CIGNA Dental (DHMO) Plan Summary Plan Description


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CIGNA Dental (DHMO) Plan Summary Plan Description Effective August 15, 2010. CIGNA Dental DHMO Plan i Table of Contents

Page 1 of 5 CIGNA Dental ... Resin-based composite-two surfaces, anterior $48 . Amalgam- three surfaces, permanent $53 . ... (fixed partial denture0 $198 .

Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates. Q: What is “Orthodontics in Progress”?

CIGNA DENTAL CARE® – DHMO1 ECONOMICAL, EASY-TO-USE DENTAL COVERAGE ... Of course, youíll pay less if you visit your selected Cigna Dental Care network dentist.

Delta Care USA DHMO DENTAL PLAN* ENROLLMENT INSTRUCTIONS www.BenefitsStore.com CA Insurance License No.: 0680704 Voice: (800) 446-2663 Fax: (925) 855-2051

Cigna Dental Care DHMO Insurance . Summary Plan Description . This brochure is not a contract. Coverage is described in rather general terms; the extent of your ...

course of, any employment for wage or profit ... The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, ...

L1-08 92151 830559 03/11 L1-08 This Patient Charge Schedule lists the benefi ts of the Dental Plan including covered procedures and patient charges.

Cigna Dental Care (*DHMO) Patient Charge Schedule This Patient Charge Schedule lists the benefits of the Dental Plan including covered procedures and patient charges.

Dentist Accepts Fidelio UCR Fee Schedule (Reduced Fee) Pre-determination of treatment plans over $300 100% 0% Health and Welfare Fund (Group G50) Dental Plan Summary

01-14037-002 Effective Date: January 1, 2009 . Introduction This document is a summary plan description (SPD) providing you with a summary of the key

Introduction Tyco Electronics Corporation (the "Plan Sponsor") maintains the Tyco Electronics Pension Plan Part II – AMP (the "Plan") for certain former eligible

Siemens Savings Plan - 3 - entirely voluntary. The sooner you enroll, the sooner you will enjoy all of the benefits the Plan offers. Automatic Enrollment

ista welfare benefits plan and trust money type i post-retirement lump sum buyout as adopted by south harrison community school corporation

KENTUCKY EMPLOYEES’ HEALTH PLAN SUMMARY PLAN DESCRIPTION STANDARD CDHP PRESCRIPTION DRUG PLAN Sponsored by the Commonwealth of Kentucky EFFECTIVE JANUARY 1, 2017

NRECA Medical PPO Plan Summary Plan Description for SOUTHEASTERN ILLINOIS ELECT CO-OP, INC. 01-14037-002 Effective Date: January 1, 2008

For a list of co -payments for all ... Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Saint Clair, Saint Joseph ... rendered by Participating ...

Plan services vary depending on the employer location. Effective January 1, 2017, this document sets forth the services available for employees who are eligible for ...

Plan: Classic Select 2000 - Calendar Year Maximum: $2,000.00 This plan uses the Maximum CareTMnetwork. Members may enjoy discounts by using one of the many

SUMMARY PLAN DESCRIPTION OF THE ... Miller, Kaplan, Arase & Co., ADMINISTRATOR ... your active participation in the Plan will resume on your

We are pleased to present you with this Summary Plan Description (SPD) which describes the rules and regulations of the Plumbers & Pipefitters National Pension Plan.

ORGANON BIOSCIENCES USA INC. Summary Plan Description for the Retirement Account Plan for the Organon BioSciences US Affiliates RAP Only Version

X VINGS PLAN URE FUTURE Summary Plan Description ... SUMMARY PLAN DESCRIPTION July 1, 2011 An Important Message about Investing for Retirement & Diversification

summary plan description. THE MATERIAL CONTAINED IN THIS SUMMARY PLAN DESCRIPTION IS FOR INFORMATION PUR- ... DAVID N. MARCATO PS Marcato Elevator Co., Inc.

MetLife Dental In-Network Out-of-Network In-Network Out-of-Network Preventative 100% • Cleanings of of • Oral Exams PDP fee* R & C Fee** ... Base Plan Preferred Plan.

Schedule of General Dentist Copayments GENERAL INFORMATION The Copay Plan is a fee -for-service dental plan designed with convenient copays.

Pitzer College Academic Retirement Plan ... Are there any limits on the amount of contributions that can be made to the Plan? ... The President of Pitzer College . 4

The following Summary Plan Description (SPD) describes the important features of the Liberty Mutual Retirement Benefit Plan (the “Plan”) as of January 1, 2017 ...

Individual & Family Plans | Cigna Dental PPO 50 | GA Page 2 of 3 844076a 1/13 Cigna Dental PPO 501 Georgia Procedure Frequency Limitations

Health Maintenance Organization (HMO) Plan Summary Plan Description (SPD) FOR Administered By Effective Date: January 1, 2016 Si necesita ayuda en español para ...

884670 MO 08/15 Contact your local ... GET TO KNOW YOUR MEDICAL PLAN ... Individual Deductible (Medical and pharmacy) $2,500 Not covered Family Deductible ...

GETE OKE fiffi˛˝ffi˙ˆˇffi˘˙ ˆ ˆ fiffi˙ ndividual and amily lans Company GET TO KNOW YOUR MEDICAL PLAN Cigna Connect HSA Bronze 6000 | 2016 Summary of Benefits

modahealth.com Dental Delta Dental PPO Plan Mac – High Calendar year costs Deductible $50 per person / $150 family1 Out-of-pocket maximum (under age 19) $350 for ...

Dental Health Maintenance Organizations: DHMO The Affordable Option ... DHMO PA3 PLAN I am enrolling ... service plan licensed in the State of California under the ...