In Detail...
You have five dental plan options including two that provide
orthodontia benefits. The options differ in the level of benefits
and in the way you receive dental care. And, the cost of each
option is different. Generally, the higher the cost of the
option, the higher the level of benefits it provides.
There are two dental claims administrators - Delta Dental
and CIGNA Dental Health. Each provides a network of dentists.
However, Delta Dental allows you the flexibility to visit
any dentist you choose. If you select a network dentist -
through Delta Dental or CIGNA Dental Health - call the network
dentist to ensure he or she is accepting new patients.
On This Page...
Your Dental Plan Options
Enrolling for Dental Coverage
How the Delta Dental Options Work
Delta Dental Benefits
Eligible Expenses
Ineligible Expenses
Maximum Benefits
Predetermination of Benefits
Extension of Benefits
If You Have Other Dental Coverage
Filing Delta Dental Claims
CIGNA Dental Health
CIGNA - How The Option Works
CIGNA - Ineligible Expenses
CIGNA - Maximum Benefit
Claims
When Coverage Ends
Your Dental Plan Options
Dental plan options available in your area may include:
- Dental Care
- Dental Care Plus (includes orthodontia benefits)
- Preventive (Note: Preventive is default coverage if you do not make any coverage election)
- CIGNA Dental Health (includes orthodontia benefits)
- No coverage (if you opt out of the plan)
The options differ in the level of benefits and in the way you receive dental care. And, the cost of each option is different. Generally, the higher the level of benefits, the more the plan will cost you.
Delta Dental administers three of your dental plan options - Dental Care, Dental Care Plus, and Preventive. These options pay benefits for eligible expenses regardless of the dentist you choose. Call Delta Dental at 1-800-336-8264 for availability in your area.
Your other dental plan option is a managed dental plan offered by CIGNA Dental Health. To receive benefits under this option, except in an emergency, you must receive care from general dentists and specialists in the CIGNA dental network. The network is available in most, but not all, locations. Call CIGNA Dental Health at 1-800-367-1037 for availability in your area.
Each plan option provides a network of dentists. However, Delta Dental allows you the flexibility to visit any dentist you choose. If you select a network dentist – through Delta Dental or CIGNA Dental Health – call the network dentist to ensure he or she is accepting new patients.
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ENROLLING FOR DENTAL COVERAGE
You may enroll for dental coverage within 31 days of your hire date or during Annual Enrollment. Generally, the dental plan option that you select for yourself and your family stays the same for the full benefit plan year.
In other words, the Annual Enrollment period is the only time you can change your dental plan option unless you move to an area where your option is not offered or have a qualified change in status (see What Is a Status Change? in this document). If you want to change your coverage category you must provide documents to substantiate the reason for the change, and the change must be consistent with the event.
If you opt out of the Vought Aircraft Industries, Inc. dental plan, you must submit a waiver of coverage form.
Coverage Categories
The dental plan options offer the same coverage categories as the Vought Aircraft Industries, Inc. medical plan options:
- Employee only
- Employee + child(ren)
- Employee + spouse
- Employee + family (employee, child[ren], and spouse)
- No coverage
If you select medical coverage, you may choose a different coverage category for dental than you choose for medical. For example, you can cover only yourself in the medical plan while covering yourself, your spouse, and your children in the dental plan.
Coverage Levels
All Delta Dental benefit levels are based either on fees negotiated with Delta dentists or average fees in your area. CIGNA Dental Health benefits are based on a set schedule of eligible expenses.
Each dental plan option offers a network of providers. But with CIGNA Dental Health, you must use a CIGNA provider to receive any benefits.
Before you choose, consider these questions:
- Do you or your family members expect to need significant dental treatment in the coming year?
- Do you or your family members live inside or outside the Delta Dental or CIGNA network of participating dentists?
- Do you want to have the choice of any dentist?
- Do you or your family members plan to have orthodontic care in the coming year?
