Cigna Global Health Dental Plan

2020 and 2021 Plan Year Information

Cigna Global Health Dental Plan

If you are a U.S. benefits-eligible expatriate or U.S. benefits-eligible international employee and your medical plan administrator is Cigna Global Health Medical, your dental benefits are provided under Cigna Global Health Dental.

Cigna Global Health Dental Plan: In-Network and Out-of-Network
Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums.

Individual Deductible

$50

Family Annual Deductible

$150

Diagnostic and Preventive Care

100% of R&C; deductible waived

Restorative Services

80% of R&C, after annual deductible

Prosthodontics

50% of R&C, after annual deductible

Orthodontics

50% of R&C after separate $50 deductible, up to a $3,000 lifetime maximum per person (children to age 19)

Annual Benefit Maximum per Person

$2,000

Out-of-Network Charges for Dental Services

Out-of-network reimbursements and maximums are based on Reasonable and Customary (R&C) charges as determined by the health plan administrator.

Orthodontics Lifetime Maximum Benefit

The orthodontics lifetime benefit maximum is combined across plan options.

A Note About Annual Benefit Maximums

In no event can any one person receive more than the annual benefit maximum during a calendar year (excluding orthodontics), even if provided by an in-network or PDP dentist.

FSAs

Flexible Spending Accounts (FSAs) allow you to set aside before-tax money to use for certain eligible expenses not covered by your health plans or to pay for certain dependent day care expenses. Using an FSA can save you from 20% to 40% depending on your tax bracket.

The Firm offers three types of FSAs: a Health Care FSA, a Limited Purpose FSA* and a Dependent Day Care FSA. The Health Care and Dependent Day Care FSAs are administered by UnitedHealthcare (UHC). The Limited Purpose FSA is administered by Your Savings Account.

*The Limited Purpose FSA is only available to employees enrolled in Medical Plan Option C and can only be used for eligible dental and vision expenses.

Dental Contributions

You and the Firm share the cost of your Dental Plan coverage. Your contributions are deducted from your pay on a before-tax basis.

Note: Your location and salary band are used to calculate only your medical contribution rates.

2021:

 Yourself OnlyYourself + Spouse/Domestic PartnerYourself + ChildrenYourself + Family
Delta Dental$13.67$27.38$27.38$41.04
MetLife Dental Plan — Option A$13.67$27.38$27.38$41.04
MetLife Dental Plan — Option B$7.75$15.50$15.50$23.50

*The costs shown are per paycheck contributions. For the monthly cost, double the amounts shown.

If you are covering a domestic partner or the children of a domestic partner, the IRS determines the tax status of a dependent and may impose a tax on the value of coverage.