Citi Benefits Handbook
Limitations on Covered Services
- Frequency: See your Patient Charge Schedule for limitations on frequency of covered services, such as cleanings.
- Specialty care: Except for pediatric dentistry and endodontics, payment approval from the Cigna Dental HMO is required for coverage of services performed by a network specialty dentist.
- Pediatric dentistry: Coverage from a pediatric dentist ends on a covered child's 13th birthday. Cigna Dental HMO may consider exceptions for medical reasons on an individual basis. The network general dentist will provide care after the child's 13th birthday.
- Oral surgery: The surgical removal of an impacted wisdom tooth is not covered if the tooth is not diseased or if the removal is only for orthodontic reasons. Your Patient Charge Schedule lists any limitations on oral surgery.
- Orthodontics in progress: If orthodontic treatment is in progress for you or your dependent at the time you enroll, call Customer Service at 1 (800) Cigna24 (1 (800) 244-6224) to find out if you are entitled to any benefit under the Plan.
Pre-existing conditions are not excluded if the procedures involved are otherwise covered under your Patient Charge Schedule.
You will pay the full cost of procedures and services that are not covered. Visit the Cigna website at www.Cigna.com or call 1 (800) Cigna24 (1 (800) 244-6224) for more information.