Your answers may help you decide which option to elect.
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HOW THE DELTA DENTAL OPTIONS WORK
Dental Care, Dental Care Plus, and Preventive provide the same preventive and diagnostic care. However, they vary in the amount of the benefit plan year deductible, eligible expenses, and maximums.
You can receive treatment from any dentist although Delta Dental offers a network of member dentists who agree to charge you fees that they negotiate with Delta. These dentists are called "Delta dentists." Call Delta Dental to request network dentist information, or visit Delta's Web site at
www.deltadentalins.com and select the Dentist Directory. From that page, select the Premier Program for your location.
The following rules apply when you select the Delta Dental plan:
- Your dentist must be practicing within the scope of his or her profession and furnishing services for which he or she is licensed. Dental charges must either be negotiated with Delta or be based on average fees for dentists in your area, as determined by Delta.
- If you do not use a Delta network dentist, you are responsible for any charges that exceed reasonable and customary.
- When you visit a Delta dentist, charges are always within the negotiated fees with Delta dentists (see below). You pay only your applicable coinsurance and deductible – nothing more for covered services – so you may pay less out of your own pocket for a Delta dentist’s services than for a non-network dentist.
- You do not file a claim form when you use a Delta dentist. Your dentist files your claims for you.
The Delta Dental Plan Deductible
A deductible is the amount you must pay each benefit plan year before the dental plan option begins to pay benefits.
There is no deductible under the Preventive option, and there is no deductible for diagnostic and preventive care under the Dental Care option or the Dental Care Plus option. These options pay 100% of the negotiated fee or average fee before you pay anything toward your deductible.
For services other than preventive, the benefit plan year deductible is:
- $25 per person or $50 per family for the Dental Care option
- $50 per person or $100 per family for the Dental Care Plus option.
The deductible is higher for the Dental Care Plus option because it offers orthodontics and the Dental Care option does not.
You can satisfy the family deductible with any combination of eligible expenses you and at least one other family member incur during the benefit plan year. However, the maximum you can count for any one family member is the amount of the dental plan’s individual deductible.
Your Share of Costs
Once you meet your benefit plan year deductible, the plan pays a percentage of negotiated fees. You pay the rest. Your share of the cost is called "coinsurance."
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DELTA DENTAL BENEFITS
The dental plan options administered by Delta Dental pay benefits for treatment necessary for good dental health care that is within the plan limits. The plan options do not pay benefits for cosmetic dentistry or for any treatment more costly or more extensive than needed. If two or more dental services are appropriate for a treatment, the dental plan options pay benefits on the basis of the least expensive service expected to produce a professionally satisfactory result, for example, amalgam (metal) vs. gold fillings.
Average Fees Vs. Negotiated Fees
Under the options administered by Delta Dental, average fees apply only when you use a dentist who does not participate in the Delta Dental network. Delta dentists charge Delta patients only the negotiated fees. For example, when you use a Delta dentist, you pay only the applicable deductible and coinsurance for eligible expenses.
See the following sections for how each of the three dental plan options administered by Delta Dental pays benefits:
The Dental Care Option
This option pays 100% of the negotiated fee for diagnostic and preventive services from Delta dentists. These services include up to two cleanings and bite-wing X-rays each benefit plan year. You pay no deductible for these services.
After you pay the benefit plan year deductible - $25 per person or $50 per family - the option pays:
- 80% of the negotiated fee for basic dental services, such as fillings and extractions, and
- 50% of the negotiated fee for major dental services, such as bridges and dentures.
You pay any remaining charges. You also pay any expenses that exceed the average fee for dentists in your area when you use a dentist who is not in the Delta Dental network.
The most the option pays during the benefit plan year is $2,000 per covered individual.
