1Your plan terms may vary. Not all preventive care services are covered by all plans. For example, most immunizations for travel are generally not covered. See your plan documents for a complete list of covered preventive care services.
2The term DHMO ("Dental HMO") 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 plan is not available in all states.
3These programs are NOT insurance and do not provide reimbursement for financial losses. Some restrictions may apply. Customers are required to pay the entire discounted charge for any discounted products or services available through these programs. Programs are provided through third party vendors who are solely responsible for their products and services. Full terms, conditions and exclusions are contained in the applicable client program description, and are subject to change. Program availability may vary by plan type and location, and are not available where prohibited by law.
A benefit is paid for covered out-of-network emergency dental care. Certain states mandate coverage for dental care received out-of-network. For example, in Minnesota, the plan will pay 50% of the value of your network benefit for covered out-of-network services. In Oklahoma, the plan will pay the same amount it pays network dentists for covered out-of-network services. You are responsible for any charges not covered by the plan. Other states may have similar mandates. Refer to your plan documents for cost and coverage details.
All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna representative. Group medical and vision plans are insured and/or administered by Cigna Health and Life Insurance Company (CHLIC) or Connecticut General Life Insurance Company (CGLIC). Medical HMO plans are offered by Cigna HealthCare of Arizona, Inc., Cigna HealthCare of California, Inc., Cigna HealthCare of Colorado, Inc., Cigna HealthCare of Connecticut, Inc., Cigna HealthCare of Florida, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Indiana, Inc., Cigna HealthCare of St. Louis, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of New Jersey, Inc., Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of Tennessee, Inc. (CHC-TN), and Cigna HealthCare of Texas, Inc. 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 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 CHLICor Cigna HealthCare of Connecticut, Inc., and administered by Cigna Dental Health, Inc. Cigna Dental PPO plans are insured or administered by CHLIC or CGLIC, 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. Group Universal Life (GUL) insurance policies are insured by CGLIC. Group term life, disability, and voluntary plans are insured or administered by Life Insurance Company of North America (LINA), except in NY, where insured plans are offered by Cigna Life Insurance Company of New York (New York, NY). Policy forms: Medical: OK - HP-APP-1 et al., OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC) & GSA-COVER, et al. (CHC-TN). Dental (CHLIC): OK – Indemnity/DPPO: HP-POL99/HP-POL-388; DHMO: POL115; OR - Indemnity/DPPO/DEPO: HP-POL68/HP-POL352, DHMO: HP-POL121 04-10; TN – Indemnity/DPPO/DEPO: HP-POL69/HC-CER2V1/HP-POL389, et al., DHMO: HP-POL134/HC-CER17V1 et al. GUL: XX-603404 et al (CGLIC). Group Insurance (LINA): Disability & Term Life - TL-004700 et al, Blanket Accident - BA‑01‑1000.00 et al, Group Accident - GA-00-1000.00 et al. Voluntary (LINA): Accidental Injury - GAI-00-1000, GAI-00-1000.OR; Critical Illness - GCI-00-1000, GCI-02-1000, GCI-00-0000.OR, GCI‑02‑0000.OR et al; Hospital Indemnity - GHIP-00-1000; GHIP-00-1000.ORa.