Coinsurance

After you meet the applicable deductible, the Expatriate Dental Plan will pay a percentage of in-network dentists' negotiated fees, or, for out-of-network expenses, a percentage of the reasonable and customary (R&C) charges for eligible expenses (see "Defined Terms" for the definition of "Reasonable and Customary"). The exact percentage depends on the type of care you receive. You'll pay the remaining amount as coinsurance, plus any amounts above R&C charges. Please see the chart below for the applicable coinsurance rate. The coinsurance amount does not vary based on whether or not the care is received inside or outside of the United States.

Pre-Determination of Benefits

If you anticipate that charges will be more than $300 for a proposed treatment, a dental consultant can review the proposed treatment before work begins, and Cigna Global Health Benefits will inform you and your dentist of the amount of the covered charges.

Preventive Care


Care Received	Coinsurance
Oral exams	100% coinsurance Maximum two per calendar year
Fluoride	100% coinsurance Maximum one per calendar year under age 19
Prophylaxis (cleaning)	100% coinsurance Maximum two per calendar year
Full-mouth X-ray	100% coinsurance Maximum one every 60 months
Bitewing X-ray	100% coinsurance Maximum one per calendar year*
Sealants	100% coinsurance Maximum two treatments per tooth (permanent molars only) per lifetime under age 19

* Two per calendar year for children up to age 19.

Basic Restorative Care

Basic restorative care includes fillings, extractions, periodontics, oral surgery, anesthesia, including non-intravenous conscious sedation when medically necessary.


Care Received	Coinsurance
Basic restorative	75% after deductible

Major Restorative Care

Major restorative care includes dentures, crowns, onlays, tooth implants, bridges, root canal.


Care Received	Coinsurance
Major restorative	50% after deductible

Orthodontia

Orthodontia care is only covered for your covered children who are under age 19. Please see "Orthodontic Covered Services" for additional information.


Care Received	Coinsurance
Orthodontia	50%

Maximum Benefits


Care Received	Maximum Benefit
Combined for preventive and restorative care	Annual maximum of $2,000
For orthodontia	Lifetime per-person maximum of $2,500