The Dental Care Plus Option
The Dental Care Plus option pays the same benefits as the Dental Care option. But there are two important differences:
- The Dental Care Plus option also covers orthodontic care at 50% of either the Delta dentist's negotiated fee or the average fee when visiting an out-of-network dentist for orthodontic care, up to a lifetime maximum of $2,000 per person. (This amount is in addition to the $2,000 per person benefit plan year maximum.)
- Your deductible is higher – $50 per person or $100 per family
The Preventive Option
This option covers only preventive care – such as cleanings, exams, and X-rays. No other services are covered.
There is no deductible. The option pays 100% of either the Delta dentist's negotiated fee or the average fee when visiting an out-of-network dentist up to a maximum benefit of $500 per person each benefit plan year.
Remember, using a Delta dentist ensures that you never pay more than the dentist's negotiated fee for covered services.
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ELIGIBLE EXPENSES
The Dental Care option and the Dental Care Plus option include coverage for diagnostic and preventive care, basic services, and major care. Only the Dental Care Plus option includes orthodontic services. The Preventive option covers only diagnostic and preventive care. The following is a description of each of these eligible expenses.
Diagnostic and Preventive Care –
No deductible for the following:
Basic Services –
Deductible applies for the following:
- Anesthesia – general anesthesia, nitrous oxide or IV sedation given by a dentist for covered oral surgery, periodontics, fractures, and dislocations
- Crowns, jackets, and cast restorations – limited to once every five years per tooth
- The dental plan option covers this treatment for cavities that cannot be restored with amalgam, synthetic, plastic, or resin fillings. A broken tooth is also covered. A tooth worn down by day-to-day wear is not covered.
- Drugs - includes antibiotic injections and other drugs administered or ordered by a dentist. If your dentist writes a prescription for you, take the prescription to your pharmacy and fill it as you would any other health care prescription
- Endodontics - includes treatment of tooth pulp, such as root canals and other endodontic treatments
- Oral surgery - includes extractions of one or more teeth, cutting procedures in the mouth, and treatment of fractures and dislocations of the jaw
- Periodontics - includes deep cleaning and scaling, treatment of disease of the gums, mouth tissue, and bones supporting teeth. Periodontal root planing (limited to one quadrant per 24-month period). Gingevectomy, gingeval curretage, muco gingeval surgery, osseous surgery and osseous grafts as part of osseous surgery (limited to once every 36 months)
- Restorative (fillings) - includes amalgam, synthetic, plastic, or resin fillings for treatment of cavities (decay). Direct composite (resin) restorations are the only benefits available on anterior teeth and the facial surface of bicuspids. Any other posterior direct composite (resin) restorations are optional services and Delta's payment is limited to the cost of the equivalent amalgam restorations
- Sealants - limited to once every three benefit plan years for children under age 14. Includes topically applied acrylic, plastics, or composite material applied to permanent posterior molars to seal teeth and prevent decay
Major Care – Deductible Applies
- Prosthodontics - limited to once every five years. Construction or repair of fixed bridges, partial dentures, and complete dentures if provided to replace missing natural teeth
Orthodontic Services (covered only under the Dental Care Plus option) –
Deductible Applies
- Bands
- Braces
- Correction of malocclusion
- Orthodontic appliances
- Services for strengthening teeth
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INELIGIBLE EXPENSES
Ineligible services, supplies, and expenses include but are not limited to:
- Charges by any hospital or other surgical or treatment facility and any additional fees charged by the dentist for treatment in any such facility
- Crowns, jackets, and cast restorations used to treat cavities that could be restored with amalgam, synthetic, plastic, or resin fillings
- Crowns, jackets, and cast restorations to replace a tooth more than once every five years.
