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|
|Calendar Year Deductible|
|Calendar Year Benefits Maximum|
|Per Individual||$1,500 per individual (Basic and Major Services combined)|
Cleanings, exams, X-rays twice per year
|0%||Member will be balance billed|
Fillings, Space Maintainers, Sealants,
20%* or more if charges are more than maximum allowable charges
Crowns, Inlays/Outlays, Dentures and
|50%*||50%* or more if charges are more than maximum allowable charges|
|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;