Citi Benefits Handbook
How the Plan Works
When you enroll in the Cigna Dental HMO, you must select a network dental office. If your first or second choice is not available, the network dental office nearest your home will be selected for you.
You can choose a different dentist in the network for you and each of your covered dependents. When you visit a network office, you will show your Cigna Dental HMO ID card and pay the amount shown on your Patient Charge Schedule for covered services. If you undergo a procedure that is not on your Patient Charge Schedule, you will pay the dentist's usual charges. If you visit an office other than your network dental office, you will pay the dentist's usual charges, except for emergencies or as authorized by Cigna Dental.
Specialized Care
If your network general dentist determines that you need specialized dental care, he or she will begin the specialty referral process. Follow your network general dentist's instructions regarding access to specialty care. Care from a network specialist is covered when Cigna Dental authorizes payment. Treatment by a network specialist must begin within 90 days from the date of Cigna Dental's authorization. If you are unable to obtain treatment within the 90-day period, call Member Services to request an extension. Your coverage must be in effect when each procedure begins. A referral is not necessary when visiting an orthodontist or pediatric dentist who participates in the Cigna Dental HMO network. Note: Services performed by a pediatric dentist are covered until the child reaches age 7. Services performed by a pediatric dentist after the child reaches age 7 are not covered.
You should verify with the network specialist that your treatment plan has been authorized for payment by Cigna Dental before treatment begins. If you receive specialty care and payment is not authorized by Cigna Dental, you may be responsible for the network specialist's usual charges.
Changing Your Dentist/Dental Office
If you decide to change your network dental office, Cigna Dental can arrange a transfer. You and your enrolled dependents may each transfer to a different network general dentist. You should complete any dental procedure in progress before transferring to another dental office.
To arrange a transfer, call Member Services at 1 (800) Cigna24 (1 (800) 244-6224). Your transfer request will take about five days to process. Transfers generally will be effective the first day of the month after your request is processed. Unless you have an emergency, you will be unable to schedule an appointment at the new dental office until your transfer becomes effective.
There is no charge to you for the transfer. However, all patient charges that you owe to your current dental office must be paid before the transfer can be processed.
Appointments
To make an appointment with your network general dentist, call the dental office that you have selected or to which you have been assigned. When you call, your dental office will ask for your ID number (which can be found on your Cigna Dental HMO ID card) and will check your eligibility.
Broken Appointments
The time your network general dentist schedules for your appointment is valuable to you and the dentist. Broken appointments make it difficult for your dental office to maintain a schedule that is convenient for you and efficient for the staff. The delay in treatment resulting from a broken appointment can turn a minor problem into a complex one resulting in higher costs to you, your dentist, and Cigna Dental.
If you or your enrolled dependent breaks an appointment with fewer than 24 hours' notice to the dental office, you may be charged a broken appointment fee for each 15-minute block of time that was reserved for your care. Consult your Patient Charge Schedule for maximum charges for broken appointments (not applicable in Texas).