- Diagnostic photos
- Full-mouth X-rays for adults within the same benefit plan year as bite wing X-rays
- Applications of fluoride or other anticavity substance to adult teeth
- Experimental procedures, techniques, or materials that are used by some dentists but have not received the full approval of government, scientific, or dental committees. Procedures remain experimental until studies are completed under scientific conditions and published in scientific literature and until they become part of what is known as "generally accepted dental practice"
- Grafting of tissue from outside the mouth to tissue inside the mouth (extraoral grafts)
- Implants (material implanted into bones or soft tissue) or the removal of implants. If implants are provided with a covered prosthodontic appliance, Delta Dental allows the cost of a standard partial or complete denture toward the cost of the implants and the prosthodontic appliances
- Oral examinations when a dentist usually does not charge for this procedure and does not have a fee on file with Delta Dental for this procedure
- Orthodontic services, unless you are enrolled in the Dental Care Plus option
- Pulp vitality test
- Postoperative examinations, the removal of stitches, or any other procedure included in the cost of surgery
- Repair or replacement of a sealant on any tooth within three years of its application
- Replacement of prosthodontic appliances more than once every five years – unless Delta determines extensive loss of the remaining teeth (or a change in supporting tissues) made the existing appliance unsatisfactory
- Services for any disturbance of the jaw joints (temporomandibular joint or "TMJ" disorders) or associated muscles, nerves, or tissues. These services may be covered under your Vought Aircraft Industries, Inc. medical plan
- Services for cosmetic purposes or for conditions that are a result of heredity or developmental defects, such as cleft palate, upper and lower jaw malformations, congenitally missing teeth, and teeth that are discolored or lacking enamel
- Services for injuries covered by workers' compensation or employer's liability laws, or services paid for by a federal, state, or local government agency – except Medi-Cal or Medicaid benefits
- Services performed by someone other than a dentist, except where performed by a qualified technician under the direction of a dentist
- Services that are furnished without cost when there is no dental coverage
- Services started before the participant became covered by the Vought Aircraft Industries, Inc. dental plan
- Specialized techniques involving precision attachments, personalization or characterization, and additional charges for adjustments within six months of the installation of prosthetic appliances
- Temporary dentures, if billed as a separate item
- Treatment that restores worn tooth structure, rebuilds or maintains chewing surfaces that are damaged because teeth are out of alignment or occlusion, or stabilizes the teeth, such as equilibration and periodontal splinting
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MAXIMUM BENEFITS
The Dental Care option and the Dental Care Plus option benefit
plan year maximum benefit is $2,000 per person.
The Preventive option has a benefit plan year maximum of
$500 per person.
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PREDETERMINATION OF BENEFITS
For dental treatments likely to cost more than $300, your
dentist should request a predetermination of benefits before
beginning treatment. To make this request
you do not need a special claim form. Your dentist should
complete a regular Delta Dental claim form, with a diagnosis
of the condition, the proposed course of treatment with itemized
services, and charges for each procedure. Dates of service
do not need to be included with this initial approval request.
Delta Dental reviews the proposed treatment for appropriateness
and cost effectiveness, and sends back to the dentist a predetermination
of benefits form. This form states the Delta Dental approved
costs for the procedures recommended.
If alternative, less costly treatments are available, Delta
Dental informs you and your dentist, in writing, of benefits
that the dental plan option pays. You and your dentist are
free to pursue any treatment plan. However, Delta Dental pays
only for the least expensive but equally effective procedure.
If you do not have a predetermination of benefits for any
treatment costing more than $300, your claim is reviewed after
treatment, and reimbursement may be less than you expect.
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EXTENSION OF BENEFITS
If your dental coverage ends, you may extend your Delta Dental
coverage for 30 days for the following dental services, provided
your dental plan option would have otherwise paid benefits:
- For an appliance - or modification of an appliance -
for which an impression was taken before your coverage ended
- For a crown, bridge, or gold restoration for which the
tooth was prepared before your coverage ended
- For root canal therapy, provided the pulp chamber was
opened before your coverage ended.
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IF YOU HAVE OTHER DENTAL COVERAGE
You and your dependents may be covered by more than one group
dental plan, such as the Vought Aircraft dental plan and your
spouse's employer's plan. In such instances, the benefits
you receive under your Vought Aircraft dental plan option
may be coordinated with benefits you receive from other plans.
