You must select a Network General Dentist (NGD) from the Prepaid (DHMO) Dental Plan list for the state’s dental plan and let Cigna
know of your choice. The list of providers in the Cigna network for the state may
be found by visiting the websitehttps://www.cigna.com/sites/stateoftn/.
You must use your selected dentist to receive benefits.
You may select a network Pediatric Dentist as the Network General Dentist (NGD) for
your dependent child under age seven. At age seven, you must switch the child to a
NGD or pay the full charge from the pediatric dentist.
There may be some areas in the state where NGDs are limited or not available. Before
enrolling, carefully check the network for your location.
With the prepaid dental plan, you may be able to cancel this coverage if you enroll
and later there are no NGDs within a 40-mile radius of your home.
You pay copays for dental treatments.
No deductibles to meet, no claims to file, no waiting periods, no annual dollar maximum.
Preexisting conditions are covered.
Referrals to Specialists are required.
Orthodontic treatment is not covered if the treatment plan began prior to the member’s
effective date of coverage with Cigna. The completion of crowns, bridges, dentures,
or root canal treatment already in progress on the member’s effective date of coverage
is also not covered.
You can use any Dentist, but you receive maximum benefits when visiting an in-network MetLife DPPO provider
for the state's dental plan. The list of providers in the MetLife DPPO network for
the state may be found by visiting the websitehttps://www.metlife.com/stateoftn/.
Deductible applies for Basic and Major dental care.
You pay coinsurance for Basic, Major, Orthodontic and out-of-network covered services.
You or your Dentist will file claims for covered services.
Some services (e.g., crowns, dentures, implants and complete or partial dentures)
require a six-month Waiting Period from the member’s coverage start date before benefits
There is a 12-month Waiting Period from the member’s coverage start date for both
the replacement of a missing tooth and also Orthodontics.
Referrals to Specialists are not required.
Pre-treatment estimates are recommended for more expensive services.
Dental treatment in progress at time of member’s effective date with MetLife may have
pro-rated benefits under the MetLife plan. MetLife has transition-of-care guidelines
for participants whose dental treatment is in progress during the benefit plan transition
You pay coinsurance for many covered services and your share is based on the "maximum
allowable charge" (MAC) for a given service. MAC is the lesser of the amount charged
by the dentist or the maximum payment amount that in-network dentists have agreed
to accept in full for the dental service. When you receive dental services from an
out-of-network provider, MetLife will reimburse a percentage of the MAC. You are then
responsible for paying everything over the percentage of MAC reimbursed up to the
charge submitted by the out-of-network dentist. Out-of-network providers typically
charge more than the allowable charge, resulting in higher costs for you.