cigna dhmo fee schedule 2021shrimp toast recipe david chang

All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000044662 00000 n All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000008121 00000 n xZ]s|a? *O|uQ|J\DBb)oL@JCvrYmvggzzvyral=yuu@gv/geangu^kDZ,2n^x}V'cV5!3W#XQf3?6%c There is also a set fee schedule, so you'll know upfront exactly how much basic and major services will cost. If my dentist were to drop . 0000044371 00000 n Here are a few benefits and limitations to consider when evaluating a DHMO plan: Benefits Lower premiums than PPO plans or other types of dental insurance plans No deductible Set copayments; often minimal or no copayment for diagnostic and preventive care Typically, no annual maximum for covered benefits Limitations Smaller dentist network size 0000047800 00000 n 20p@didagr99)1&^Jo,,oYN(k^,ny'9]p\*uCJx.6%/tqWnszJ&m2^*}y"k7WP/CK// 0000004436 00000 n 0000007842 00000 n endstream endobj 90 0 obj <> endobj 91 0 obj <> endobj 92 0 obj <>stream Why take out a health insurance policy for employees at your SME? 0000008806 00000 n 0000013184 00000 n 0000028205 00000 n Different codes may be used to describe these covered procedures. 0000015076 00000 n 0000016019 00000 n 0000025889 00000 n 89 0 obj <> endobj D_0*[sQGfO=nnS:Cz8B?nzi~ 0000038804 00000 n The CCSD schedule is reviewed regularly and reflects current medical practice. 0000002140 00000 n $C@ 9&L`A :\E&ekfaa~$g;laea#u3jgEl2M^7_pvtB2m3uePM$N(];qB{K:WnIQPlnSJmy+mE F*URS6=t {v9]p[QIdsYvC&} s.tI1YbV'lmBCCDM\ e4 &UBA*n. :TZ k1xv3qv$#}>>h)4P!n7%9~4^[O *E1GH!2DP'%NSS'8JxVWGu 0000007475 00000 n 2021 Cigna Spotlight Event FAQ's Dental Customer Support (Hover over each logo to link to access website) Cigna Customer Support: 1.800.244.6224 1.866.611.8005 . 0000025718 00000 n Important Highlights This P atient Char ge Schedule applies only when c overed dental servic es are performed by your Network Dentist, unless otherwise authorized 0000080587 00000 n CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE . 6 0 obj hbbd``b`9$OH0 B D8 vn H0@B} 0000021133 00000 n 0000078886 00000 n 0000009175 00000 n hb```b``g`c`d`@ V(0u6|LN0?fqgc\bd(JM9+\,EhE~.=~.cCW%&9uw}.uh, eRs;{4 hbbd``b`@$. Patient cost estimator is available on our provider portal on Availity. jg{/6vk2%6VMWy+:AIB&%%TqTJMDQ6R)4kH.`00@,*(^- %%EOF When you meet your annual deductible and satisfy any waiting periods, you pay a coinsurance (a portion of covered charges), and the dental plan pays the rest (up to the yearly or lifetime dollar limit of the plan). 0000046987 00000 n The contracted fee schedules vary by network dentist. 0000011168 00000 n Patient Charges) Office Visit Fee $5.00 Diagnostic/Preventive - Oral Evaluations are Limited to a Combined Total of 4 of the Following Evaluations During a 12 Consecutive Month Period: Periodic Oral CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This P atient Char ge Schedule lis ts the benefits of the Dental Plan including covered procedures and patient charges. 0000018616 00000 n 147 0 obj <> endobj Different codes may be used to describe these covered procedures. 0 endstream endobj 68 0 obj <>>> endobj 69 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 70 0 obj <>stream CIGNA DENTAL CARE PLAN PATIENT CHARGE SCHEDULE (A3O09) Important Highlights (Continued) Cigna DHMO insurance plan features 3 %%EOF %PDF-1.5 % %PDF-1.3 % hb```f`` hb```f`` 0000014773 00000 n 92249 909351 08/17 B1I09 B1I09 CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and . startxref Cigna Dental PPO Benefit Summary. %PDF-1.5 % Cigna Dental Care Patient Charge Schedule 1-06-2-w Code Procedure Description Patient Charge Diagnostic/Preventive D9310 Consultation (normally not the same dentist who provides the treatment) $0.00 D9430 Office Visit for Observation - No Other Services 0000012824 00000 n 0000015088 00000 n 92254.