Can someone take a look at my dental insurance, I have a question about it?
Please review your plan documents for full details, including exclusions, limitations and state mandates that might affect your benefits.
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, Orthodontic
.00 .00
Family Calendar Year Deductible
Basic & Major Restorative, Orthodontic
0.00 0.00
Maximums In-Network Out-of-Network
Individual Calendar Year Maximum
Diagnostic & Preventive, Basic & Major Restorative
,000.00 ,000.00
Individual Lifetime Maximum
Orthodontic
,000.00 ,000.00
Member’s Coinsurance Percents In-Network Out-of-Network
Reimbursement: Fee Schedule Reasonable and Customary
Basic Restorative 20 % 20 %
Diagnostic & Preventive 0 % * 0 % *
Major Restorative 50 % 50 %
Orthodontic 50 % 50 %
* Fields that display zero as the Member’s Coinsurance Percent indicate that CIGNA covers this service at 100%.
Frequency and Age Limitations
Specific Coverage Information In-Network Out-Of-Network
Dependent Age Limitation 19 19
Student Age Limitation 25 25
Date Coverage Ends Birth Month Birth Month
Procedure In-Network
Frequency/ Age Limit Out-of-Network
Frequency/ Age Limit
Oral Exam Twice per Calendar Year Twice per Calendar Year
Full Mouth X-Rays Once per 36 Consecutive Months Once per 36 Consecutive Months
Adult Cleaning Twice per Calendar Year Twice per Calendar Year
Child Fluoride Once per Calendar Year /
Under Age 19 Once per Calendar Year /
Under Age 19
Topical Sealant Application Once per 36 Consecutive Months /
Under Age 14 Once per 36 Consecutive Months /
Under Age 14
Crown Once per 60 Consecutive Months Once per 60 Consecutive Months
Bridge Work Once per 60 Consecutive Months Once per 60 Consecutive Months
Orthodontics Coverage for Dependent Children Coverage for Dependent Children
Now my question is….see where it says "frequency and age limitations"? where it says something about being 25? I turned 25 on september 2nd, can I not use this insurance anymore for myself, its dental insurance through my employer so it wasnt explained very well, or can I use it maybe until right before I turn 26, meaning can I use it while I’m 25 or did it end as soon as I turned 25?
and why does it say "student age limitation age 25" I’m not a student…this is through where I work, if I cant use it anymore I dont want it so I am trying to figure this out.
Tagged with: adult • amp • birth month • bridge work • calendar year • cigna • coinsurance • deductibles • exclusions • family calendar • lifetime • maximums • oral exam • percents • plan documents • reimbursement fee • sealant application • state mandates • x rays
Filed under: Individual Dental Insurance
You are the holder of this insurance policy? You don’t have an age limitation. That would apply to a dependent. They have different ages to cover a student longer. It’s extremely common.
This would be for dependents (kids of yours) who were covered under this plan……..they could stay on the plan till they were 25 as long as they were students. Pretty good age limit actually- my plan has a student age limitation of only 23 so yours is more generous. So it doesn’t affect you, as the main insured, only if you covered older kids.
Yes, keep the insurance, you are the insured and the age limitations do not apply to you just your dependents. You do not have orthodontic insurance for yourself though only the dependents.
student under 25 meaning if you were on the plan through a parent or if you have a child he/she would be covered till age 25 if they are in school only.. in this case you are the policy holder so there are no age limitations for you..just a yearly max and so forth..
and then frequencies are the regular routine exam and cleaning and x-rays..
your insurance only pays 1,000 per year so that means anything that goes over you are responsible for and you do have a deductible like how you would if you got into a car accident..so you have to pay that no matter what when you are seen..
for fillings or root canal/crowns/dentures..there will be a copay too..
any questions feel free to emai me =)
Student limitation is most likely towards any dependants that you have on your coverage - not you as the policy holder.
I worked in the insurance industry for ten years and I want to assure you that you can use this insurance, even after you turn 26. The first person is correct in that the "student" is referring to any dependent that you may have, not you yourself.
Fairly good coverage, too.