^XyrL|k:N,NW=(W4F]t10tf>WS?n3v\CM{plTy"N^My 7\6Ga)X:! 0U<4+;W" Q@KQG\4BBS/t}w9z$M\\\BC;A8-ep1#(6K !I#C E Y]H (.IK*d.- +Ab-c-e]1@*[th-a, 2]xJ:;X?\SAM fbm vf`- With this dental health maintenance organization (DHMO) plan, preventive services are covered 100% with no deductible. 0000061883 00000 n xref Please go toccsd.org.ukto view the schedule and to learn more about the objectives of CCSD. However, this may be reviewed in the future and you should regularly check this website for updates. 0000078271 00000 n "a\[x3A LN 00 + endstream endobj startxref 0 %%EOF 230 0 obj <>stream than the limitation allows, Cigna Dental will waive the applicable limitation. Different codes may be used to describe these covered procedures. 0000043896 00000 n When you meet your annual deductible and satisfy any waiting periods, you pay a coinsurance (a portion of covered charges), and the dental plan pays the rest (up to the yearly or lifetime dollar limit of the plan). 0000037057 00000 n Use this form to request a CIGNA Dental Care patient charge schedule. CIGNA DENTAL CARE PLAN PATIENT CHARGE SCHEDULE (A3O09) Important Highlights (Continued) Health Insurance Premiums . 0000009819 00000 n Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. 0000021775 00000 n dentist and is calculated based on the network dentist's contracted fee schedule, which is the amount Cigna agrees to pay dentists for their services. 0000011168 00000 n All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. Cigna Fee Schedule Cigna Fee Schedule We expect all accredited Cigna providers to abide by The Cigna Fee Schedule, the schedule contains fair and reasonable maximum fees for Surgery and Anaesthesia, as well as guideline fees for Initial and Follow up consultations. Lv!:$Kvh ]j "j>z 'kQ>Oxog*6 nS f%#qh ;#@C\eB~\mD/a\~G&p/7C+MA\E2*Qu@z7kRi*kuevof[d^Dt$ORnzf#g+@2XC'FEH[1#66 44K,J^0t/Rrqxtg[n}Rw~ k6S=`CaW4^7. All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000059263 00000 n Initial Consultation face to face - 205, Follow-up Consultation face to face - 145, Initial Consultation remote - 205 (where clinically appropriate), Follow-up Consultation remote - 145 (where clinically appropriate), Extended Physician Consultation - 250 (over 40 mins). Office Visit Fee . Different codes may be used to describe these covered procedures. 92249 909351 08/17 B1I09 B1I09 CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and . All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. startxref Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. 0000047772 00000 n hb```f`` endstream endobj 90 0 obj <> endobj 91 0 obj <> endobj 92 0 obj <>stream %PDF-1.3 0000002770 00000 n If my dentist were to drop . 0000046987 00000 n Read important information about our fees including certain procedures, unlisted, bilateral and multiple procedures, anaesthesia and sedation, standby fees and the use of second specialists. Same day in-office CAD/CAM CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (W1-09 AZ) - 6 - 0000004408 00000 n UnitedHealthcare Choice Open Access Plan Summary. ?2h` h 0000011147 00000 n %%EOF 92260.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE . 0000004890 00000 n SmartBenefits Enrollment Application & Change Form. 0000086902 00000 n trailer hXn8}}gH Hf&M2Ll~(hHII>K8iLJ"{/y9RFHZr2NR0LXR4EDb=J-{Kz|H3P>4uBeFm=$:Qu&vhlYGEpEc@4|f_%"1hPOf8G.8$oXE{;q0TUnu0X. nu hbbd``b`@$. startxref Yes, they share the same network. 