When the Vought Aircraft dental plan option is the secondary
payer, the benefits from other plans are taken into account
and you can receive payment for up to 100% of your eligible
expenses from both plans combined. This provision prevents
double payments of benefits.
For example, assume you receive dental services to fill a
cavity, and your eligible expenses total $ 100. Also assume
the primary plan pays 80% (or $80) of eligible expenses for
this service and your Vought Aircraft dental plan option -the
secondary plan - typically pays 80% of eligible expenses.
In this case, since payment cannot exceed 100% of the fees
charged, your Vought Aircraft dental plan option pays only
the remaining $20 and you pay nothing.
Remember to inform your dentist of all programs under which
you have dental coverage and have him or her complete the
dual coverage portion of the Attending Dentist's Statement.
This helps ensure that you receive all of the benefits to
which you are entitled. For more information, contact the
Delta Dental Customer and Member Service Department at 1-800-336-8264.
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FILING DELTA DENTAL CLAIMS
Delta dentists file your claims for you. When visiting your dentist, show your identification card and verify that the provider files the claim with Delta Dental.
If you use a non-participating Delta dentist, you must file a claim form with Delta Dental. Claims must be submitted with receipts, bills, or an explanation of benefits (EOB) for the expense.
You must submit claims that occur during the benefit plan year within six months after the benefit plan year ends. Dental claim forms are available from your local Vought Aircraft Industries, Inc. Benefits Services office or the Vought Benefits Center, or you can download the forms from the Download Forms section on the Excel Web site.
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CIGNA Dental Health
CIGNA Dental Health administers your other Vought Aircraft Industries, Inc. dental plan option. This is a managed dental plan option, or dental maintenance organization (DMO), available in most, but not all, locations where Vought Aircraft employees work. The following is a brief discussion of benefits in the CIGNA plan and includes a partial list of eligible and ineligible expenses. However, the list is not intended to be all-inclusive. For a detailed description of eligible and ineligible expenses, contact CIGNA at 1-800-367-1037 and request a copy of the enrollment literature.
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HOW THE OPTION WORKS
If you select the CIGNA Dental Health option, you must receive
care from one of the general dentists or specialists in the
CIGNA dental network to receive any benefits - except in an
emergency. CIGNA also requires you to select a dental office
for you and each of your enrolled dependents from a list of
CIGNA providers.
With the CIGNA Dental Health option, you save on out-of-pocket
expenses for dental care. That is because there are:
- No deductibles
- No maximum benefits
- No claim forms.
You pay only a copayment for services - if any - according
to CIGNA’s copayment. schedule.
Selecting a Cigna Provider
You must
choose a network dentist or specialist. If you like, you and
each of your enrolled dependents may choose a different dental
office in the network.
Any office you choose is a private dental practice operated
by a licensed, independent dentist and a qualified dental
health team of hygienists, dental assistants, and technicians.
Each network dentist selected for the program contracts with CIGNA
to provide care for members who enroll in this option.
If your first or second choice of dentist is no longer accepting
new patients, you are assigned to the network dental office
nearest your home. Call CIGNA at 1-800-367-1037 to request
network dentist information, or view the CIGNA Dental Directory
by clicking here.
Changing Your Dental Provider
If you decide to change your dental provider, simply call
CIGNA at 1-800-367-1037. There is no charge to transfer to
another dental office. However, your current dentist must
be paid in full before your transfer can be processed.
Transfers are effective the first day of the month after
your request is processed. Unless you have a dental emergency,
you may be unable to schedule an appointment at the new dental
office until your transfer is effective.
Receiving Care
When you visit a CIGNA network dental office, you pay the amount shown on your copayment schedule. For example, you may pay nothing for a filling or a small copayment for more extensive care. If you have a health care Flexible Spending Account and your provider or pharmacy accepts Master Card, you may be able to use your debit card for your copay and avoid filing a claim for reimbursement of your costs.