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (A2I09) 94 0 obj <>/Filter/FlateDecode/ID[<8BF460A43C550941AE38FFB2C5D3284C>]/Index[67 49]/Info 66 0 R/Length 119/Prev 170514/Root 68 0 R/Size 116/Type/XRef/W[1 2 1]>>stream 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (B1-09) Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. Important Highlights 92260 856593 02/13 Q5-00 %%EOF 0000003434 00000 n Due to evolving medical practice, The Cigna Fee Schedule is reviewed periodically and therefore, complexities and/or fee values of procedures may change, maximum procedure fee reimbursement could go up or down. ?2h` h Patient Charge Schedules are available to CIGNA Dental Care members only. 0 0000009694 00000 n 0000047246 00000 n 0000086554 00000 n 0000061883 00000 n Highlights and benefits of the Humana Dental Value plan 0000047828 00000 n stream 10624 0 obj <>stream 0 0000086902 00000 n %%EOF UnitedHealthcare Choice Open Access Plan Summary. Cigna Fee Schedule Cigna Fee Schedule We expect all accredited Cigna providers to abide by The Cigna Fee Schedule, the schedule contains fair and reasonable maximum fees for Surgery and Anaesthesia, as well as guideline fees for Initial and Follow up consultations. Details, What does good health and wellbeing look like, Promoting positive emotional wellbeing in the workplace, The emerging role of digital in employee health and wellbeing. 0000048251 00000 n Patient Charge Schedule. endstream endobj startxref Same day in-office CAD/CAM CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (W1-09 AZ) - 6 - Porcelain, if used on molar teeth, will be charged to the 0000002842 00000 n xZr7}W1a}rdvmQb*/#rD"!iCmM$>}|>3[S3/C/~:[}>ffgfsC_zK?o^}K7JU }s{7iWaV6Zp5Q4w j} GSyKF.Yt.`uUb56{:7.o8nRxitYunU+Not~\0:%~` Z;[@%re7?:w i&;_v[w7=}ohv.WZ0'eX27*}& Gm_j@v\m*,b6 durPt. #EZ-6Pt;K,ZR V\evsag1!4IO)n .XXA1a,pa-V. S-A-GA-STD-VALUE-R21 Page: 1 GA16I Value BP - V21 SCHEDULE A Description of Benefits and Copayments . cS^d4V$%UXH% $Bf'5Zdi V ANfkULLWXpxYQ bADIq,X.44A*iC8` OL>ADY ds endstream endobj 179 0 obj <>22<>]>>/PageMode/UseNone/Pages 173 0 R/Type/Catalog/ViewerPreferences<>>> endobj 180 0 obj <> endobj 181 0 obj <>/MediaBox[0 0 396 612]/Parent 174 0 R/Resources 207 0 R/Rotate 0/TrimBox[0 0 396 612]/Type/Page>> endobj 182 0 obj <>stream 0000012213 00000 n CIGNA DENTAL CARE PLAN PATIENT CHARGE SCHEDULE (G1-V9) 92249.b - 3 - D0240 X-rays intraoral - Occlusal radiographic image $0.00 0000043896 00000 n We expect all accredited Cigna providers to abide by The Cigna Fee Schedule, the schedule contains fair and reasonable maximum fees for Surgery and Anaesthesia, as well as guideline fees for Initial and Follow up consultations. 0000012659 00000 n $hUR7D vHw*d kjL/@V20@ Eh .}\U\ 199 0 obj <>stream All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000036848 00000 n .6#MoM}^eZ%E6a2x\r,dhWIj-z9R:G(8rp0\[P{ K^|b^h8@/mt(twG**yea{_r_T#v5B:-k. %PDF-1.6 % After entering basic patient and claims information, the cost estimator uses your fee schedule and your patients' benefits plans to: Show you our estimated payment to you. Now that's something to smile about. 0000006823 00000 n 0000004408 00000 n Yes, they share the same network. 