Find claims for:   JOHN DOEJANE DOESAMMY DOE Select a date range of no more than 3 months and click "Search". History is available for the past 24 months. From:   JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031200320022001 To: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember12345678910111213141516171819202122232425262728293031200320022001

Below are benefit plan highlights for:    JOHN DOEJANE DOESAMMY DOE    Please review your plan documents for full details, including exclusions, limitations and state mandates that might affect the benefits described below. Please be aware Deductibles and Maximums apply to both the In Network and Out-of-Network Benefits.

Deductibles In-Network Out-of-Network Individual Calendar Year Deductible     Basic & Major Restorative  $25  $25  Family Calendar Year Deductible     Basic & Major Restorative  $75  $75  Maximums In-Network Out-of-Network Individual Calendar Year Maximum     Diagnostic & Preventive, Basic & Major Restorative  $2000  $2000  Individual Lifetime Maximum     Orthodontic  $2000  $2000  Member's Coinsurance Percents In-Network Out-of-Network Reimbursement: Fee Schedule Reasonable and Customary Diagnostic & Preventive  0%*  0%*  Basic Restorative  10%  10%  Major Restorative  50%  50%  Orthodontic  50%  50%

* Fields that display zero as the Member's Coinsurance Percent, indicate that CIGNA pays 100% of covered charges. View more employee benefit details View your year to date dental cost tracker (deductibles, out-of-pocket spending and lifetime max).