Benefits -- Dental

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Dental
Plan B: Moderate Option

Plan B offers a moderate level of dental coverage. This plan stresses preventive care to help you and your family avoid serious dental problems. The plan pays 100% of the covered cost (reasonable and customary charges) of preventive services. It also pays 80% of the covered cost (reasonable and customary charges) of basic restorative services, and 50% of major services and orthodontia care. The maximum benefit you can receive under this plan each year is $1,500 per person in-network, or $1,000 out of network. Orthodontia carries a separate $1,500 lifetime maximum in-network.

Plan B also includes a Preferred Provider Organization (PPO) feature, which gives you the option of receiving care from PPO participating dental care providers and paying less out-of-pocket.

Participating dentists agree to charge negotiated rates. These rates are typically lower than the rates charged by non-participating dentists. This means that when you visit a participating dentist, your out-of-pocket costs may be less. Here's an example of how you might save money using a participating dentist compared to a non-participating dentist.

Here's an Example
Let's assume you need a major procedure that's covered at 50%:

	Participating Dentist	Non-participating Dentist
Provider's Regular Fee	$600	$600
Negotiated Fee	$375	N/A
Reasonable & Customary Limit	N/A	$500
Plan Pays	50% of $375 = $187.50	50% of $500= $250
You Pay	50% of $375 = $187.50	$350 ($600-$250 = $350)
Savings obtained by using a participating provider: $162.50

NOTE: This chart is for illustrative purposes only.

To locate a participating provider in your area, visit www.cigna.com or call (800) 345-4511 to request a provider directory.

Plan Option B Benefit Summary:

Coverage Type:	In-Network	Out-of-Network
Type A - Preventive	100% of PDP Fee*	100% of R&C Fee**
Type B - Basic Restorative	80% of PDP Fee*	80% of R&C Fee**
Type C - Major Restorative	50% of PDP Fee*	50% of R&C Fee**
Type D - Orthodontia	50% of PDP Fee*	50% of R&C Fee**

Deductible***	In-Network	Out-of-Network
Individual	$25	$25
Family	$50	$50

Annual Maximum Benefit:	In-Network	Out-of-Network
Per Person	$1,500	$1,000

Orthodontia Lifetime Maximum:	In-Network	Out-of-Network
Per Person	$1,500	$1,000


*	PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full.
**	Reasonable & Customary charges are based on the research of a dentist's usual, actual & community average charge as determined by Cigna.
***	Applies only to Type B & C Services.


Dental
	Plan A: High Option
	Plan B: Moderate Option
	What Is Covered
	What Is Not Covered
	2023-2024 Dental Rates
	Orthodontia
	When Coverage Ends
	Glossary

Related Forms
	Cigna Dental Benefit Summary Option A
	Cigna Dental Benefit Summary Option B
	Cigna
	myCigna.com

Related Links
	Cigna

Disclaimer: Brandywine Benefits Online provides only an overview of your benefits from Brandywine School District and The State of Delaware. Brandywine School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.