0000030031 00000 n T2IV9 STATE OF TENNESSEE PLAN EFFECTIVE 1/1/2021 CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE Important Highlights This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges. 92260.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE . Cigna Dental HMO Patient Charge Schedule. 0000014582 00000 n Your secure provider portal for working with Cigna The information, tools, and resources you need to support the day-to-day needs of your office are all on the Cigna for Health Care Providers' website, CignaforHCP.com : Check patient eligibility and benefits Check claims, payments, and fee schedules Update your Cigna provider directory information 0000006539 00000 n For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees. %J) Ca:[LqXha fJ:fz6OPXc" 0000006418 00000 n Lv!:$Kvh ]j "j>z 'kQ>Oxog*6 nS f%#qh ;#@C\eB~\mD/a\~G&p/7C+MA\E2*Qu@z7kRi*kuevof[d^Dt$ORnzf#g+@2XC'FEH[1#66 44K,J^0t/Rrqxtg[n}Rw~ k6S=`CaW4^7. hb```b``{% @1v(`;af. 0000003298 00000 n 0000014214 00000 n 0000037369 00000 n 0000002700 00000 n %PDF-1.3 % %PDF-1.5 % %%EOF Cigna Dental Care Patient Charge Schedule (P6XV0)-2-Code Procedure Description Patient Charge. CIGNA Dental Care Patient Charge Schedule (DC-07) Code Procedure Description Patient . All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000059794 00000 n However, this may be reviewed in the future and you should regularly check this website for updates. I8S::z&\JGN$S."'$%O!xhDc Hjp2[-UK6izjE$_L{px:eGpT\5BWW|&XI]r/5g{:a19zLm1*{jEBox\3-'m=w5 gS9"#06KCtbf2x-)]Cze5* ;ORD0Un]0t'; dKP3Fq"Y3D(g1K*,$B. cigna dental care (*dHMO) patient cHarge scHedule This Patient Charge Schedule describes the benefits of your dental plan and includes a list of covered procedures, and coinsurance percentage or copay for each covered procedure. hXnF>( Cigna is a member of The Clinical Coding and Schedule Development (CCSD) group. ^ 178 0 obj <> endobj 205 0 obj <>/Filter/FlateDecode/ID[<85349BCD85CC4F888A8518BE1BCA34A9>]/Index[178 53]/Info 177 0 R/Length 111/Prev 181789/Root 179 0 R/Size 231/Type/XRef/W[1 2 1]>>stream 0000061293 00000 n The information, tools, and resources you need to support the day-to-day needs of your office Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. hb```a``d`e``f`@ +s,`@_e%4{0G(tlXp=e|8Cwfg{YfMasP"{_EJ[xm!O@GYr%#PXR7JwG>0E'Bgu6A2NPI[Xw=./Q}9nQYCh$%cc4 X(i@e Log in to our provider portal. i '08%^0";?{h|. % 0000029880 00000 n 0000008230 00000 n 0000027388 00000 n Additional charge per tooth/unit for crowns, inlays, onlays, post $150.00 and cores, and veneers if your dentist uses same day in-office CAD/CAM (ceramic) services. 0000010470 00000 n 0000086632 00000 n than the limitation allows, Cigna Dental will waive the applicable limitation. 0000026712 00000 n 0000014082 00000 n 0000062208 00000 n 0000002304 00000 n dentist and is calculated based on the network dentist's contracted fee schedule, which is the amount Cigna agrees to pay dentists for their services. 0000039703 00000 n of the charges for services provided and not separately chargeable. 0000016764 00000 n 0000006933 00000 n Search the Fee Schedule by entering a code or keyword. 856631c 11/21 A3O09 . For further information on Consultations and all other information on how accredited practitioners should interact with Cigna, in relation to services that may not be eligible for reimbursement, please read ourTerms and Conditions section here. hXkO+g# r[ 0000025329 00000 n How often does a dentist change network? 