Self Pay Dental: Equity-League Fund

CIGNA Self Pay Dental Information

Participants that are able to participate in the Self-Pay Voluntary Dental Plan are those that are ELIGIBLE FOR HEALTH BENEFITS, which includes all of Self-Pay participants, and dependents. You and your dependents can enroll for coverage once you first become eligible for health benefits or between November 1 and December 1 of each year during the Plan's Annual Open Enrollment Period. For election during the Annual Open Enrollment Period, the coverage effective date will be the first day of the following year, January 1. Dependent coverage can also be added at any time (as long you as are still eligible for health benefits) based on any of the life events listed on pages 4 and 5 under the Special Enrollment Situations section of the Health Summary Plan Description (SPD). Once we have received your payment, you will be billed automatically by the Fund Office for the next quarter. If you elect not to pay, then you and/or your dependents WILL NOT be eligible to join the plan until the next time you become eligible for health benefits through covered employment. To receive more information, please contact the Fund Office at (212) 869-9380, or toll free (800) 344-5220.

The following is a comparison of the two offered plans to choose from:

CIGNA Dental PPO Overview -This is the plan under which dental benefits used to be provided, now offered on a self-pay basis. This Overview provides a refresher on how it works.

CIGNA Dental PPO Overview (PDF, 68k) Dentalppobensum.pdf

CIGNA Dental Care (DHMO) Overview - This option, which costs less than the Dental PPO, works like an HMO, in that you’re limited to using providers in the CIGNA Dental Care network exclusively.

CIGNA Dental HMO Overview (PDF, 738K) cigna_dental_dhmo.pdf

2009 Self-Pay Dental Coverage Costs

	Quarterly Premium
If You Elect to Cover	CIGNA Dental Core PPO	CIGNA Dental Health (DHMO)
Yourself	$159.69	$77.79
Yourself + 1 dependent	$317.91	$125.79
Yourself + 2 or more dependents	$472.83	$220.62

The Next Step

If you are eligible for self-pay dental (covered for health benefits through employment) and want to enroll for coverage you must complete the CIGNA Dental Enrollment form listed below and send it, along with your check, made payable to the Equity-League Health Trust Fund, for your first quarterly payment. The enclosed form should be returned to the Equity-League Health Trust Fund (P.O. Box 11533 New York, NY 10286-1533). To locate a Primary dentist under the DHMO plan or find in-network dentists under the Dental Core PPO plan, please visit Cigna's website, www.cigna.com , and follow these steps:

Click “Provider Directory” at the top of the page.
Click “Dentist”. Enter your search criteria – location, name, etc.
Next, for the Dental Core Plan, select the CIGNA Dental PPO and in the drop down box, select “CORE NETWORK”. For the DHMO Plan, select the CIGNA Dental Care (HMO) instead.

Use this form to enroll in the Dental HMO or the Dental PPO.

Dental Enrollment Form

When enrolling a dependent under either dental plan, you MUST provide proof of dependent status – for example, a marriage certificate, birth certificate, certification of student status, proof of residence and/or proof of financial dependency. This information is to be provided along with your completed dental enrollment form.

If you are electing the DHMO, please make sure you also include a first and second choice selection for the Primary Dentist on the enrollment form as well. You may change your dentist on the DHMO by calling member services at the following number 1 800-244-6224. Member services can tell you when the change will take effect. Note that in order to maintain your coverage at all times, you must pay your quarterly premiums on time.

If you have any questions on either of the self-pay dental plans, please contact CIGNA Member Services at 1-800-244-6224 or call the Fund Office 212- 869-9380, or toll free 1-800-344-5220.

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