A: When you sign up in the DHMO plan, you must select a network general dentist who will handle your dental care needs. You then receive a Patient Charge Schedule that lists the specific dental procedures covered by the plan and the amount you will pay the dentist. These copays apply only when you receive treatment from your selected dentist or dental specialists in the Cigna Healthcare network for the state of Tennessee. You may be billed lab fees for certain procedures.
If a dental procedure is not listed on your PCS, it is not covered, and you will have to pay according to the dentist’s regular fees. If you receive a covered service from a dentist who does not participate in the Cigna Dental Care® DHMO network for the Partners for Health plan, your dental benefits may not be covered at all except in the case of an emergency or where required by law.4 You can take your PCS to dental appointments to discuss treatment options and costs with your dentist, but it is not required.
A: When searching for a participating dentist found at Cigna.com/stateoftn, please note that the list of providers who accept DHMO coverage and are seeing new patients are only for present day. A dentist who shows up on the provider search at one time does not guarantee participation in the future. A provider or dental office leaving the network is not a qualifying event that allows for canceling or changing your enrollment in the DHMO-Prepaid Provider program.
A: You can find a network dentist by visiting Cigna.com/stateoftn. Instructions are posted on how to access the pre-effective myCigna.com log on process. This will allow you to view dental network information specific to the Cigna Dental Care® DHMO plan. If you are already a member, you can go to your personalized myCigna.com account. If you need help finding a dentist, you can call customer service at 800.997.1617 and request to have a list of providers mailed, emailed or faxed to you.
You can change your network dentist at any time; changes made by the 15th of the month go into effect the first of the following month. If you need an immediate change, customer service can help 24/7. Remember, if you visit a non-network dentist, your treatment may not be covered at all.5
If you’d like to speak with someone, call customer service at 800.997.1617. You can also follow the phone prompts to use our automated Dental Office Locator. The automated system will speak the names of the dentists in your area, mail, email or fax a list of dentists to you.
A: That depends. If your current dentist participates in the Cigna Dental Care® DHMO network for the Partners for Health plan, you can choose him/her as your network general dentist. You can look online at Cigna.com/stateoftn to find out, or ask your dental office directly. When calling a dental office directly, please be sure to notify the dentist that you are in the Cigna Dental Care DHMO state of Tennessee network. Sometimes, Cigna Healthcare’s online Dental Office Directory may show that your dental office is not accepting new patients even when their office says they are. If this happens, please contact customer service at 800.997.1617 for assistance.
A: Yes. If you require specialty care, your network general dentist will refer you to a network dental specialist and handle any paperwork. Referrals are required for all network specialists except orthodontists and pediatric dentists up to age 13. Coverage for treatment by a pediatric dentist ends on your child’s 13th* birthday. Effective on your child’s 13th* birthday, dental services generally must be obtained from a network general dentist.
A: No. ID cards are not required to use the plan. When you call to schedule your appointment, just let your selected network dental office know you are covered under the Cigna Dental Care® DHMO plan. If for some reason the dental office does not see your name on its list of Cigna Dental Care® DHMO plan members, they can call us to verify. You can also call customer service at 800.997.1617 if you need more help.
A: Typically copays are due at the time services are received. However, it depends on the financial arrangement between you and your network dentist. We encourage you to discuss costs and payment arrangements for dental treatment with your dentist before you receive care. Most dentists will work with their patients to arrange payment plans for more costly treatments.
A: No. There are no claim forms required when receiving care from a network dentist.
A: Yes. A maximum benefit of 24 months of interceptive and/or comprehensive orthodontic treatment is covered as shown on your PCS. Cases beyond 24 months may require additional payments by the patient. If you or your family member started treatment before you joined the Cigna Dental Care® DHMO plan (called “orthodontics in progress”), please contact Cigna Healthcare customer service for more information related to coverage available.
A: Yes. Surgical placements of implants is covered as shown on your PCS. It is limited to one implant per calendar year with a replacement of one every ten years.
A: Emergency services: If you are out of your service area or unable to contact your network general dentist, you may receive emergency services by any licensed dentist for unexpected but necessary services. Emergency services are limited to relieving severe pain, controlling excessive bleeding and eliminating serious and sudden infection. Routine restorative procedures or definitive treatment (such as a root canal) are not considered emergency care and you should return to your network general dentist for these procedures.
Emergency care out of your service area: For emergency covered services, you will be responsible for the patient charges listed on your PCS. Cigna Dental will reimburse you 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 (this amount may vary by state). To request reimbursement, send the dentist’s itemized statement to Cigna Dental at the address listed for your state on your plan materials.
Emergency care after hours: There is a copay listed on your PCS for emergency care received after regularly scheduled office hours. This copay will be in addition to other copays that may apply.
