Citi Benefits Handbook
Emergencies
An emergency is a dental condition of recent onset and severity that would lead a prudent layperson possessing an average knowledge of dentistry to believe the condition needs immediate dental procedures to control excessive bleeding, relieve severe pain or eliminate acute infection. You should contact your network general dentist if you have an emergency.
Examples of a dental emergency include:
- The loss of a large filling in a tooth or crown, or a cracked tooth that results in significant acute pain and discomfort; and
- Swelling of the mouth that is a result of an infection, normally associated with an abscess.
Examples of non-dental emergencies include:
- A slight injury that did not result in significant bleeding, severe pain or acute infection;
- A sore spot under dentures that has created a small ulcer;
- A wisdom tooth that is erupting or painful, but there is no swelling; and
- A chipped tooth that produced a sensitive spot that irritates the tongue.
Routine restorative or definitive treatment (root canal therapy) is not considered emergency care and should be performed or referred by the network general dentist or network pediatric dentist.
Away from Home
If you have an emergency while you are out of your service area or unable to contact your network general dentist, you may receive emergency covered services from any general dentist. Routine restorative procedures or definitive treatments (e.g., root canal) are not considered emergency care. You should return to your network general dentist for these procedures. For emergency covered services, you will be responsible for the patient charges listed on your Patient Charge Schedule. Cigna Dental will reimburse you for the difference, if any, between the dentist's usual fee for emergency covered services and your patient charge, up to a total of $50 per incident.
- For Arizona residents: An emergency is a dental problem that requires immediate treatment (includes control of bleeding, acute infection or relief of pain, including local anesthesia). Reimbursement for emergencies will be made by Cigna Dental in accordance with your plan benefits regardless of the location of the facility providing the services.
- For Pennsylvania residents: If any emergency arises and you are out of your service area or are unable to contact your network general dentist, Cigna Dental covers the cost of emergency dental services so that you are not responsible for greater out-of-pocket expenses than if you were attended to by your network general dentist.
- For Texas residents: Emergency dental services are limited to procedures administered in a dental office, dental clinic or another comparable facility to evaluate and stabilize emergency dental conditions of recent onset and severity accompanied by excessive bleeding, severe pain or acute infection that would cause a prudent layperson with average knowledge of dentistry to believe that immediate care is needed.
To receive reimbursement, send appropriate reports and X-rays to the following Cigna Dental address:
Cigna Dental
PO Box 188045
Chattanooga, TN 37422-8045
PO Box 188045
Chattanooga, TN 37422-8045
After Hours
There is a patient charge listed on your Patient Charge Schedule for emergency care rendered after regularly scheduled office hours. This charge will be in addition to other applicable patient charges.