0000008230 00000 n 0000047744 00000 n CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (L1-09 TX) - 3 - Patient Charge Code Procedure Description D0220 X-rays intraoral - Periapical - First radiographic image $0.00 If you have PPO or Traditional Indemnity coverage, please contact your employee relations office or your provider to obtain a benefit schedule. There is also a set fee schedule, so you'll know upfront exactly how much basic and major services will cost. 0000027741 00000 n VIDEO Cigna Dental PPO 0000000016 00000 n %PDF-1.3 % Maintenance Organization (DHMO) Schedule of Benefits Effective January 1, 2021 . U\$6hXttOg}wuNNc0t8a1+v3ij9)&@^WS1m;h=RXY|v+r=u\3+=Ih ]?JXO4oK"I-8IiU 6vi@xC{zGtB" E0bM5eu|nGE yl Cigna Dental Care Patient Charge Schedule (P6XV0)-2-Code Procedure Description Patient Charge. H|Tj1"/l@)hkEs&+,9f7gg/y!}iNx4Un%:/erWD}!Y+bkB)r;O UGE-7Wx:Ze|%J,isr=x.>}p\G ZImzH4r@h q%t ItfKb278MJ6p8h|)@Tr ?S=?Yv yA?3HZQ;yUZ:&T7|N|o#Xv>yXk9'5V2S|ju0kU6581_Fo!>b bd `R[w#-HaEH6LPidE2L. Do the new Total Care DHMO plan and the Cigna DHMO plan use the same network? 948550 09/20 DENTAL INSURANCE THAT FITS Cigna Dental Care/DHMO Plan MTI09 PLAN HIGHLIGHTS IN-NETWORK Adult cleaning (two per calendar year - each at $0) $0 Child cleaning (two per calendar year - each at $0) $0 Periodic oral evaluation $0 Comprehensive oral evaluation $0 0000017737 00000 n 0000003405 00000 n 0000086632 00000 n Log in to our provider portal. 0000015088 00000 n Office visit fee $0.00 Diagnostic/preventive - Oral evaluations are limited to a combined total of 4 of the . 0000003547 00000 n ***It is important to note that, in order to support both its Members and Providers during the pandemic, Cigna has decided to reimburse remote consultations at the same level as face to face; subject to clinical appropriateness. 0000048491 00000 n Additional charge per tooth/unit for crowns, inlays, onlays, post $150.00 and cores, and veneers if your dentist uses same day in-office CAD/CAM (ceramic) services. e`ea =AG/LGtQ0q(MyPADbso{U,,? wuX,zOW8:m;5*q* F!Q',3s`RRRh CDHfc0BeT#L S@3-Bc=FM@Zea 7iX;\%8>pwnv7`Am H3q[20F Vg 0000037369 00000 n costly service, the fee listed on the Patient Charge Schedule will not apply. 0000009324 00000 n 0000044371 00000 n stream <> hXnF>( 0000040333 00000 n %PDF-1.5 % 0 92249 856609 02/13 L1-09 L1-09 cigna dental care (*dHMO) patient cHarge scHedule This Patient Charge Schedule lists the benefits of the Dental Plan including hb```b``g`c`d`@ V(0u6|LN0?fqgc\bd(JM9+\,EhE~.=~.cCW%&9uw}.uh, eRs;{4 How often does a dentist change network? VV*5V1,cI;AAA@=c L3@L/Xh1533,q(3D:o@$Vfi? 0000003825 00000 n of the charges for services provided and not separately chargeable. Different codes may be used to describe these covered procedures. 0000037577 00000 n %R( %%EOF % 0000013269 00000 n 0000079419 00000 n We expect all accredited Cigna providers to abide by The Cigna Fee Schedule, the schedule contains fair and reasonable maximum fees for Surgery and Anaesthesia, as well as guideline fees for Initial and Follow up consultations. %PDF-1.6 % CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This P atient Char ge Schedule lis ts the benefits of the Dental Plan including covered procedures and patient charges. 0000030031 00000 n hb```b``{% @1v(`;af. 0000011811 00000 n PATIENT CHARGE SCHEDULE . 0000078060 00000 n For premiums to remain affordable, practitioners, private facilities and health insurers need to work together to provide quality private healthcare at a reasonable and affordable price. 