Dental Plan
The plan pays benefits for covered preventive and diagnostic services with no need for you to pay a deductible (whether services are obtained in-network or out-of-network). NOTE: You may elect dental coverage whether or not you elect medical coverage.
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Carlisle Cigna DPPO Plan | ||
---|---|---|
IN-NETWORK | OUT-OF-NETWORK | |
Calendar Year Deductible | ||
Individual | $50 | $50 |
Family | $150 | $150 |
Calendar Year Benefits Maximum | ||
Per Individual | $1,500 per individual (Basic and Major Services combined) | |
YOU PAY | ||
Preventive Care | ||
Cleanings, exams, X-rays twice per year |
0% | Member will be balance billed |
Basic Services | ||
Fillings, Space Maintainers, Sealants, |
20%* |
20%* or more if charges are more than maximum allowable charges |
Major Procedures | ||
Crowns, Inlays/Outlays, Dentures and |
50%* | 50%* or more if charges are more than maximum allowable charges |
Orthodontia | ||
24-Month Treatment Fee. Additional fees will apply for pre-ortho visits and treatment, records and retention, and banding. | ||
Children and Adults |
50% up to a lifetime maximum benefit of $1,500 per individual; |
*After Deductible