0000047327 00000 n 136 0 obj <>stream 0000058744 00000 n CIGNA Dental Care (*DHMO) Patient Charge Schedule . The crucial role of data when supporting clients through COVID-19, Building structural COVID-19 resilience through a fundamental focus on healthier living, Why is it important to implement a health and wellness plan in a small or medium-sized enterprise, Offering family health cover from the sme, first step in providing employees with comprehensive health care. 0000080253 00000 n At each review, new codes are added, existing codes updated and some codes deleted. Patient Charge Schedule This Patient Charge Schedule describes the benefits of your dental plan and includes a list of covered . 66 0 obj <> endobj endstream endobj startxref 0000002658 00000 n 0000001356 00000 n 92249 856612 02/13 K1-V9 K1-V9 cigna dental care (*dHMO) patient cHarge scHedule This Patient Charge Schedule lists the benefits of the Dental Plan including Please go toccsd.org.ukto view the schedule and to learn more about the objectives of CCSD. 0000078271 00000 n All practitioners should advise Cigna members of the costs of any treatment (including consultations) being provided. SmartBenefits Enrollment Application & Change Form. Cigna dental Care (*dHMO) . hbbd``b`^$AU $,AD6l Rb} $ .e$"h ,@o RHv&FK@# L im The American Dental Association may periodically change CDT Codes or definitions. 0000033620 00000 n 92260.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE . The American Dental Association may periodically change CDT Codes or definitions. xref 0000009706 00000 n Health Insurance for Employees Hired Before October 1, 1987. 0000039447 00000 n Consultation fees and surgery/anaesthetist fees represent a significant element of total claims costs in private medical insurance and subsequently, have a major effect on premiums. 0000005123 00000 n hb```a``}xAb@Y(@ DnbeN`!@vt@:M\I7'O 3nN*:J{>f X8Et$>xe0Y#duR.+b,k^Nv[CsLm&jF5Db4juU 0000016111 00000 n endstream endobj startxref Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee $10.00 $10.00 Diagnostic/preventive - Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: periodic oral evaluations "I+3o?`13}o+BY5k2\Ivw_G>U`o|V9~BxX!\NPe6 IyVD$9I8 adM::|G_,?t{C%-sM0 s4w7mmV"4hUkV%G67Cku{[Ya|uXtJ3\9U743),fKe&Y#6rPFtEixYzQsyk_,d_d>c(u#,rq m|XO?X 0'!$GSx2D 0QY9($ 0000037057 00000 n If you have PPO or Traditional Indemnity coverage, please contact your employee relations office or your provider to obtain a benefit schedule. Office visit fee (Per patient, per office visit in addition to any other applicable patient charges) . 0000027741 00000 n H10+U-a`1';vfk@Ze\b 0000001476 00000 n 0000006170 00000 n Their key initiative is to develop a common set of codes and descriptions across the UK private healthcare sector. With Cigna Dental Care DHMO, you get comprehensive dental coverage that's easy to use. The CCSD schedule contains industry standard codes for surgical procedures and diagnostic tests in UK private healthcare. FhZ\BgX0*\\e?Wlb+B+D$wwZKS|CM~rwI8.?2G(p ;M^xyt]~{W=|PIB'4)P96il>mhx; 0000079419 00000 n 0000004890 00000 n 0000085902 00000 n ***It is important to note that, in order to support both its Members and Providers during the pandemic, Cigna has decided to reimburse remote consultations at the same level as face to face; subject to clinical appropriateness. Different codes may be used to describe these covered procedures. Office visit fee $0.00 Diagnostic/preventive - Oral evaluations are limited to a combined total of 4 of the . CIGNA DENTAL CARE (*DHMO) PATIENT CHARGE SCHEDULE This P atient Char ge Schedule lis ts the benefits of the Dental Plan including covered procedures and patient charges. PATIENT CHARGE SCHEDULE . 