0000004978 00000 n Highlights and benefits of the Humana Dental Value plan The application of local anesthetic is covered as part of your dental treatment. Cigna Dental HMO Patient Charge Schedule. How to protect employees mental health during COVID-19 no matter where they are in the world. The crucial role of data when supporting clients through COVID-19, Building structural COVID-19 resilience through a fundamental focus on healthier living, Why is it important to implement a health and wellness plan in a small or medium-sized enterprise, Offering family health cover from the sme, first step in providing employees with comprehensive health care. Deliver estimates of patient copayments, coinsurance and deductibles. 0000048422 00000 n 0000029950 00000 n Cigna is a member of The Clinical Coding and Schedule Development (CCSD) group. 20p@didagr99)1&^Jo,,oYN(k^,ny'9]p\*uCJx.6%/tqWnszJ&m2^*}y"k7WP/CK// 0000018616 00000 n 0000029880 00000 n 0000085278 00000 n The Cigna Dental Care (DHMO) plan includes coverage for many procedures that may not be available on other dental plans. 0000002700 00000 n CIGNA Dental Care (*DHMO) Patient Charge Schedule . GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D1351 Sealant - Per Tooth $36 D1352 Preventive Resin Restoration In A Moderate To High Caries Risk Patient - Permanent Tooth $35 D1353 Sealant Repair - Per Tooth $35 D1354 Interim Caries Arresting Medicament Application - Per Tooth $29 All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000025718 00000 n % xZ]s|a? *O|uQ|J\DBb)oL@JCvrYmvggzzvyral=yuu@gv/geangu^kDZ,2n^x}V'cV5!3W#XQf3?6%c 147 0 obj <> endobj Cigna DHMO insurance plan features 3 Details, What does good health and wellbeing look like, Promoting positive emotional wellbeing in the workplace, The emerging role of digital in employee health and wellbeing. 0000044662 00000 n 0000033062 00000 n "S} lXYMkB,.qE(PGND & /W8NjRk18>`ihf~;~y""[_&4~,}E9 s~M6jO$2'wc0l}&[Lh=l0b7r*L A TJu;leTq;%HvAt~')k'7g^ {Tdpad1G),&ZtVBo:mjVs%Yos1Q!U1*$xf/UC,lEaya)/L{^Cp`. 0000011053 00000 n 0000008121 00000 n 0000080587 00000 n 0000047800 00000 n <]/Prev 575455>> 0000014214 00000 n For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. 0000047246 00000 n 0000009694 00000 n 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (W1-09) Hh>) $"x# q7?0 vw 0000002220 00000 n 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (B1-09) %PDF-1.5 % %J) Ca:[LqXha fJ:fz6OPXc" 0000005847 00000 n 89 0 obj <> endobj Due to evolving medical practice, The Cigna Fee Schedule is reviewed periodically and therefore, complexities and/or fee values of procedures may change, maximum procedure fee reimbursement could go up or down. 0000008684 00000 n %PDF-1.6 % 'mec`PcsPFZ%5&: {8Fen cS 3@ 0000008806 00000 n 115 0 obj <>stream 92260.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE . 0000017836 00000 n 0000007475 00000 n $hUR7D vHw*d kjL/@V20@ Eh 10597 0 obj <>/Filter/FlateDecode/ID[<0F3F0D1BE2BD3847B9BF5CE826221B8D>]/Index[10574 51]/Info 10573 0 R/Length 105/Prev 385298/Root 10575 0 R/Size 10625/Type/XRef/W[1 2 1]>>stream At a wallet-friendly price. All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000078886 00000 n %&iNeWl $20*` \C endstream endobj 2608 0 obj <>/Filter/FlateDecode/Index[98 2467]/Length 70/Size 2565/Type/XRef/W[1 1 1]>>stream %PDF-1.3 Cigna does not control the linked sites' content or links. 0 0000025789 00000 n For further information on Consultations and all other information on how accredited practitioners should interact with Cigna, in relation to services that may not be eligible for reimbursement, please read ourTerms and Conditions section here. 0000014082 00000 n %%EOF Mental health: what health insurance can do for the emotional wellness of employees of SMEs, Embracing the digital age within healthcare, Tips for selecting a dental plan for your business, Addressing a 5 point workplace cancer strategy. FhZ\BgX0*\\e?Wlb+B+D$wwZKS|CM~rwI8.?2G(p ;M^xyt]~{W=|PIB'4)P96il>mhx; %MFclR*4))[3nqC) w_iStv'tSX%U'R31qWDes- h$fE?