SPECIALIZED CARE
If your network dentist determines you need specialized dental care, your dentist refers you to a specialist. Simply follow your dentist's instructions. Care from a network specialist is covered when CIGNA Dental Health authorizes payment. If you receive specialty care that is not authorized by CIGNA, you are responsible for 100% of the charges.
EMERGENCY CARE
If you have a dental emergency, contact your network dentist immediately. You pay an additional $25 charge for emergency care provided after office hours. If you are more than 50 miles away from home or are unable to contact your dentist, seek care immediately at the nearest dental office. CIGNA reimburses eligible expenses for diagnosis and pain relief only – less any Copayments that apply. To receive reimbursement, submit your dental reports and X-rays to CIGNA Dental Health.
Click
Here to View a Chart of Cigna Eligible Expenses
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INELIGIBLE EXPENSES
Expenses for the following treatments, services and supplies
are not eligible under the CIGNA Dental Health option.
- Completion of crowns and bridges, dentures, or root canal
treatment already in progress on the effective date of your
CIGNA Dental Health coverage.
- Cosmetic dentistry or cosmetic dental surgery (performed
solely to improve appearance).
- General anesthesia, sedation, or nitrous oxide.
- Hospitalization, including any associated incremental
charges for dental services performed in a hospital.
- Implants (material implanted into bones or soft tissue)
or the removal of implants.
- Prescription drugs prescribed by your CIGNA dentist.
- Procedures, appliances, or restorations if the main purpose
is to change vertical dimension (degree of separation of
the jaw when teeth are in contact).
- Procedures, appliances, or restorations if the main purpose
is to diagnose or treat abnormal conditions of the temporomandibular
joint.
- Procedures or appliances for minor tooth guidance or to
control harmful habits, such as thumb sucking.
- Replacement of fixed and/or removable prosthodontic appliances
that were lost or stolen or appliances damaged due to patient
abuse, misuse, or neglect.
- Services considered by the plan to be unnecessary or
experimental in nature.
- Services for any disturbance of the jaw joints (temporomandibular
joint or "TMJ" disorders) or associated muscles,
nerves, or tissues.
- Services not listed on the
CIGNA eligible expenses chart.
- Services provided by a nonnetwork general dentist or a
non-network specialist without CIGNA Dental Health's prior
payment approval (except for emergencies).
- Services provided or paid for by or through a federal
or state governmental agency or authority or political subdivision
or a public program, other than Medicaid and Medi-Cal.
- Services related to an injury or illness covered under
workers' compensation, occupational disease or similar laws.
- Services related to injuries intentionally self-inflicted.
- Services required while serving in the armed forces of
any country or international authority or relating to a
declared or undeclared war or acts of war.
- Services to the extent you are compensated for them under
any group medical plan, nofault auto insurance policy or
insured motorist policy
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MAXIMUM BENEFIT
The CIGNA Dental Health option does set a benefit plan
year maximum for dental services or a lifetime maximum for
orthodontic services.
General
FILING CLAIMS
CIGNA Dental Health
With CIGNA Dental Health, you file no claim forms. Your provider
takes care of that for you.
For a dental emergency, you may have to pay for services
when you receive them. CIGNA reimburses you up to $50 per
incident, less any copayments that apply
To receive reimbursement for emergency service, you must submit
your dental reports and X-rays to CIGNA Dental Health.
Call 1-800-367-1037 and speak to a customer service representative,
who will provide you with the mailing address for your area.
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WHEN COVERAGE ENDS
Dental coverage ends when the first of these events occurs:
- You or your dependents are no longer eligible to participate
in the Vought Aircraft dental plan
- The Vought Aircraft dental plan terminates.
Changes in coverage are outlined in "What
Happens to Your Benefits in Special Situations."
You and your dependents may continue dental coverage under
certain circumstances when coverage otherwise would end.
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