0000040333 00000 n VIDEO Cigna Dental PPO dWR)]gP{ey01KGs9}eV}m#lVSfi7Gph 0000017836 00000 n Use this form to request a CIGNA Dental Care patient charge schedule. All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 115 0 obj <>stream J('5&% 0000002374 00000 n Deliver estimates of patient copayments, coinsurance and deductibles. 0000058952 00000 n 0000010068 00000 n 0000001196 00000 n 0000080015 00000 n 0000009324 00000 n 0000003405 00000 n *Indicates required field. Important Highlights This P atient Char ge Schedule applies only when c overed dental servic es are performed by your Network Dentist, unless otherwise authorized 0000002220 00000 n %&iNeWl $20*` \C endstream endobj 2608 0 obj <>/Filter/FlateDecode/Index[98 2467]/Length 70/Size 2565/Type/XRef/W[1 1 1]>>stream 0000000016 00000 n 0000014266 00000 n Vision Plan Summary. 0000002770 00000 n VV*5V1,cI;AAA@=c L3@L/Xh1533,q(3D:o@$Vfi? Cigna Dental considers infection control and/or sterilization to be incidental to and part of the charges for services provided and not separately chargeable. 0000023411 00000 n With this dental health maintenance organization (DHMO) plan, preventive services are covered 100% with no deductible. costly service, the fee listed on the Patient Charge Schedule will not apply. %MFclR*4))[3nqC) w_iStv'tSX%U'R31qWDes- h$fE?/9aSSJ;b"Azo,LiWg?0z2->b> ,(s6a k04QP\NI(?* M ,hTjmsTTbrrq:0E`a I A1)A1Xb`uAYXPd3 E(@jr( pqqKKC8EM/PvWdeSA(2 67 0 obj <> endobj 0000047736 00000 n 0000084766 00000 n Easily search for DPPO network providers in the directory on Cigna.com . 0000003252 00000 n The application of local anesthetic is covered as part of your dental treatment. Effective January 1, 2021, Cigna Behavioral Health will begin administering two Behavioral Health for Children and Adolescents (BHCA) services, Family Support and Training and Therapeutic Mentoring in accordance with the requirements of Massachusetts Division of Insurance Bulletin 2018-07. xref Initial Consultation face to face - 205, Follow-up Consultation face to face - 145, Initial Consultation remote - 205 (where clinically appropriate), Follow-up Consultation remote - 145 (where clinically appropriate), Extended Physician Consultation - 250 (over 40 mins). 0000026301 00000 n For premiums to remain affordable, practitioners, private facilities and health insurers need to work together to provide quality private healthcare at a reasonable and affordable price. Patient Charge Schedule Request. <]/Prev 575455>> 0000008684 00000 n Temporary Continuation of Coverage Benefits Enrollment Form. How often are fees reviewed or increased? 0000029950 00000 n 0000017737 00000 n hbbd``b`%$8 ~ zlH0L uA,3a Different codes may be used to describe these covered procedures. e`ea =AG/LGtQ0q(MyPADbso{U,,? wuX,zOW8:m;5*q* F!Q',3s`RRRh CDHfc0BeT#L S@3-Bc=FM@Zea 7iX;\%8>pwnv7`Am H3q[20F Vg 0000048422 00000 n 0000027140 00000 n 0000003547 00000 n The American Dental Association may periodically change CDT Codes or definitions. 0000025789 00000 n "` h`E(Zb3q"D"cbC. Procedures listed on the Patient Charge Schedule are subject to the plan limitations and exclusions described in your plan book/certificate of coverage and/or group contract. At a wallet-friendly price. %R( of high noble metal, an additional fee up to $100.00 per tooth may be charged for the upgraded post and core. Of the rest of the land, 2.93 km 2 (1.13 sq mi) or 19.3% is settled (buildings or roads), 0.13 km 2 (32 acres) or 0.9% is either rivers or lakes and 0.14 km 2 (35 acres) or 0. . 