/9aSSJ;b"Azo,LiWg?0z2->b> ,(s6a k04QP\NI(?* M ,hTjmsTTbrrq:0E`a I A1)A1Xb`uAYXPd3 E(@jr( pqqKKC8EM/PvWdeSA(2 0000027140 00000 n endstream endobj 10575 0 obj <> endobj 10576 0 obj <>/MediaBox[0 0 396 612]/Parent 10566 0 R/Resources 10602 0 R/Rotate 0/StructParents 0/Tabs/S/TrimBox[0 0 396 612]/Type/Page>> endobj 10577 0 obj <>stream 0000000016 00000 n Different codes may be used to describe these covered procedures. 199 0 obj <>stream 0000025329 00000 n 0000036848 00000 n 0000013079 00000 n 0000004436 00000 n 0000005123 00000 n 0000009963 00000 n Health Insurance for Employees Hired Before October 1, 1987. hb```,V!] %PDF-1.3 % Your secure provider portal for working with Cigna The information, tools, and resources you need to support the day-to-day needs of your office are all on the Cigna for Health Care Providers' website, CignaforHCP.com : Check patient eligibility and benefits Check claims, payments, and fee schedules Update your Cigna provider directory information Please use the search function to calculate your fees. i '08%^0";?{h|. And a healthy body. of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Cigna Dental Care Patient Charge Schedule 1-06-2-w Code Procedure Description Patient Charge Diagnostic/Preventive D9310 Consultation (normally not the same dentist who provides the treatment) $0.00 D9430 Office Visit for Observation - No Other Services S-A-GA-STD-VALUE-R21 Page: 1 GA16I Value BP - V21 SCHEDULE A Description of Benefits and Copayments . 0000002842 00000 n %PDF-1.5 % 0000006933 00000 n Patient Charge Schedule Request. "I+3o?`13}o+BY5k2\Ivw_G>U`o|V9~BxX!\NPe6 IyVD$9I8 adM::|G_,?t{C%-sM0 s4w7mmV"4hUkV%G67Cku{[Ya|uXtJ3\9U743),fKe&Y#6rPFtEixYzQsyk_,d_d>c(u#,rq m|XO?X 0'!$GSx2D 0QY9($ "u+t&6_I $9mt9yzLHLHLHmQNa-AATQ"YjtNZc ).`xPDLP 0000080139 00000 n 0000060795 00000 n 0000009930 00000 n 0000025889 00000 n #EZ-6Pt;K,ZR V\evsag1!4IO)n .XXA1a,pa-V. %%EOF 0000012346 00000 n 0000017376 00000 n 0000013184 00000 n .6#MoM}^eZ%E6a2x\r,dhWIj-z9R:G(8rp0\[P{ K^|b^h8@/mt(twG**yea{_r_T#v5B:-k. Now that's something to smile about. .}\U\ This overview shows you a sampling of covered services. 0000032768 00000 n Consultation fees and surgery/anaesthetist fees represent a significant element of total claims costs in private medical insurance and subsequently, have a major effect on premiums. The fee policy means that Delta Dental's payment to participating dentists is based on the lesser of your submitted fee or the maximum fee that Delta Dental approves for a given procedure in a given region of the state for all Delta Dental-covered patients. 0000007842 00000 n <> 0000009706 00000 n hb```a``d`e``f`@ +s,`@_e%4{0G(tlXp=e|8Cwfg{YfMasP"{_EJ[xm!O@GYr%#PXR7JwG>0E'Bgu6A2NPI[Xw=./Q}9nQYCh$%cc4 X(i@e H10+U-a`1';vfk@Ze\b 0000003348 00000 n Patient Charge Schedule This Patient Charge Schedule describes the benefits of your dental plan and includes a list of covered . 6 0 obj 0000007192 00000 n 0000047037 00000 n 0000038804 00000 n 124 0 obj <>stream 10624 0 obj <>stream CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This P atient Char ge Schedule lis ts the benefits of the Dental Plan including covered procedures and patient charges. 0000010574 00000 n Vision Plan Summary. 0000084766 00000 n Cigna Dental Care DHMO1 Regular dental care is important for a healthy smile. 0000012659 00000 n CIGNA DENTAL CARE PLAN PATIENT CHARGE SCHEDULE (G1-V9) 92249.b - 3 - D0240 X-rays intraoral - Occlusal radiographic image $0.00 @L{Mbg{0LzIGv389. 