0000027311 00000 n 0000048491 00000 n 0000033062 00000 n Hh>) $"x# q7?0 vw ^XyrL|k:N,NW=(W4F]t10tf>WS?n3v\CM{plTy"N^My 7\6Ga)X:! 0U<4+;W" Q@KQG\4BBS/t}w9z$M\\\BC;A8-ep1#(6K !I#C E Y]H (.IK*d.- +Ab-c-e]1@*[th-a, 2]xJ:;X?\SAM fbm vf`- 0000011147 00000 n 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (W1-09) 0000013571 00000 n 0000000016 00000 n 10574 0 obj <> endobj **For services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. 0000080139 00000 n 112 0 obj <>/Filter/FlateDecode/ID[<6695E701AF37B16E8C3D1BA6A46188AD><69E937107F330D469161AA1CAB15D6CD>]/Index[89 48]/Info 88 0 R/Length 108/Prev 89674/Root 90 0 R/Size 137/Type/XRef/W[1 2 1]>>stream Do the new Total Care DHMO plan and the Cigna DHMO plan use the same network? stream All patient charges must correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. 0000021775 00000 n hb```,V!] CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (L1-09 TX) - 3 - Patient Charge Code Procedure Description D0220 X-rays intraoral - Periapical - First radiographic image $0.00 0000007192 00000 n Mental health: what health insurance can do for the emotional wellness of employees of SMEs, Embracing the digital age within healthcare, Tips for selecting a dental plan for your business, Addressing a 5 point workplace cancer strategy. GENERAL DENTIST FEE SCHEDULE ALL PROCEDURES Effective from 06/01/2022 D1351 Sealant - Per Tooth $36 D1352 Preventive Resin Restoration In A Moderate To High Caries Risk Patient - Permanent Tooth $35 D1353 Sealant Repair - Per Tooth $35 D1354 Interim Caries Arresting Medicament Application - Per Tooth $29 CIGNA Dental Care (*DHMO) . If fees exceed the Cigna Fee Schedule, practitioners should advise the member to contact Cigna member servicesbeforeany treatment takes place. 0000002804 00000 n 0000060795 00000 n CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE Code Procedure Description Patient Charge Office visit fee (per patient, per office visit in addition to any other applicable patient charges) Office visit fee $5.00 Diagnostic/preventive - oral evaluations are limited to a combined total of 4 of the following . 66 59 Different codes may be used to describe these covered procedures. 0000013658 00000 n 0000007481 00000 n Cigna Dental considers infection control and/or sterilization to be incidental to . {6LG3IsUz119Wf6aj'\`SG`]xIS7B< H|Tj1"/l@)hkEs&+,9f7gg/y!}iNx4Un%:/erWD}!Y+bkB)r;O UGE-7Wx:Ze|%J,isr=x.>}p\G ZImzH4r@h q%t ItfKb278MJ6p8h|)@Tr ?S=?Yv yA?3HZQ;yUZ:&T7|N|o#Xv>yXk9'5V2S|ju0kU6581_Fo!>b bd `R[w#-HaEH6LPidE2L. trailer 0000009819 00000 n hXn8}}gH Hf&M2Ll~(hHII>K8iLJ"{/y9RFHZr2NR0LXR4EDb=J-{Kz|H3P>4uBeFm=$:Qu&vhlYGEpEc@4|f_%"1hPOf8G.8$oXE{;q0TUnu0X. nu 0000012346 00000 n 'mec`PcsPFZ%5&: {8Fen cS 3@ 0000010574 00000 n 0000009963 00000 n Cigna does not control the linked sites' content or links. "S} lXYMkB,.qE(PGND & /W8NjRk18>`ihf~;~y""[_&4~,}E9 s~M6jO$2'wc0l}&[Lh=l0b7r*L A TJu;leTq;%HvAt~')k'7g^ {Tdpad1G),&ZtVBo:mjVs%Yos1Q!U1*$xf/UC,lEaya)/L{^Cp`. This overview shows you a sampling of covered services. 0000019248 00000 n trailer <<1FBCA24BFA4448CBB29C1A11C4104F0D>]/Prev 171543/XRefStm 1917>> startxref 0 %%EOF 2609 0 obj <>stream 0000013079 00000 n 0 0000002402 00000 n Sorry, you need to enable JavaScript to visit this website. %PDF-1.3 0000011811 00000 n 0000085278 00000 n 24 U a`i0-h0>PrCD00@lg8"?x0LwZta Ui! L1I09 Code Procedure description L1I09 D0364 Cone beam CT capture and interpretation with limited field of view - less than one whole jaw (only covered in conjunction with the surgical placement of an implant; limit of a total of only one D0364, D0365, D0366, or D0367 per Offered by: Cigna Health and Life Insurance Company or its affiliates. 