67 0 obj <> endobj 0000002374 00000 n Cigna Dental Care (DHMO)* Patient Charge Schedules 887393 09/15 Page 1 CDT 2016 Covered under Procedure Code1 Dental Description and Nomenclature Cigna Dental 09 PCS Cigna Dental I09 PCS Chair Time Per Y/N Minutes Code # (if different) Y/N Code # (if different) Clinical oral evaluations D0120 Periodic oral evaluation - Discuss your options and increased financial obligations with your dentist. The American Dental Association may periodically change CDT Codes or definitions. There are no deductibles to pay before coverage begins, no annual dollar maximums on covered services, no claim forms, and no waiting periods. If fees exceed the Cigna Fee Schedule, practitioners should advise the member to contact Cigna member servicesbeforeany treatment takes place. 0000040004 00000 n endstream endobj startxref 2565 0 obj <> endobj xref 2565 45 0000000016 00000 n At each review, new codes are added, existing codes updated and some codes deleted. Patient Charges) Office Visit Fee $5.00 Diagnostic/Preventive - Oral Evaluations are Limited to a Combined Total of 4 of the Following Evaluations During a 12 Consecutive Month Period: Periodic Oral All practitioners should advise Cigna members of the costs of any treatment (including consultations) being provided. With Cigna Dental Care DHMO, you get comprehensive dental coverage that's easy to use. Different codes may be used to describe these covered procedures. The CCSD schedule is reviewed regularly and reflects current medical practice. 0000025537 00000 n 0000020083 00000 n Saint-Lgier-La Chisaz has an area, as of 2009, of 15.2 square kilometers (5.9 sq mi).Of this area, 5.16 km 2 (1.99 sq mi) or 34.0% is used for agricultural purposes, while 6.88 km 2 (2.66 sq mi) or 45.4% is forested. hbbd``b`^$AU $,AD6l Rb} $ .e$"h ,@o RHv&FK@# L im 0000007481 00000 n trailer Patient Charge Schedule. endstream endobj startxref 0000003691 00000 n 0000027311 00000 n 0000021133 00000 n 0000062208 00000 n endstream endobj 68 0 obj <>>> endobj 69 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 70 0 obj <>stream $C@ 9&L`A :\E&ekfaa~$g;laea#u3jgEl2M^7_pvtB2m3uePM$N(];qB{K:WnIQPlnSJmy+mE F*URS6=t {v9]p[QIdsYvC&} s.tI1YbV'lmBCCDM\ e4 &UBA*n. Programs and Initiatives (CCF, DLP, ISYLP, Career Pathways), DC Government Benefits Enrollment Instructions, UnitedHealthcare Choice Open Access Plan Summary, SmartBenefits Enrollment Application & Change Form, Temporary Continuation of Coverage Benefits Enrollment Form, Health Insurance for Employees Hired Before October 1, 1987, Health Insurance Premiums for Employees Hired on or After October 1, 1987, DCEHBP Temporary Continuation of Coverage (TCC) Premiums, How to Enroll in Your DC Government Benefits, Coronavirus (COVID-19) Resources for DC Government Employees, Electronic District Personnel Manual (eDPM), Electronic-District Personnel Manual (E-DPM), Whistleblower Protections and Obligations, Sexual Harassment Prevention Officer Directory, Human Resource Officer - Advisor Directory, 2023 Cigna Dental HMO Patient Charge Schedule, 2022 Cigna Dental HMO Patient Charge Schedule, 2021 Cigna Dental HMO Patient Charge Schedule. 0000085902 00000 n 0000028205 00000 n T2IV9 STATE OF TENNESSEE PLAN EFFECTIVE 1/1/2021 CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE Important Highlights This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. 0000080253 00000 n *Indicates required field. 0000012824 00000 n 0000002804 00000 n 2021 Cigna Spotlight Event FAQ's Dental Customer Support (Hover over each logo to link to access website) Cigna Customer Support: 1.800.244.6224 1.866.611.8005 . 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