0000026124 00000 n Health Insurance Premiums . trailer 92249.a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (K1-V9) 2565 0 obj <> endobj xref 2565 45 0000000016 00000 n <> CIGNA DENTAL CARE (*DHMO) . Please use the search function to calculate your fees. 0000047037 00000 n % 92254.b. 147 53 0000078060 00000 n The American Dental Association may periodically change CDT Codes or definitions. 0000005847 00000 n 10597 0 obj <>/Filter/FlateDecode/ID[<0F3F0D1BE2BD3847B9BF5CE826221B8D>]/Index[10574 51]/Info 10573 0 R/Length 105/Prev 385298/Root 10575 0 R/Size 10625/Type/XRef/W[1 2 1]>>stream And a healthy body. 124 0 obj <>stream 0000014055 00000 n 0 0000060301 00000 n How to protect employees mental health during COVID-19 no matter where they are in the world. 0000025537 00000 n 0000011173 00000 n U\$6hXttOg}wuNNc0t8a1+v3ij9)&@^WS1m;h=RXY|v+r=u\3+=Ih ]?JXO4oK"I-8IiU 6vi@xC{zGtB" E0bM5eu|nGE yl %PDF-1.6 % 0000013269 00000 n Discuss your options and increased financial obligations with your dentist. 0000047772 00000 n 0000001917 00000 n endstream endobj 10575 0 obj <> endobj 10576 0 obj <>/MediaBox[0 0 396 612]/Parent 10566 0 R/Resources 10602 0 R/Rotate 0/StructParents 0/Tabs/S/TrimBox[0 0 396 612]/Type/Page>> endobj 10577 0 obj <>stream @L{Mbg{0LzIGv389. 92249 856609 02/13 L1-09 L1-09 cigna dental care (*dHMO) patient cHarge scHedule This Patient Charge Schedule lists the benefits of the Dental Plan including Office Visit Fee . <> The American Dental Association may periodically change CDT Codes or definitions. 0000003825 00000 n Maintenance Organization (DHMO) Schedule of Benefits Effective January 1, 2021 . 0000059263 00000 n These fees are based on complexity, average duration of the procedure, information from our claims experience, the CCSD schedule and benchmarked against other fee schedules in the public domain in the United Kingdom. hA 04s\GczC. 0000017376 00000 n 0000011915 00000 n 0000037577 00000 n 0000003691 00000 n 0000032768 00000 n 0000004978 00000 n 0000020083 00000 n The Cigna Dental Care (DHMO) plan includes coverage for many procedures that may not be available on other dental plans. 0000038912 00000 n All patient charges correspond to the Patient Charge Schedule in effect on the date the procedure is initiated. Dentist may charge an additional fee not to exceed $150.00 in addition to the listed 6 0 obj 0000009930 00000 n <<4DFFD0FAA740384DAF78994982233F75>]/Prev 268013>> Programs and Initiatives (CCF, DLP, ISYLP, Career Pathways), DC Government Benefits Enrollment Instructions, UnitedHealthcare Choice Open Access Plan Summary, SmartBenefits Enrollment Application & Change Form, Temporary Continuation of Coverage Benefits Enrollment Form, Health Insurance for Employees Hired Before October 1, 1987, Health Insurance Premiums for Employees Hired on or After October 1, 1987, DCEHBP Temporary Continuation of Coverage (TCC) Premiums, How to Enroll in Your DC Government Benefits, Coronavirus (COVID-19) Resources for DC Government Employees, Electronic District Personnel Manual (eDPM), Electronic-District Personnel Manual (E-DPM), Whistleblower Protections and Obligations, Sexual Harassment Prevention Officer Directory, Human Resource Officer - Advisor Directory, 2023 Cigna Dental HMO Patient Charge Schedule, 2022 Cigna Dental HMO Patient Charge Schedule, 2021 Cigna Dental HMO Patient Charge Schedule. 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